Use of 3D Models in the Surgical Decision-Making Process in a Case of Double-Outlet Right Ventricle With Multiple Ventricular Septal Defects

Abstract

3D printing has recently become an affordable means of producing bespoke models and parts. This has now been extended to models produced from medical imaging, such as computed tomography (CT). Here we report the production of a selection of 3D models to compliment the available imaging data for a 12-month-old child with double-outlet right ventricle and two ventricular septal defects. The models were produced to assist with case management and surgical planning. We used both stereolithography and polyjet techniques to produce white rigid and flexible color models, respectively. The models were discussed both at the joint multidisciplinary meeting and between surgeon and cardiologist. From the blood pool model the clinicians were able to determine that the position of the coronary arteries meant an arterial switch operation was unlikely to be feasible. The soft myocardium model allowed the clinicians to assess the VSD anatomy and relationship with the aorta. The models, therefore, were of benefit in the development of the surgical plan. It was felt that the clinical situation was stable enough that an immediate intervention was not required, but the timing of any intervention would be dictated by decreasing oxygen saturation. Subsequently, the oxygen saturation of the patient did decrease and the decision was made to intervene. A further model was created to demonstrate the tricuspid apparatus. An arterial switch was ultimately performed without the LeCompte maneuver, the muscular VSD enlarged and baffled into the neo aortic root and the perimembranous VSD closed. At 1 month follow up SO 2 was 100%, there was no breathlessness and no echocardiogram changes.

Development of a Clinical 3D Modeling Program to Guide Pediatric Cardiothoracic Surgery and Intervention

“…Predictably, nearly onethird of all modeling cases were performed for evaluation of complex biventricular repair feasibility. The most commonly published descriptions of 3D printing in congenital heart disease are of patients with double outlet right ventricle, [10][11][12][13][14][15]18 and in this cohort we found similar utility in creating models for patients with other conotruncal anomalies and similar need for an intracardiac ba e. In addition, based on proceduralist feedback and number of requests, it was evident that 3D modeling was impactful for planning transcatheter innominate vein turndowns, closure of multiple muscular VSDs and "nontraditional" Fontan conduit placement.…”

“…[1][2][3][4][5][6][7][8][9] In patients with congenital heart disease much of the published data focuses on using 3D printing and more recently virtual or augmented reality, to inform surgical planning for patients with complex intracardiac anatomy such as double outlet right ventricle. [10][11][12][13][14] As a result of the improved visuospatial understanding of patient speci c cardiac lesions conferred by viewing 3D representations of the anatomy, these 3D tools are heralded as bene cial adjunctive imaging tools that bring added-value to the preoperative planning space. However, the translation and scaling of these research methods to a routine clinical practice has not been well described.…”

Hemodynamic testing using three-dimensional printing and computational fluid dynamics preoperatively may provide more information in mitral repair than traditional image dataset

“…3DP cardiovascular models provide surgeons with impressive insights and better understanding of the location and size of lesions, which cannot be achieved with 2D images. However, previous studies were focused on forming rigid anatomical models made of hard polymers (16)(17)(18)(19)(20)(21), whereas a 3DP dynamic model made of flexible silicone can offer more detailed information concerning hemodynamics. Although CFD has also been applied for mitral repair simulation in previous research, models of the left heart system are often simplified and derived from only one modality (e.g., MRI) (22).…”

3D Modeling and Printing in Congenital Heart Surgery: Entering the Stage of Maturation

“…While 3D modeling of the blood pool provides an excellent overview of the pathology, 3D endocardial surface imaging reproduces the surgical scenes of the opened cardiac cavities (Figure 1) (1,11). Double outlet right ventricle (DORV) is by far the most common referral indication for 3D printing (11,(19)(20)(21)(22)(23). DORV is not a single pathologic entity but a collective term for various malformations with a unifying feature of origin of more than half of both arterial trunks from the right ventricle (24).…”