Three-Dimensional Printing-Guided Precise Surgery for Complex Pulmonary Arteriovenous Malformation
Three-dimensional (3D) printing is a new modality which makes a true-to-life 3D model using sophisticated technology. The authors report its first use in a complex case of a large pulmonary arteriovenous (AV) malformation.
A 23-year-old patient presented with severe central cyanosis and clubbing. His echocardiogram was normal. A chest computed tomography (CT) and pulmonary angiogram revealed a large AV malformation. A repeat echocardiogram with injection of agitated saline into a peripheral vein showed appearance of the saline in the left ventricle. Since the CT showed a complex anatomy, a 3D print of the lesion was made. The print helped the authors in counseling the patient and his relatives, and in planning the operation. Plan A was for a device closure, and the hardware for this was ordered. Plan B was for open surgery. While waiting for the endovascular equipment to be obtained, the patient had hemoptysis, and so semiurgent open surgery was performed. A standard posterolateral thoracotomy was performed and a right lower lobectomy done.
The 3D print gave an excellent understanding of the lesion. Because of the 3D print, an accurate understanding of the intricate pathology allowed for a very precise surgery. A lower lobe resection was done.
3D printing is a useful modality for complex cardiac and vascular lesions. It adds to the armamentarium of the surgeon, and it helps allow for a precise and quick surgery. Its use is very likely to increase in the future.
Summary of Advantages
- Makes planning repair of a complex lesion much more precise.
- One can plan multiple operative approaches.
- Avoids emergency planning during operation and refines approach.
- Better preoperative counselling of patient and relatives.
- Good for training.
- Like a batting practice, allows for a trial run.
- Allows surgeon to see around corners.
- Allows surgeon to ‘see’ through blood.
- Reduced operative time, reduced cardiopulmonary bypass time in open heart procedures.
- Less chances of residual lesion.
- Less chances for reintervention.
- Assess hemodynamics by putting in a virtual valve, close a hole, etc.
- Luo H, Meyer-Szary J, Wang Z, Sabiniewicz R, Liu Y. Three-dimensional printing in cardiology: current applications and future challenges. Cardiol J. 2017;24(4):436-444.