Surgical Planning by 3D Printing for Primary Cardiac Schwannoma Resection

Abstract

We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach.

Three-dimensional printing in cardiology: Current applications and future challenges

“…3D TTE/TEE Left atrial appendage occlusion [14], postoperative hemodynamic testing following MitraClip procedure [41] MRI TGA, VSD, PS [42], DORV [43], hypoplastic aortic arch [44], aortic arch aneurysm [45], pulmonary atresia, ASD, tricuspid regurgitation, dextrocardia [46], retroesophageal LSA + right aortic arch [47] MSCT ASD [48,49], VSD [50], LAA occlusion [51], severe AS [52], extensive AA [53], severe mitral valve regurgitation [54], neopulmonary stenosis [55], primary dilated cardiomyopathy [56], primary cardiac schwannoma [57], double-chambered right ventricle [58], severe pulmonary venous stenosis [59], complex aortic obstruction [60], juxtarenal AA [61], DOLV, VSD, PS [62], left atrium osteosarcoma [63], hypertrophic cardiomyopathy [64], prosthetic MV perivalvular leak [65], ventricular aneurysm [66], pulmonary venous baffle to the systemic right ventricle [67], tricuspid atresia [67], His bundle pacing [68] AA -atherosclerotic aneurysm; rest abbreviations are the same with the Table 1 www.cardiologyjournal.org three challenges are discussed which need to be addressed in the future.…”

Utility and reproducibility of 3‐dimensional printed models in pre‐operative planning of complex thoracic tumors

“…In that study, of 19 surgeons who used a total of 52 models of tumors throughout the body, 94% considered them very helpful for treatment planning, and 71% felt they improved the surgical approach. To our knowledge, 3D‐printed models specific to thoracic tumors have been reported for two patients with Pancoast tumors, a pediatric patient with primary mediastinal synovial sarcoma invading the SVC, a patient with an ectopic mediastinal thymoma, a patient with a pectoralis minor muscle spindle cell neoplasm, and a patient with a cardiac schwannoma . Benefits reported for these cases include better understanding of tumor relationship to surrounding normal tissues, helping to avoid resecting uninvolved structures, and enhancing the likelihood of complete resection.…”

“…To our knowledge, 3D-printed models specific to thoracic tumors have been reported for two patients with Pancoast tumors, 5,6 a pediatric patient with primary mediastinal synovial sarcoma invading the SVC, 16 a patient with an 5 and a patient with a cardiac schwannoma. 18 Benefits reported for these cases include better understanding of tumor relationship to surrounding normal tissues, helping to avoid resecting uninvolved structures, and enhancing the likelihood of complete resection. One difficulty in adopting the technology described in all the above studies is that they have used either research 5,16 or engineering-oriented 2,6 3D printing software that is unfamiliar and/or unavailable to most radiologists.…”

Three-Dimensional Printing for Cardiology: A Useful Tool for Cardiac Intervention

“…Besides, the 3D printed model is more instrumental in guiding surgery compared to 2D measurement data. Son et al [7] reported that they successfully performed a primary cardiac schwannoma excision with the guidance of a 3D printed model. The model was adopted because the tumor origin of the patient could not be ascertained by CT, MRI or echocardiography.…”