Dicom Director

Case of the Week from DICOM Director

Right Ventricular Assist Device
A right ventricular assist device does just what it claims, assisting the right heart in pumping blood from the venous system into the lungs.
In this video, we first see the external view with right and left chest tubes seen in blue, cardiac pacing wires in purple and the RVAD itself entering the patient’s left chest wall in green.
With the skin removed, we see more clearly the sternal closure wires in light blue, the right chest tube, placed laterally and coursing superiorly and posteriorly in the pleural space and the left tube placed anterolaterally, running posteriorly and inferiorly. If we enter the right chest directly, we are able to see the both chest tubes in their full orientation within the pleural spaces.
Isolating all the foreign bodies with our Cutting Plane, we are able to clearly see the sternal wires, both thoracostomy tubes, a nasogastric tube running posteriorly, two cardiac pacing wires anteriorly in purple and the three components of the RVAD in green.
Finally, we focus on just the RVAD itself, with pump input catheters in the superior and inferior vena cavae and the pump output catheter, punctured directly into the pulmonary artery. Note the shape of the collapsed balloon on the SVC and PA catheters, indicating that the image was taken during diastole.

Segmentation by Synopsys Simpleware; viewed with the Apple Vision Pro

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Tetralogy of Fallot Part 3
Ventricular septal defect
Externally, there is no indication of developmental issues with the ventricular septum. As we enter the right ventricle, we again see the trabeculae carnae, and the leaflets of the tricuspid valve with the attached chordae tendinae. As we approach the ‘overriding’ aortic valve, note that we can suddenly enter into the left ventricle through a large defect in the intraventricular septum, just below the aortic valve. Within the left ventricle, we again see the papillary muscles and associated chordae tendinae. Note that what appeared to be the lateral edge of the aortic valve, is in fact the inferior edge of the ventricular septal defect itself; the aortic valve sits almost perfectly astride the intraventricular septum. The developmental defect of the aortic root and the VSD are intimately related.

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Viewed with the Apple Vision Pro; Segmentation by Synopsys Simpleware Software.