Application of 3D printing technology in the personalized surgery of right ventricular double outlet_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DONG Zhu ^1,2 , ZHANG Ben ¹ , CAO Yiqiu ¹ , YANG Bo ¹ , LIU Ying ¹ , ZHENG Yanchun ¹ ,  WANG Xiaowu ^1,2

1. Department of Cardiovascular Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, P.R.China;
2. The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, P.R.China;

Corresponding author：

WANG Xiaowu, Email: 1062877572@qq.com

Keywords：

3D printing technology; right ventricular double outlet; personalized; surgery

DOI：

10.7507/1007-4848.202004016

Video：

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Objective To evaluate the clinical value of three-dimensional (3D) printing model in accurate and minimally invasive treatment of double outlet right ventricle (DORV).Methods From August 2018 to August 2019, 35 patients (22 males and 13 females) with DORV aged from 5 months to 17 years were included in the study. Their mean weight was 21.35±8.48 kg. Ten patients who received operations guided by 3D printing model were allocated to a 3D printing model group, and the other 25 patients who received operations without guidance by 3D printing model were allocated to a non-3D printing model group. Preoperative transthoracic echocardiography and CT angiography were performed to observe the location and diameter of ventricular septal defect (VSD), and to confirm the relationship between VSD and double arteries.Results The McGoon index of patients in the 3D printing model group was 1.91±0.70. There was no statistical difference in the size of VSD (13.20±4.57 mm vs. 13.40±5.04 mm, t=−0.612, P=0.555), diameter of the ascending aorta (17.10±2.92 mm vs. 16.90±3.51 mm, t=0.514, P=0.619) or diameter of pulmonary trunk (12.50±5.23 mm vs. 12.90±4.63 mm, t=−1.246, P=0.244) between CT and 3D printing model measurements. The Pearson correlation coefficients were 0.982, 0.943 and 0.975, respectively. The operation time, endotracheal intubation time, ICU stay time and hospital stay time in the 3D printing model group were all shorter than those in the non-3D printing model group (P<0.05).Conclusion The relationship between VSD and aorta and pulmonary artery can be observed from a 3D perspective by 3D printing technology, which can guide the preoperative surgical plans, assist physicians to make reasonable and effective decisions, shorten intraoperative exploration time and operation time, and decrease the surgery-related risks.

Citation： DONG Zhu, ZHANG Ben, CAO Yiqiu, YANG Bo, LIU Ying, ZHENG Yanchun, WANG Xiaowu. Application of 3D printing technology in the personalized surgery of right ventricular double outlet. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(4): 441-446. doi: 10.7507/1007-4848.202004016 Copy

1.	Oladunjoye O, Piekarski B, Baird C, et al. Repair of double outlet right ventricle: Midterm outcomes. J Thorac Cardiovasc Surg, 2020, 159(1): 254-264.
2.	Li S, Ma K, Hu S, et al. Biventricular repair for double outlet right ventricle with non-committed ventricular septal defect. Eur J Cardiothorac Surg, 2015, 48(4): 580-587.
3.	Bhatla P, Tretter JT, Chikkabyrappa S, et al. Surgical planning for a complex double-outlet right ventricle using 3D printing. Echocardiography, 2017, 34(5): 802-804.
4.	董柱, 刘莹, 曹一秋, 等. 3D打印技术在先天性心脏病个性化诊治中的应用. 实用医学杂志, 2018, 34(15): 2481-2484.
5.	徐佳俊, 舒强. 三维打印技术在先天性心脏病中的应用. 浙江大学学报(医学版), 2019, 48(5): 573-579.
6.	龚瑾, 张儒舫, 谢业伟, 等. Taussig-Bing 畸形合并主动脉弓病变的外科治疗. 中国心血管病研究, 2018, 16(9): 825-828.
7.	Bramlet M, Olivieri L, Farooqi K, et al. Impact of three-dimensional printing on the study and treatment of congenital heart disease. Circ Res, 2017, 120(6): 904-907.
8.	Shi JY, Glen SA. 3D printing in surgical management of double outlet right ventricle. Front Pediatr, 2018, 5: 289.
9.	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 Cardiothorac Surg, 2002, 21(6): 1042-1048.
10.	Zhou X, Vannan MA, Qian Z. 3D printing for trans-catheter aortic valve replacement: Integrating anatomy and physiology to plan, predict and optimize procedural outcomes. Int J Cardiol, 2018, 258: 334-335.
11.	Anwar S, Singh GK, Varughese J, et al. 3D printing in complex congenital heart disease: Across a spectrum of age, pathology, and imaging techniques. JACC Cardiovasc Imaging, 2017, 10(8): 953-956.
12.	Qian Z, Wang K, Liu S, et al. Quantitative prediction of paravalvular leak in transcatheter aortic valve replacement based on tissue-mimicking 3D printing. JACC Cardiovasc Imaging, 2017, 10(7): 719-731.
13.	Yim D, Dragulescu A, Ide H, et al. Essential modifiers of double outlet right ventricle: Revisit with endocardial surface images and 3-dimensional print models. Circ Cardiovasc Imaging, 2018, 11(3): e006891.
14.	董柱, 张本, 王晓武, 等. 3D打印技术在干下型室间隔缺损精准个性化微创治疗中的应用. 临床心血管病杂志, 2020, 36(2): 173-177.
15.	李林林, 于振坤, 樊红光, 等. 虚拟现实技术在心血管外科手术教学培训中的初步应用研究. 中国循环杂志, 2019, 34(3): 289-294.

