Use of 3-dimensional printing to demonstrate complex intracardiac relationships in double-outlet right ventricle for surgical planning.

D ouble-outlet right ventricle falls under the category of congenital heart disease known as conotruncal defects, which possess abnormal ventriculoarterial relationships. 1 For complex cases, the surgeon must determine whether the left ventricle and one of the great arteries can be aligned using the ventricular septal defect to construct an unobstructed pathway or baffle, resulting in a 2-ventricle repair. 2 Creation of the baffle can be complicated by anatomic obstructions because of prominent conal septum, straddling atrioventricular valve attachments, or location of the ventricular septal defect in the inlet septum, remote from any great artery. Three-dimensional (3D) printing has been applied in the management of many different congenital heart diseases. 3 In this specific patient population, in whom communicating the complex intracardiac anatomy to the surgeon is so critical, the use of 3D modeling and printing is invaluable. We used this approach in a patient with dextrocardia, complex double-outlet right ventricle (S,L,A) 1 and supratricuspid ring. She underwent pulmonary artery banding in infancy and had been doing relatively well clinically; so that any further surgical intervention was deferred until she was 8 years old. Although she was growing well and required no medication, she had some dyspnea on exertion and had become progressively more desaturated with oxygen saturations in the low 80s. The patient underwent a cardiac MRI to better outline the anatomy (Figure 1). The 3D balanced steady state free pre-cession images were used to create a 3D virtual model that allowed visualization of the intracardiac anatomy (Figure 2, left). The 3D stereolithography file was then printed (Projet 3500 HD Max; 3D systems, Rock Hill, SC) to create a physical model that allowed clear delineation of potential baffle pathways (Figure 2, right). The aorta, which was anterior to the pulmonary artery in this patient, was relatively far removed from the left ventricle, and the ventricular septal defect was subpulmonary. After assessment of the 3D intra-cardiac anatomy, it was decided that the patient would have a double-switch procedure. The right atrium was baffled to the right ventricle (left-sided), and the left ventricle (right-sided) was baffled, via the ventricular septal defect, to the pulmonary artery. An arterial switch was then performed to direct the deoxygenated blood to the pulmonary artery and the oxy-genated blood to the aorta. There was an excellent correlation between the 3D model and the actual anatomy. She is doing well clinically 6 months post procedure. There are …