Application of 3D Printing to Improve Surgical Outcome of Double Outlet Right Ventricle with Non-committed Ventricular Septal Defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUAZhong-dong , YANGXin-ling , LIUKai-yang , LIURui , ZHANGBen-qing , GAOHua-wei , RUILu , HUSheng-shou ,  LIShou-jun

Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P.R.China;

Corresponding author：

LIShou-jun, Email: drlishoujun@yahoo.com

Keywords：

Double outlet right ventricle; Biventricular repair; Non-committed ventricular septal defect

DOI：

10.7507/1007-4848.20160128

Video：

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Objective To evaluate the efficacy of 3-dimensional printing model (3DPM) aiding decision making and surgery rehearsal for the treatment of double outlet right ventricle (DORV) with non-committed ventricular septal defect (NC-VSD). Methods From January 1st, 2012 through December 30th, 2014, 12 patients with DORV and NC-VSD were operated with the aid of “3DPM guidance” to do decision making and surgical technique rehearsal preoperatively. There were 9 males and 3 females at age of 2.9±2.2 years. The “3DPM guidance” consisted of step by step procedures: computerized tomography (CT) scan for the patients, CT based 3DPM rendering, 3DPM exploration, decision making, and surgery rehearsal. During surgery rehearsal, surgeons did patch designing, VSD enlargement planning, muscle bundle resection etc. Eight out of the twelve patients underwent biventricular repair, 4 patients underwent single ventricle repair. Six of the eight biventricular repair patients had intra-ventricular baffle repair, 1 patient had intra-ventricular baffle repair and arterial switch procedure, 1 had modified Nikaidoh procedure. VSD enlargement was performed in all the patients in biventricular repair group. The reasons not to do a biventricular repair included very restrictive VSD, tricuspid attachments across the sub-aortic passway. Results The operation findings correlated well with the 3DPM in all the cases. There was no hospital death, no major complication. One patient had a mild sub-aortic stenosis and he was under close follow-up. There was no late death and reoperation. Surgeons involved were satisfied with the “3DPM guidance”. Conclusions 3-D printing model is an excellent way to help decision making for DORV with NC-VSD and can provide surgery simulation which decrease complication rate and help achieve good outcomes.

Citation： HUAZhong-dong, YANGXin-ling, LIUKai-yang, LIURui, ZHANGBen-qing, GAOHua-wei, RUILu, HUSheng-shou, LIShou-jun. Application of 3D Printing to Improve Surgical Outcome of Double Outlet Right Ventricle with Non-committed Ventricular Septal Defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(6): 532-536. doi: 10.7507/1007-4848.20160128 Copy

1.	Lev M, Bharati S, Meng CCL, et al. A concept of double-outlet right ventricle. J Thorac Cardiovasc Surg, 1972, 64: 271-280.
2.	Kirklin JW, Paci^®co AD, Blackstone EH, et al. Current risks and protocols for operations for double-outlet right ventricle: derivation from an 18 year experience. J Thorac Cardiovasc Surg, 1986, 92: 913-930.
3.	Kleinert S, Sano T, Weintraub RG, et al. Anatomic features and surgical strategies in double-outlet right ventricle. Circulation, 1997, 9: 1233-1239.
4.	Stellin G, Ho SY, Anderson RH, et al. The surgical anatomy of double-outlet right ventricle with concordant atrioventricular connection and noncommitted ventricular septal defect. J Thorac Cardiovasc Surg, 1991, 102(6): 849-855.
5.	Mottl-Link S, Hübler M, Kühne T, et al. Physical models aiding in complex congenital heart surgery. Ann Thoracic Surg, 2008, 86(1): 273-277.
6.	Kim MS, Hansgen AR, Wink O, et al. Rapid prototyping a new tool in understanding and treating structural heart disease. Circulation, 2008, 117(18): 2388-2394.
7.	Kim MS, Hansgen AR, Carroll JD. Use of rapid prototyping in the care of patients with structural heart disease.Trends Cardiovasc Med, 2008, 18(6): 210-216.
8.	Gibson I, Cheung L K, Chow S P, et al. The use of rapid prototyping to assist medical applications. Rapid Prototyping J, 2005, 12(1): 53-58.
9.	Schievano S, Migliavacca F, Coats L, et al. Percutaneous pulmonary valve implantation based on rapid prototyping of right ventricular outflow tract and pulmonary trunk from MR data. Radiology, 2007, 242(2): 490-497.
10.	Freedom RM, Yoo SL. DORV: pathology and angiocardiography. Semin Thorac Cardiovasc Surg, 2000, 3: 3-19.
11.	Hu SS, Liu ZG, Li SJ, et al. Strategy for biventricular outflow tract reconstruction: Rastelli, REV, or Nikaidohprocedure? J Thorac Cardiovasc Surg, 2008, 135(2): 331-338.
12.	Barbero-Marcial M, Tanamati C, Atik E, et al. Intraventricular repair of double-outlet right ventricle with concommitted ventrir septaldefect : advantages of multiple patches. J Thorac Cardiovasc Surg, 1999, 118(6): 1056-1067.
13.	Lacour-Gayet F, Haun C, Ntalakoura K, et al. Biventricular repair of double outlet right ventricle with non-committed ventricular septal defect (VSD) by VSD rerouting to the pulmonary artery and arterial switch. Eur J CardiothoracSurg, 2002, 21(6): 1042-1048.
14.	Lecompte Y, Sidi D. Transposition and malposition of the great arteries with ventricular septal defects. In: Moller JH, Hoffman JIE,editors. Pediatric Cardiovascular Medicine, New York: ChurchillLivingstone, 2000. 363-373.

