Adult Congenital Heart Disease


Diagnosis

Age at imaging study (years)

Weight at study (kg)

Reason for printing

Modality

Did 3D model add value over prior imaging?

Pre-intervention cases: Did the 3D model aid in making management decisions?

Bicuspid aortic valve, severe dilation of aortic root and ascending aorta, moderate AR, dilated LV, mild LV dysfunction

20

83

Patient counseling

Trainee education

CT

Yes

N/A

Coarctation of aorta, s/p repair

21

55

Trainee education

MRI

No

N/A

DORV, s/p VSD closure (Rastelli) and RV-PA conduit. Complex LVOT obstruction

30

121

Pre-intervention planning

Patient counseling

Trainee education

MRI

Yes

Yes

Dextrocardia, DORV, right-sided IVC, extracardiac Fontan baffle to LPA, left SVC to left-sided superior cavo-pulmonary connection

31

64

Patient counseling

Trainee education

MRI

Yes

N/A

D-transposition of the great arteries, s/p atrial switch (Senning)

36

86

Patient counseling

Trainee education

MRI

Yes

N/A

DORV, D-malposition of the great arteries. H/o Blalock-Hanlon procedure (atrial septectomy), PA band in infancy. Followed by classic Glenn (SVC to RPA anastomosis), PA band takedown and modified Mustard procedure (IVC baffled to left atrium). Cyanosis and atrial arrhythmia

40

54

Pre-intervention planning

Patient counseling

Trainee education

MRI

Yes

Yes

DORV, s/p repair followed by RVOT reconstruction, SubAS resection. Recurrent LVOT obstruction

45

65

Pre-intervention planning

Patient counseling

Trainee education

MRI

Yes

Yes

Unbalanced AV canal, left dominant, superior-inferior atria, DORV, Taussig bing type, L-malposed great arteries, sub-PS, PS. Increasing cyanosis

45

67

Pre-intervention planning

Patient counseling

Trainee education

MRI

Yes

Yes


AR Aortic regurgitation, LV Left ventricle, DORV Double outlet right ventricle, VSD Ventricular septal defect, RVPA Right ventricle to pulmonary artery, LVOT Left ventricular outflow tract, IVC Inferior vena cava, SVC Superior vena cava, D Dextro, RVOT Right ventricular outflow tract, subAS Sub-aortic stenosis, AV canal Atrioventricular canal, L Levo, PS Pulmonary stenosis

Reproduced from Anwar et al. [14]; ​dx.​doi.​org/​10.​1016/​j.​jcmg.​2016.​03.​013, with permission of Elsevier



The following cases show specific applications of 3D printing in ACHD patients.



Case 1


A twenty-nine-year-old (121 kg) male with history of double outlet right ventricle (DORV) underwent a two ventricle repair with a Rastelli procedure, ventricular septal defect (VSD) closure with baffling of left ventricle (LV) to aorta, and RV to pulmonary artery (PA) conduit placement in early life. He presented with exercise intolerance. Cardiac MRI showed complex LVOT obstruction, a small residual VSD, dilation of aortic root (sinus of Valsalva), and aortic regurgitation. A 3D model was printed to aid in surgical planning. Figure 11.1 shows complex obstruction under the aortic valve with muscle bundles in the LVOT. Note the small VSD and buckling of the VSD patch into the LVOT. A catheter crosses the VSD from the RV with the tip in the LV. A ridge of muscle crosses the LVOT. Figure 11.1b shows a second model, created to simulate the “surgeon’s view.” Corresponding anatomy from the operating room is shown in Fig. 11.1c.

A370805_1_En_11_Fig1_HTML.gif


Fig. 11.1
a Complex obstruction under the aortic valve with muscle bundles in the LVOT. Note the small VSD and buckling of the VSD patch into the LVOT. A catheter crosses the VSD from the RV with the tip in the LV. A ridge of muscle crosses the LVOT. b Shows a second model, created to simulate the “surgeon’s view.” Corresponding anatomy from the operating room is shown in (c)


Case 2


A sixteen-year-old male with history of heterotaxy syndrome, single ventricle anatomy with a systemic RV, had undergone a total cavo-pulmonary connection (aka Fontan) palliation with an extracardiac fenestrated conduit. He subsequently underwent percutaneous device closure of the Fontan fenestration. A surveillance MRI was performed to evaluate single ventricle anatomy and physiology. A 3D model was printed for teaching purposes. The model (Fig. 11.2) shows a dilated and hypertrophied RV, the aorta as the only outflow from the functional single ventricle and the Fontan conduit and superior vena cava connecting to the pulmonary arteries. The fenestration occlusion device is shown in green.

A370805_1_En_11_Fig2_HTML.gif


Fig. 11.2
Dilated and hypertrophied RV, the aorta as the only outflow from the functional single ventricle and the Fontan conduit and superior vena cava connecting to the pulmonary arteries. The fenestration occlusion device is shown in green

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Oct 11, 2017 | Posted by in CARDIOLOGY | Comments Off on Adult Congenital Heart Disease
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