PMC9852815_01
Preoperative measurements using computed tomography, angiography, and echocardiography were assessed before the surgical repair. (A) Congenitally corrected transposition of the great arteries (ccTGAs). (B) Membranous ventricular septal aneurysm (MVSA). (#) Represents MVSA. (C) Atrial septal defect (ASD). (*) Represents ASD. (D) Severe pulmonary stenosis (PS). (E) Severe tricuspid regurgitation (TR). PA, pulmonary artery; Ao, aorta.
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F1
PS, and membranous ventricular septal aneurysm (MVSA) (maximum diameter was up to 14 mm) with multiple defects, atrial septal defect (ASD) (the length of ASD was 1.5 cm) (Figures 1A-C). Preoperative echocardiography (ECG) displayed severe PS (the inner diameter of the pulmonary artery was 22 mm) and severe TR (the regurgitation volume was 8.0 mL) (Figures 1D, E). The left ventricular systolic function was normal [left ventricular end-diastolic volume index (LVEDVI) was 47 mL/m2].
Reconstructed process of three-dimensional (3D) printed model and preoperative evaluation. (A) Original computed tomography angiography data. (B) Edition of the mask. (C,D) The 3D reconstructed and printed models are shown in the front view, respectively. (E,F) The 3D reconstructed and printed models are shown in the rearview, respectively. In the 3D printed model, the red part is the aorta (Ao), the blue part is the pulmonary artery (PA), the yellow part is the left atrial appendage (LAA), the pink part is the left atrium (LA) and left ventricle (LV), and the light blue part is right atrium (RA) and right ventricle (RV).
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F2
Digital imaging and communication of medicine (DICOM) format of the patient CTA data was imported into Materialize Mimics version 21.0 (Leuven, Belgium), and the 3D reconstructed model was segmented using the threshold segmentation function (Figure 2A). Then, the acquired 3D reconstructed model of the heart was digitally removed, trimmed, smoothened, and repaired in Materialize 3-matic (Leuven, Belgium) to restore the complete anatomical structures of the heart (Figure 2B). Standard tessellation language (STL) file of 3D reconstruction was exported to Stratasys Polyjet 850 multi-material full-color 3D printer (Figures 2C, E). The digital acrylonitrile butadiene styrene was used to print the model, different anatomical structures were matched with different colors, and then the 3D printed whole-heart model was obtained (Figures 2D, F).
Main procedural steps. (A) The membranous ventricular septal aneurysm (MVSA) was positioned toward the right ventricular outflow tract (RVOT). The arrowheads to MVSA. (B) MVSA was resected, and the residual membranous part of the interventricular septum was directly stitched. The arrowheads to the suture. (C) The extracardiac pipe (EP) made by a bovine pericardial patch was tested before connection. (D) EP completed the connection between the right ventricle and the pulmonary artery.
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F3
MVSA was formed, and the aneurysm presented like protrusion to RVOT (Figure 3A). MVSA was removed, and the residual membranous part of the interventricular septum was directly stitched (Figure 3B). Three leaflets of the same size were cut and sewn parallel to the bovine pericardial patch. Then, the bovine pericardial patch was rolled into the tube shape and sutured to form a self-made pipe, which was used in RVOT reconstruction (Figures 3C, D).
Postoperative evaluation using multimodal imaging verified the curative effect of the surgical repair. (A) The residual membranous part of the interventricular septum was in a good position and well-functioning. (B) The extracardiac pipe functioned well. (C,D) The postoperative 3D printed model was observed clearly to verify the effect of the operation. EP, extracardiac pipe.
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F4
The residual membranous part of the interventricular septum was positioned well (Figure 4A). The extracardiac pipe was well-functioning without regurgitation or stenosis (Figure 4B). The postoperative 3D reconstructed and printed model showed the morphology of the anatomical structures, indicating that the operation achieved good results (Figures 4C, D).