Tailor-made simulation in paediatric surgery: anomalous pulmonary venous drainage

Dr. Pedro Becker Rencoret

Hospital Clínico UC Christus - Santiago de Chile, Chile


Increased understanding of anatomy

Practice of the surgical plan

Changes to the original surgical plan

Reduced surgical time

Guidance on the surgical approach in the operating theatre

Improved patient-physician interaction

Improved interaction between involved clinicians

Significant changes in the patient's postoperative period

Clinical case

Diagnostic studies were performed in a 2-year-old female patient with a history of corrected left heart hypoplasia (Norwood and Glenn surgery). They determined that her entire left lung drains abnormally through the left vertical into the innominate vein.

Surgical plan and results in operating room

Two physical biomodels were made:

1. Blood pool: printed with FDM technology in PLA material, white and compact with a resolution of 0.2 mm.

2. Endocardial surfaces: Printed with SLA technology in translucent and flexible resin with a resolution of 0.02 mm.

Surgical plan and results in operating room

The surgery the patient needed to improve the left pulmonary drainage was to remove the connection between the vertical vein and the innominate vein and to perform an anastomosis of the vertical vein to the left appendage.

Due to the complexity of the anatomy, the distances between the named structures and the limited two-dimensionality of the tomography images, the surgeon in charge of the case was uncertain as to whether corrective intervention would be possible. For this purpose, Dr. Becker implemented 3D biomodels.

The virtual 3D reconstruction was extremely helpful to easily recognise the structures and their boundaries due to the colour markers. The biomodelling of the blood pool made it possible to understand the anatomy from a three-dimensional, life-size view and to assess the flow in the individual regions.

Finally, the flexible model of the endocardial surfaces corresponding to the atria with their appendages, aorta artery with the arterial outlets of the arch, jugular, innominate and vertical veins, made it possible to simulate surgery and corroborate whether the vertical vein would connect to the left atrium and what its angulation would be like.

In which other congenital heart diseases are 3D models used?: "3D in congenital heart diseases: Double outlet right ventricle". Dr. Pedro Becker used 3D models in different views to better understand the anatomical abnormalities in the patient's small heart.

Conclusions reached due to the use of 3D models and intraoperative findings:

1. The vertical vein would reach the left atrial appendage without the addition of an extracardiac tube and would be left with an acceptable angulation. Indeed, the surgery could be performed with the indicated procedure.

2. It would be necessary to divide the aorta in order to be able to perform the surgery and finally to reconstruct the aorta.

3. The procedure could be clearly explained to the patient's family.

4. The 3D models were taken to surgery for consultation whenever there were any doubts about the approach.

5. The reference taking to facilitate the location of the left atrial appendage in the operating theatre was important. The auricle was where the model indicated, which gave them a lot of security and peace of mind.

6. By generating the plan accurately and having the possibility to test it, the surgery time was shorter.

7. Post surgery, the patient's saturation improved by 5 to 10 points.