ABSTRACT
OBJECTIVES: To evaluate the impact of 3D printed models (3D models) on surgical planning in complex congenital heart disease (CHD). METHODS: A prospective case-crossover study involving 10 international centres and 40 patients with complex CHD (median age 3 years, range 1 month-34 years) was conducted. Magnetic resonance imaging and computed tomography were used to acquire and segment the 3D cardiovascular anatomy. Models were fabricated by fused deposition modelling of polyurethane filament, and dimensions were compared with medical images. Decisions after the evaluation of routine clinical images were compared with those after inspection of the 3D model and intraoperative findings. Subjective satisfaction questionnaire was provided. RESULTS: 3D models accurately replicate anatomy with a mean bias of -0.27 ± 0.73 mm. Ninety-six percent of the surgeons agree or strongly agree that 3D models provided better understanding of CHD morphology and improved surgical planning. 3D models changed the surgical decision in 19 of the 40 cases. Consideration of a 3D model refined the planned biventricular repair, achieving an improved surgical correction in 8 cases. In 4 cases initially considered for conservative management or univentricular palliation, inspection of the 3D model enabled successful biventricular repair. CONCLUSIONS: 3D models are accurate replicas of the cardiovascular anatomy and improve the understanding of complex CHD. 3D models did not change the surgical decision in most of the cases (21 of 40 cases, 52.5% cases). However, in 19 of the 40 selected complex cases, 3D model helped redefining the surgical approach.
Subject(s)
Heart Defects, Congenital/surgery , Heart/diagnostic imaging , Models, Anatomic , Printing, Three-Dimensional , Adolescent , Adult , Child , Child, Preschool , Cross-Over Studies , Echocardiography, Three-Dimensional , Female , Heart Defects, Congenital/diagnostic imaging , Humans , Imaging, Three-Dimensional , Infant , Infant, Newborn , Magnetic Resonance Imaging, Cine , Male , Preoperative Period , Prospective Studies , Reproducibility of Results , Tomography, X-Ray Computed , Young AdultABSTRACT
Introducción. El nacimiento anómalo de la arteria pulmonarizquierda (sling de la arteria pulmonar) es una malformacióncardiaca en la que la arteria pulmonar izquierdanace de la derecha y se sitúa entre tráquea y esófago. Provocasíntomas respiratorios como consecuencia de la compresióndel bronquio principal derecho y la tráquea. Caso clínico. Lactante de 7 meses de edad con episodios de dificultad respiratoria desde los 3 meses de vida catalogados de bronquitis. Diagnosticado de sling de la arteria pulmonar, se realizó cirugía correctora con desinserción de la API y anastomosis directa al lado izquierdo del tronco de la arteria pulmonar. Comentarios. El origen anómalo de la arteria pulmonar izquierda o sling de la arteria pulmonar es un raro anillo vascular que requiere un alto índice de sospecha en lactantes con sintomatología respiratoria recurrente. El diagnóstico precoz de esta enfermedad es crucial, porque puede conducir a un severo compromiso respiratorio que puede amenazar la vida e incluso producir la muerte antes del año de edad. Una adecuada evaluación de las anomalías asociadas del árbol traqueo-bronquial es importante para decidir la cirugía y mejorar el pronóstico. Revisamos la literatura de esta rara entidad, en sus aspectos epidemiológicos, fisiopatológicos, clínicos, diagnósticos y quirúrgicos
Introduction. The anomalous left pulmonary artery(pulmonary artery sling) is a congenital condition in whichthe left pulmonary artery arises from the right pulmonaryartery forming a sling between the trachea and the esophagusand leading to respiratory symptoms by compressionof the right main stem bronchus and trachea.Case Report. A 7 month old infant presented with respiratorydistress since 3 months of age, for which he hadbeen diagnosed with bronchitis. The diagnosis of pulmonaryartery sling was made and he underwent a surgicalrepair with detachment of the aberrant left pulmonary arteryand reimplantation to the left side of the main pulmonaryartery.Comments. The anomalous origin of the left pulmonaryartery known as pulmonary artery sling is a rare formof vascular ring that requires a high index of suspicion ininfants with recurrent respiratory symptomatology. Theearly recognition of this condition is crucial because thesepatients may experience life-threatening respiratory compromiseand early death. An adequate assessment of theanomalies of the tracheobronchial tree is very importantin order to improve surgical planning and prognosis. Theauthors review the literature and discuss the epidemiology,pathophysiology, clinical presentation and diagnosis,and surgical aspects of this anomaly
