The Impact Of 3D Printing And 3D Interactive Visualization On The Ability To Repair Previously Palliated Complex Congenital Heart Disease
Marcus P. Haw, MBBS, MS, FRCS, FECTS, Giedrius Baliulis, MD, FRCS(CT), Neal D. Hillman, MD, Jordan M. Gosnell, BS, RDCS (AE PE), FASE, Bennett P. Samuel, MHA, BSN, RN, John L. Byl, MPH, RDCS (AE PE), Joseph J. Vettukattil, MBBS, MD, DNB, CCST, FRCPCH, FRSM, FRCP.
Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, MI, USA.
AbstractObjective: To review the utility of 3D printing, and of novel interactive 3D visualisation (I3DV), in clinical decision making and surgical planning in complex congenital heart disease. Methods: We reviewed a series of seven surgical patients. In six cases bi-ventricular repair was previously considered inappropriate. Using interactive 3D printing, and also interactive 3D visualisation software (Echopixel), 7 patients aged 3-21 years underwent corrective surgery. Previous attempts at treatment had resulted in complications such that palliation or no surgery had been preferred. All patients had significant symptoms. Results: 3D printing and I3DV review was performed in all 7 patients. I3DV was superior to 3D printing in 4 cases and critical for surgical planning in 5 cases. There was no mortality and bi-ventricular repair was possible in all cases. (Table).
| Transplant Possible | Previous Sternotomies | Age | Interactive 3D Visualization | Palliative Care | |
| Heterotaxy, Dextrocardia, Bilateral SVC, TAPVR AVSD, DORV, PA. Palliation with BD Glenn, PV occlusion | No | X3 | 3 | Critical to decision and plan | Yes |
| Heterotaxy, Dextrocardia, TAPVR, AVSD,DORV, PV stenosis and occlusion, PAH | No | X2 | 11 | Critical decision and plan | Yes |
| TGA, PS post Rastelli, conduit compression | Yes | X3 | 14 | Critical to surgical plan | No |
| Univentricular Heart, ASD post PAB | Yes | X1 | 7 | Critical to decision and to plan | No |
| DORV, PA, Dextrocardia, crisscross heart, post bilateral Glenn shunts | Yes | X1 | 9 | Not Critical to decision or plan | No |
| Heterotaxy, TGA, DORV, straddling Mitral valve, previous Fontan, HOCM, failed subaortic resection | No | X3 | 10 | Critical to decision and to plan | Almost |
| PA, IVS, failing atrio-pulmonary Fontan, Low cardiac output state | No | X3 | 21 | Not Critical to decision or plan | No |
Conclusions: 3D printing and I3DV were highly effective in the decision to treat and in planning the appropriate surgical technique. Surgical techniques and repair strategies were altered based on the new technologies. 3D printing and I3DV should be considered in some patients with complex CHD prior to finalising management plans.