Pediatric Cardiology

Mapping the Heart: Imaging and Planning

At a Glance

Advanced imaging like echocardiograms, cardiac CTs, and MRIs are essential for mapping the unique anatomy of a child's Double Outlet Right Ventricle (DORV). These tools help surgeons determine whether a biventricular or single-ventricle repair is the safest path before entering the operating room.

Because every heart with Double Outlet Right Ventricle (DORV) is unique, doctors use advanced imaging to create a highly detailed map of your child’s specific anatomy. This process is like using a GPS to plan a complex journey—the more precise the map, the more prepared the surgical team will be when they enter the operating room ^[1]^[2].

The Initial Evaluation: Echocardiography

The first step in diagnosing DORV is almost always an echocardiogram, or “echo.” This is an ultrasound of the heart that uses sound waves to create moving pictures of the chambers and valves ^[1]^[3].

Fetal Echocardiogram: Many families learn about DORV before birth through a fetal echo. This allows specialists to begin planning care even before the baby is born ^[4]^[5].
Postnatal Echocardiogram: After birth, a more detailed echo is performed. While excellent for looking at the heart’s internal structures and blood flow, it can sometimes be limited in seeing the “big picture” of the larger blood vessels or the exact path of the coronary arteries ^[1]^[3].

Detailed Mapping: CT and MRI

For many children with DORV, the medical team will need a more comprehensive “3D” view than an echo can provide.

Cardiac CT: A CT scan is exceptional at showing the extracardiac structures, such as the aortic arch and the branching of the major arteries ^[1]^[6]. It is also the “gold standard” for mapping the coronary arteries, which are the small vessels that supply blood to the heart muscle itself ^[6]^[3].
Cardiac MRI: An MRI provides high-resolution images of the heart’s interior without using radiation. It is highly reliable, widely used as standard practice for surgical planning, and especially useful for calculating the volume of blood flow ^[7]^[8].

Specialized Planning: 3D Printing and VR

One of the most exciting emerging advancements in pediatric cardiology at specialized centers is the use of 3D modeling ^[2]^[9].

3D Printing: This creates a physical, life-sized model of the heart that a surgeon can actually hold. They can use it to determine if a VSD (the hole) is “routable,” meaning they can safely build a tunnel from that hole to the aorta ^[9]^[10].
Virtual Reality (VR): Some centers use VR headsets to “walk through” a virtual version of your child’s heart. This allows them to simulate the surgery in a 3D digital space, identifying potential obstacles ^[2]^[11].
While these are incredible tools, note that many excellent surgeons plan perfectly successful surgeries using high-quality CT and MRI scans alone.

Why This Level of Detail Matters

The primary goal of this mapping is to decide the safest and most effective surgical path. Specifically, doctors use these tools to determine if a biventricular repair (resulting in a two-pump heart) is possible, or if a single-ventricle pathway is a safer long-term option ^[12]^[13]. By moving this decision-making from the middle of a surgery to the planning phase, your team can enter the operating room with a clear, tested strategy tailored specifically to your child ^[14]^[15].

Common questions in this guide

Will my child need more than an echocardiogram to plan DORV surgery?

While an echocardiogram is the crucial first step, most children with double outlet right ventricle also need a cardiac CT or MRI. These advanced scans provide a comprehensive 3D view of the blood vessels and coronary arteries needed to carefully plan the surgery.

What is the purpose of a cardiac CT scan for DORV?

A cardiac CT scan gives surgeons an exceptional view of structures outside the heart, like the aortic arch. It is also considered the gold standard for mapping the small coronary arteries that supply blood to the heart muscle itself.

How do doctors use 3D printing for heart surgery planning?

Some specialized centers use imaging scans to create a life-sized, 3D-printed physical model of a child's heart. Surgeons can hold this model to determine the safest way to build a tunnel between the hole in the heart (VSD) and the aorta.

How do imaging tests help decide the type of DORV repair?

Detailed imaging allows the medical team to see if a two-pump (biventricular) repair is possible or if a single-ventricle pathway is the safer long-term option. This preparation ensures the surgeon enters the operating room with a clear, tested strategy.

Curated prompts to bring to your next appointment.

1.Will our child need a cardiac CT or MRI to get a more detailed 'map' than the echocardiogram provides?
2.Based on the imaging, how confident are you that a biventricular (two-pump) repair is feasible?
3.Are there any 'straddling' heart valves or heart strings (chordae) that might block the path of a surgical tunnel?
4.Do you plan to use 3D printing or a 3D virtual model to plan the specific 'tunnel' for our child's heart?

