• MIRAI 3D

3D printing for cardiac transplant evaluation in complex patients

Dr. Alejandro Bertolotti


Hospital Universitario Fundación Favaloro - Buenos Aires, Argentina


Benefits

Generates a better perception of the anatomy.

Provides the possibility to anticipate different scenarios that may arise.

Allows the surgical structure to be designed taking into account such scenarios

Reduces technical complications

Reduces surgical time

Improves the postoperative period and quality of life of the patient

Improves the patient's postoperative period and quality of life


Clinical case

13-year-old male with a prenatal diagnosis of left ventricular hypoplasia.


In his neonatal stage, he underwent surgery twice, with Norwood Sano surgery and Glenn surgery. Subsequently, collateral arteries were embolised by catheterisation and, finally, at the age of 3 years, he underwent Fontan surgery followed by closure of the fenestration by haemodynamics.


The patient remained under control, with ejection fractions at the limit of normality, and he was frequently physically active.


At the last cardiological check-up, a significant deterioration of right ventricular function was observed, including dilatation with an ejection fraction of 28%, which in turn led to moderate atrioventricular valve coaptation failure. The catheter-based haemodynamic assessment of venous and arterial pressures was adequate, as was the oximetry. Because of all this, the patient was referred for evaluation for cardiac transplantation.


3D anatomical model

Binder Jetting technology

Material: Ceramic powder

Resolution: 0.01 mm

Finish: Three colors





Surgical plan

Congenital heart diseases with all the interventions involved and the anatomical and physiological restructuring of the patient's heart result in an abnormal and complex state of the mediastinal structures.


So, "How is this represented in the virtual image that you generate in your head at the time of surgery? The truth is that with all these anomalies and anatomical variations it is difficult and the margin of error is greater. It is different to have the heart we are going to operate on in our hands", says Dr Bertolotti.


The model made it possible to define exactly the characteristics of the Glenn anastomosis, i.e. its location and size; where the anastomosis of the extracardiac tube (Fontan) was located and where the extracardiac tube originating from the inferior vena cava passed through. Thus, it was possible to give an assessment of the dilatation that the patient had in this vein prior to the extracardiac tube.


It also provided dimensions of the left atrial cap, whose information is relevant because this structure has to be anastomosed for cardiac transplantation. It also allowed to assess whether the pulmonary branches were of adequate size, information that added to the already existing knowledge of their patency.


Finally, 3D model was useful to know where the coronary arteries were located. All this additional information provided by 3D printing makes the representation that the doctor can make in his or her mind much more favourable.

¿Do you want to know more applications in cardiovascular surgery?: "3D in congenital heart disease: Double outlet right ventricle". Find out how Dr. Pedro Becker Rencoret, Head of Paediatric Cardiac Surgery at Clínica UC (Chile), uses 3D models for his most complex surgeries.


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