1. Oladunjoye O, Piekarski B, Baird C, et al. Repair of double outlet right ventricle: Midterm outcomes. J Thorac Cardiovasc Surg, 2020, 159(1): 254-264.
2. Li S, Ma K, Hu S, et al. Biventricular repair for double outlet right ventricle with non-committed ventricular septal defect. Eur J Cardiothorac Surg, 2015, 48(4): 580-587.
3. Bhatla P, Tretter JT, Chikkabyrappa S, et al. Surgical planning for a complex double-outlet right ventricle using 3D printing. Echocardiography, 2017, 34(5): 802-804.
4. 董柱, 刘莹, 曹一秋, 等. 3D打印技术在先天性心脏病个性化诊治中的应用. 实用医学杂志, 2018, 34(15): 2481-2484.
5. 徐佳俊, 舒强. 三维打印技术在先天性心脏病中的应用. 浙江大学学报(医学版), 2019, 48(5): 573-579.
6. 龚瑾, 张儒舫, 谢业伟, 等. Taussig-Bing 畸形合并主动脉弓病变的外科治疗. 中国心血管病研究, 2018, 16(9): 825-828.
7. Bramlet M, Olivieri L, Farooqi K, et al. Impact of three-dimensional printing on the study and treatment of congenital heart disease. Circ Res, 2017, 120(6): 904-907.
8. Shi JY, Glen SA. 3D printing in surgical management of double outlet right ventricle. Front Pediatr, 2018, 5: 289.
9. 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 Cardiothorac Surg, 2002, 21(6): 1042-1048.
10. Zhou X, Vannan MA, Qian Z. 3D printing for trans-catheter aortic valve replacement: Integrating anatomy and physiology to plan, predict and optimize procedural outcomes. Int J Cardiol, 2018, 258: 334-335.
11. Anwar S, Singh GK, Varughese J, et al. 3D printing in complex congenital heart disease: Across a spectrum of age, pathology, and imaging techniques. JACC Cardiovasc Imaging, 2017, 10(8): 953-956.
12. Qian Z, Wang K, Liu S, et al. Quantitative prediction of paravalvular leak in transcatheter aortic valve replacement based on tissue-mimicking 3D printing. JACC Cardiovasc Imaging, 2017, 10(7): 719-731.
13. Yim D, Dragulescu A, Ide H, et al. Essential modifiers of double outlet right ventricle: Revisit with endocardial surface images and 3-dimensional print models. Circ Cardiovasc Imaging, 2018, 11(3): e006891.
14. 董柱, 张本, 王晓武, 等. 3D打印技术在干下型室间隔缺损精准个性化微创治疗中的应用. 临床心血管病杂志, 2020, 36(2): 173-177.
15. 李林林, 于振坤, 樊红光, 等. 虚拟现实技术在心血管外科手术教学培训中的初步应用研究. 中国循环杂志, 2019, 34(3): 289-294.

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Application of 3D printing technology in the personalized surgery of right ventricular double outlet

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