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References (15)

1
Optimising pre-operative assessment in double-outlet right ventricle: the complementary role of echocardiography and CT angiography.
Güzelbağ AN, Baş S, Kangel D, et al.
Cardiology in the young 2025; (35(10)):2071-2080 doi:10.1017/S1047951125109773.
PMID: 41054313
2
Printed Models for Better Prediction of Surgery in Patients with Double Outlet Right Ventricle.
Hoogerbeets SF, Roest AAW, Valverde I, et al.
Pediatric cardiology 2026; (47(1)):201-213 doi:10.1007/s00246-024-03747-8.
PMID: 39762516
3
Assessment of Double Outlet Right Ventricle Associated with Multiple Malformations in Pediatric Patients Using Retrospective ECG-Gated Dual-Source Computed Tomography.
Shi K, Yang ZG, Chen J, et al.
PloS one 2015; (10(6)):e0130987 doi:10.1371/journal.pone.0130987.
PMID: 26115034
4
Comparison of the Results of Prenatal and Postnatal Echocardiography and Postnatal Cardiac MRI in Children with a Congenital Heart Defect.
Mamalis M, Koehler T, Bedei I, et al.
Journal of clinical medicine 2023; (12(10)) doi:10.3390/jcm12103508.
PMID: 37240614
5
Diagnostic performance of fetal intelligent navigation echocardiography (FINE) in fetuses with double-outlet right ventricle (DORV).
Ma M, Li Y, Chen R, et al.
The international journal of cardiovascular imaging 2020; (36(11)):2165-2172 doi:10.1007/s10554-020-01932-3.
PMID: 32642877
6
Coronary artery anomalies on preoperative cardiac CT in children with tetralogy of Fallot or Fallot type of double outlet right ventricle: comparison with surgical findings.
Goo HW
The international journal of cardiovascular imaging 2018; (34(12)):1997-2009 doi:10.1007/s10554-018-1422-1.
PMID: 30051301
7
Modeling Tool for Rapid Virtual Planning of the Intracardiac Baffle in Double-Outlet Right Ventricle.
Vigil C, Lasso A, Ghosh RM, et al.
The Annals of thoracic surgery 2021; (111(6)):2078-2083 doi:10.1016/j.athoracsur.2021.02.058.
PMID: 33689734
8
Practical approach to using cardiac magnetic resonance imaging for pre-surgical planning in complex paediatric congenital heart disease.
Fitzgerald NM, Singh AA, Barron DJ, et al.
Pediatric radiology 2025; (55(11)):2272-2285 doi:10.1007/s00247-025-06233-2.
PMID: 40227499
9
Clinical Application and Multidisciplinary Assessment of Three Dimensional Printing in Double Outlet Right Ventricle With Remote Ventricular Septal Defect.
Garekar S, Bharati A, Chokhandre M, et al.
World journal for pediatric & congenital heart surgery 2016; (7(3)):344-50 doi:10.1177/2150135116645604.
PMID: 27142402
10
MRA-based 3D-printed heart model-an effective tool in the pre-surgical planning of DORV.
Bharati A, Garekar S, Agarwal V, et al.
BJR case reports 2016; (2(3)):20150436 doi:10.1259/bjrcr.20150436.
PMID: 30459986
11
Mixed-reality hologram for diagnosis and surgical planning of double outlet of the right ventricle: a pilot study.
Ye W, Zhang X, Li T, et al.
Clinical radiology 2021; (76(3)):237.e1-237.e7 doi:10.1016/j.crad.2020.10.017.
PMID: 33309030
12
Imaging Spectrum of Double-Outlet Right Ventricle on Multislice Computed Tomography.
Priya S, Nagpal P, Sharma A, et al.
Journal of thoracic imaging 2019; (34(5)):W89-W99 doi:10.1097/RTI.0000000000000396.
PMID: 30801451
13
Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle.
Kumar P, Bhatia M
Journal of cardiovascular imaging 2021; (29(3)):205-227 doi:10.4250/jcvi.2020.0196.
PMID: 34080329
14
Recent advances in multimodal imaging in tetralogy of fallot and double outlet right ventricle.
Singh AAV, Yoo SJ, Seed M, et al.
Current opinion in cardiology 2024; (39(4)):323-330 doi:10.1097/HCO.0000000000001154.
PMID: 38652290
15
Surgical Repair of Double Outlet Right Ventricle Infants Guided by Three Dimensional-Computed Tomography Cardiac Modeling and Printing.
Ganta S, Ryan JR, Lewis MJ, Nigro JJ
World journal for pediatric & congenital heart surgery 2025; (16(4)):500-508 doi:10.1177/21501351241305129.
PMID: 39840424

This information about imaging and surgical planning for Double Outlet Right Ventricle (DORV) is for educational purposes only. Always consult your pediatric cardiologist and surgical team for medical advice tailored to your child's specific heart anatomy.

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