Application of 3D printing in the diagnosis and surgical treatment of congenital tracheal stenosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Hao ¹ , ZHANG Hengyi ¹ , WANG Shunmin ¹ , LU Zhaohui ¹ , ZHU Limin ² , FU Wei ³ , LIU Jinlong ³ ,  XU Zhiwei ^1,3

1. Department of Cardiothoracic Surgery, Shanghai Childrens’ Medical Center Affiliated to Medical College, Shanghai Jiaotong University, Shanghai, 200127, P.R.China;
2. Cardiac Intensive Care Unit, Shanghai Childrens’ Medical Center Affiliated to Medical College, Shanghai Jiaotong University, Shanghai, 200127, P.R.China;
3. Institute of Congenital Heart Disease, Shanghai Children’s Medical Center Affiliated to Medical College, Shanghai Jiaotong University, Shanghai, 200127, P.R.China;

Corresponding author：

XU Zhiwei, Email: xuzhiwei@scmc.com.cn

Keywords：

Congenital tracheal stenosis; 3D printing; surgical operation; congenital heart disease

DOI：

10.7507/1007-4848.201607018

Video：

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Objective To assess the application value of 3-dimensional(3D) printing technology in surgical treatment for congenital tracheal stenosis. Methods We retrospectively analyzed the clinical data of preoperative diagnosis, intra-operative decision-making and postoperative follow-up of four children with congenital tracheal stenosis under the guidance of 3D printing in our hospital between February 2013 and May 2014. There were 3 males and 1 female aged 23.0±7.1 months. Among them, two children were with pulmonary artery sling, one with ventricular septal defect, and the other one with tetralogy of Fallot. The airway stenosis was diagnosed preoperatively by chest CT scan and 3D printing tracheal models, and was confirmed by the help of bronchoscopy under anesthesia. During operation the associated cardiac malformation was corrected firstly under extracorporeal circulation followed by tracheal malformation remedy. The design and implementation of tracheal operation plans were guided by the shape and data from 3D printing trachea models. There were two patients with long segment of tracheal stenosis who received slide anastomosis. And the other two patients were characterized with tracheal bronchus, one of which combined ostial stenosis of right bronchial performed extensive slide anastomosis, and the other one performed end to end anastomosis. Results All the children’s preoperative 3D printing trachea models were in accord with bronchoscopy and intra-operative exploration results. Intra-operative bronchoscopy confirmed that all tracheal stenosis cured completely. All anastomotic stomas were of integrity, and all the luminals were fluent. There was no operative death or no serious complication. During 1-2 years follow-up, all patients breathed smoothly and their airways were of patency by postoperative 3D printing trachea model. Conclusion 3D printing can provide a good help to congenital tracheal stenosis in preoperative diagnosis, the design of operation plan, intra-operative decision-making and manipulation, which can improve the operation successful rate of tracheal stenosis.

Citation： WANG Hao, ZHANG Hengyi, WANG Shunmin, LU Zhaohui, ZHU Limin, FU Wei, LIU Jinlong, XU Zhiwei. Application of 3D printing in the diagnosis and surgical treatment of congenital tracheal stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(3): 169-174. doi: 10.7507/1007-4848.201607018 Copy

1.	薛邦德, 徐志伟, 梁蓓蓓, 等. 婴幼儿先天性气管狭窄合并先天性心脏病一期手术纠治. 中国现代手术学杂志, 2013, 17(3): 199-202.
2.	徐志伟, 王顺民, 陆兆辉, 等. “Slide”方法在小儿先天性气管狭窄的应用. 中华小儿外科杂志, 2011, 32(3): 6-9.
3.	Auchincloss HG, Wright CD. Complications after tracheal resection and reconstruction: prevention and treatment. J Thorac Dis, 2016, 8(Suppl 2): S160-S167.
4.	Hofferberth SC, Watters K, Rahbar R, et al. Evolution of surgical approaches in the management of congenital tracheal stenosis: single-center experience. World J Pediatr Congenit Heart Surg, 2016, 7(1): 16-24.
5.	Giannetti S, Bizzotto N, Stancati A, et al. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing. Injury, 2016, 1383(16): 30753-30757.
6.	Burdall OC, Makin E, Davenport M, et al. 3D printing to simulate laparoscopic choledochal surgery. J Pediatr Surg, 2016, 51(5): 828-831.
7.	花中东, 杨新令, 刘凯飏, 等. 应用 3D 打印技术改进远离型右室双出口的外科治疗结果. 中国胸心血管外科临床杂志, 2016, 2(6): 532-536.
8.	Ryan J, Gregg C, Frakes D, et al. Three-dimensional printing: changing clinical care or just a passing fad? Curr Opin Cardiol, 2017, 32(1): 86-92.
9.	徐志伟, 张海波, 王顺明, 等. 婴幼儿先天性气管狭窄伴复杂先心病的I期纠治. 中华小儿外科杂志, 2003, 24(1): 15-17.
10.	Chung SR, Yang JH, Jun TG, et al. Clinical outcomes of slide tracheoplasty in congenital tracheal stenosis. Eur J Cardiothorac Surg, 2015, 47(3): 537-542.
11.	Pfammatter JP, Casaulta C, Pavlovic M, et al. Important excess morbidity due to upper airway anomalies in the perioperative course in infant cardiac surgery. Ann Thorac Surg, 2006, 81(3): 1008-1012.
12.	Herrera P, Caldarone C, Forte V, et al. The current state of congenital tracheal stenosis. Pediatr Surg Int, 2007, 23(11): 1033-1044.
13.	Xue BD, Liang BB, Wang SM, et al. One-stage surgical correction of congenital tracheal stenosis complicated with congenital heart disease in infants and young children. J Card Surg, 2015, 30(1): 97-103.
14.	Hofferberth SC, Watters K, Rahbar R, et al. Management of congenital tracheal stenosis. Pediatrics, 2015, 136(3): e660-e669.
15.	Chiu PP, Kim PC. Prognostic factors in the surgical treatment of congenital tracheal stenosis: a multicenter analysis of the literature. J Pediatr Surg, 2006, 41(1): 221-225.
16.	Huang SC, Wu ET, Wang CC. Management of long-segment tracheal stenosis: a continuing surgical challenge. Eur J Cardiothorac Surg, 2015, 47(1): 153.
17.	Butler CR, Speggiorin S, Rijnberg FM, et al. Outcomes of slide tracheoplasty in 101 children: a 17-year single-center experience. J Thorac Cardiovasc Surg, 2014, 147(6): 1783-1789.
18.	Antón-Pacheco JL, Comas JV, Luna C, et al. Treatment strategies in the management of severe complications following slide tracheoplasty in children. Eur J Cardiothorac Surg, 2014, 46(2): 280-285.
19.	Dawood A, Marti B, Sauret-Jackson V, et al. 3D printing in dentistry. Br Dent J, 2015, 219(11): 521-529.
20.	Han X, Bibb R, Harris R. Engineering design of artificial vascular junctions for 3D printing. Biofabrication, 2016, 8(2): 025018.
21.	Qiao F, Li D, Jin Z, et al. A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures. Int Orthop, 2016, 40(4): 835-841.