1. Lev M, Bharati S, Meng CCL, et al. A concept of double-outlet right ventricle. J Thorac Cardiovasc Surg, 1972, 64: 271-280.
2. Kirklin JW, Paci^®co AD, Blackstone EH, et al. Current risks and protocols for operations for double-outlet right ventricle: derivation from an 18 year experience. J Thorac Cardiovasc Surg, 1986, 92: 913-930.
3. Kleinert S, Sano T, Weintraub RG, et al. Anatomic features and surgical strategies in double-outlet right ventricle. Circulation, 1997, 9: 1233-1239.
4. Stellin G, Ho SY, Anderson RH, et al. The surgical anatomy of double-outlet right ventricle with concordant atrioventricular connection and noncommitted ventricular septal defect. J Thorac Cardiovasc Surg, 1991, 102(6): 849-855.
5. Mottl-Link S, Hübler M, Kühne T, et al. Physical models aiding in complex congenital heart surgery. Ann Thoracic Surg, 2008, 86(1): 273-277.
6. Kim MS, Hansgen AR, Wink O, et al. Rapid prototyping a new tool in understanding and treating structural heart disease. Circulation, 2008, 117(18): 2388-2394.
7. Kim MS, Hansgen AR, Carroll JD. Use of rapid prototyping in the care of patients with structural heart disease.Trends Cardiovasc Med, 2008, 18(6): 210-216.
8. Gibson I, Cheung L K, Chow S P, et al. The use of rapid prototyping to assist medical applications. Rapid Prototyping J, 2005, 12(1): 53-58.
9. Schievano S, Migliavacca F, Coats L, et al. Percutaneous pulmonary valve implantation based on rapid prototyping of right ventricular outflow tract and pulmonary trunk from MR data. Radiology, 2007, 242(2): 490-497.
10. Freedom RM, Yoo SL. DORV: pathology and angiocardiography. Semin Thorac Cardiovasc Surg, 2000, 3: 3-19.
11. Hu SS, Liu ZG, Li SJ, et al. Strategy for biventricular outflow tract reconstruction: Rastelli, REV, or Nikaidohprocedure? J Thorac Cardiovasc Surg, 2008, 135(2): 331-338.
12. Barbero-Marcial M, Tanamati C, Atik E, et al. Intraventricular repair of double-outlet right ventricle with concommitted ventrir septaldefect : advantages of multiple patches. J Thorac Cardiovasc Surg, 1999, 118(6): 1056-1067.
13. Lacour-Gayet F, Haun C, Ntalakoura K, et al. Biventricular repair of double outlet right ventricle with non-committed ventricular septal defect (VSD) by VSD rerouting to the pulmonary artery and arterial switch. Eur J CardiothoracSurg, 2002, 21(6): 1042-1048.
14. Lecompte Y, Sidi D. Transposition and malposition of the great arteries with ventricular septal defects. In: Moller JH, Hoffman JIE,editors. Pediatric Cardiovascular Medicine, New York: ChurchillLivingstone, 2000. 363-373.

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Application of 3D Printing to Improve Surgical Outcome of Double Outlet Right Ventricle with Non-committed Ventricular Septal Defect

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