Gupta Mudit, Amin Silvani, Cianciulli Alana, Barak-Corren Yuval, Pinter Csaba, Dewey Hannah, Lasso Andras, Russell William, Colello Stephanie, Gartenberg Ari J, Obsekov Vlad, Williams Trevor, Silvestro Elizabeth, O'Byrne Michael L, Glatz Andrew C, Jolley Matthew A
Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Catheter Cardiovasc Interv. 2025 Jun;105(7):1730-1739. doi: 10.1002/ccd.31510. Epub 2025 Mar 28.
Ductus arteriosus stenting (DAS) is used to palliate infants with ductal-dependent pulmonary blood flow (DD-PBF), however patent ductus arteriosus (PDA) anatomy can be complex and heterogenous.
We developed custom, open-source software to model and quantify PDA anatomy.
We retrospectively identified 33 neonates with DD-PBF with a CTA before DAS. A novel custom workflow was implemented in 3D Slicer and SlicerHeart to semi-automatically extract centerlines of the course of the PDA and surrounding vessels. 3D ductal length, diameter, curvature and tortuosity were automatically calculated (3D automatic) and compared to manually adjusted 3D measurements (3D semi-automatic), and manual measurements of PDA dimensions in 2D projectional angiograms before and after stent angioplasty.
Ductal anatomy was successfully modeled and quantified in all subjects. 3D automatic and semi-automatic measurements of straight-line aortic to pulmonary artery length were not significantly different than 2D measurements. Semi-automatic 3D measurements were similar to 2D measurements of the total length. Minimum and maximum ductal diameters were not significantly different by 3D automatic and 2D measurements, however semi-automatic 3D diameters were significantly larger. Inter-reader reliability of ductal length and diameter was higher with manual adjustment of 3D centerlines compared to standard measurement of 2D angiograms. These differences were consistent across PGE doses between CTA and DAS.
Automatic PDA modeling is feasible and efficient, enabling reproducible quantification of ductal anatomy for procedural planning of DAS in patients with DD-PBF. Further development is needed as well as investigation of whether 3D modeling-derived measurements influence procedural duration or outcome.
动脉导管支架置入术（DAS）用于缓解患有动脉导管依赖性肺血流（DD-PBF）的婴儿的症状，然而动脉导管未闭（PDA）的解剖结构可能复杂且具有异质性。
我们开发了定制的开源软件来对PDA解剖结构进行建模和量化。
我们回顾性地确定了33例在DAS术前接受CTA检查的患有DD-PBF的新生儿。在3D Slicer和SlicerHeart中实施了一种新颖的定制工作流程，以半自动提取PDA及其周围血管走行的中心线。自动计算3D导管长度、直径、曲率和扭曲度（3D自动测量），并与手动调整后的3D测量值（3D半自动测量）以及支架血管成形术前和术后二维投影血管造影中PDA尺寸的手动测量值进行比较。
在所有受试者中均成功对导管解剖结构进行了建模和量化。从主动脉到肺动脉的直线长度的3D自动测量和半自动测量与二维测量无显著差异。3D半自动测量的总长度与二维测量相似。3D自动测量和二维测量的导管最小和最大直径无显著差异，但3D半自动测量的直径明显更大。与二维血管造影的标准测量相比，手动调整3D中心线时，导管长度和直径的阅片者间可靠性更高。在CTA和DAS之间，这些差异在不同剂量的前列腺素E（PGE）之间是一致的。
自动PDA建模是可行且高效的，能够为患有DD-PBF的患者进行DAS手术规划时对导管解剖结构进行可重复的量化。还需要进一步开发，并研究3D建模得出的测量值是否会影响手术持续时间或结果。