1. 薛邦德, 徐志伟, 梁蓓蓓, 等. 婴幼儿先天性气管狭窄合并先天性心脏病一期手术纠治. 中国现代手术学杂志, 2013, 17(3): 199-202.
2. 徐志伟, 王顺民, 陆兆辉, 等. “Slide”方法在小儿先天性气管狭窄的应用. 中华小儿外科杂志, 2011, 32(3): 6-9.
3. Auchincloss HG, Wright CD. Complications after tracheal resection and reconstruction: prevention and treatment. J Thorac Dis, 2016, 8(Suppl 2): S160-S167.
4. Hofferberth SC, Watters K, Rahbar R, et al. Evolution of surgical approaches in the management of congenital tracheal stenosis: single-center experience. World J Pediatr Congenit Heart Surg, 2016, 7(1): 16-24.
5. Giannetti S, Bizzotto N, Stancati A, et al. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing. Injury, 2016, 1383(16): 30753-30757.
6. Burdall OC, Makin E, Davenport M, et al. 3D printing to simulate laparoscopic choledochal surgery. J Pediatr Surg, 2016, 51(5): 828-831.
7. 花中东, 杨新令, 刘凯飏, 等. 应用 3D 打印技术改进远离型右室双出口的外科治疗结果. 中国胸心血管外科临床杂志, 2016, 2(6): 532-536.
8. Ryan J, Gregg C, Frakes D, et al. Three-dimensional printing: changing clinical care or just a passing fad? Curr Opin Cardiol, 2017, 32(1): 86-92.
9. 徐志伟, 张海波, 王顺明, 等. 婴幼儿先天性气管狭窄伴复杂先心病的I期纠治. 中华小儿外科杂志, 2003, 24(1): 15-17.
10. Chung SR, Yang JH, Jun TG, et al. Clinical outcomes of slide tracheoplasty in congenital tracheal stenosis. Eur J Cardiothorac Surg, 2015, 47(3): 537-542.
11. Pfammatter JP, Casaulta C, Pavlovic M, et al. Important excess morbidity due to upper airway anomalies in the perioperative course in infant cardiac surgery. Ann Thorac Surg, 2006, 81(3): 1008-1012.
12. Herrera P, Caldarone C, Forte V, et al. The current state of congenital tracheal stenosis. Pediatr Surg Int, 2007, 23(11): 1033-1044.
13. Xue BD, Liang BB, Wang SM, et al. One-stage surgical correction of congenital tracheal stenosis complicated with congenital heart disease in infants and young children. J Card Surg, 2015, 30(1): 97-103.
14. Hofferberth SC, Watters K, Rahbar R, et al. Management of congenital tracheal stenosis. Pediatrics, 2015, 136(3): e660-e669.
15. Chiu PP, Kim PC. Prognostic factors in the surgical treatment of congenital tracheal stenosis: a multicenter analysis of the literature. J Pediatr Surg, 2006, 41(1): 221-225.
16. Huang SC, Wu ET, Wang CC. Management of long-segment tracheal stenosis: a continuing surgical challenge. Eur J Cardiothorac Surg, 2015, 47(1): 153.
17. Butler CR, Speggiorin S, Rijnberg FM, et al. Outcomes of slide tracheoplasty in 101 children: a 17-year single-center experience. J Thorac Cardiovasc Surg, 2014, 147(6): 1783-1789.
18. Antón-Pacheco JL, Comas JV, Luna C, et al. Treatment strategies in the management of severe complications following slide tracheoplasty in children. Eur J Cardiothorac Surg, 2014, 46(2): 280-285.
19. Dawood A, Marti B, Sauret-Jackson V, et al. 3D printing in dentistry. Br Dent J, 2015, 219(11): 521-529.
20. Han X, Bibb R, Harris R. Engineering design of artificial vascular junctions for 3D printing. Biofabrication, 2016, 8(2): 025018.
21. Qiao F, Li D, Jin Z, et al. A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures. Int Orthop, 2016, 40(4): 835-841.

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