Three-Dimensional Printing-Guided Precise Surgery for Complex Pulmonary Arteriovenous Malformation

2018-11-26T18:44:58Z (GMT) by Harinder Singh Bedi
<p><strong>Introduction</strong></p><p>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.</p><p><strong>Case Summary</strong></p><p>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.</p><p><strong>Results</strong></p><p>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.</p><p><strong>Conclusion</strong></p><p>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.</p><p><strong>Summary of Advantages</strong></p><ol><li>Makes planning repair of a complex lesion much more precise.</li><li>One can plan multiple operative approaches.</li><li>Avoids emergency planning during operation and refines approach.</li><li>Better preoperative counselling of patient and relatives.</li><li>Good for training.</li><li>Like a batting practice, allows for a trial run.</li><li>Allows surgeon to see around corners.</li><li>Allows surgeon to ‘see’ through blood.</li><li>Reduced operative time, reduced cardiopulmonary bypass time in open heart procedures.</li><li>Less chances of residual lesion.</li><li>Less chances for reintervention.</li><li>Assess hemodynamics by putting in a virtual valve, close a hole, etc.</li></ol><p><strong>Suggested Reading</strong></p><ol><li>Luo H, Meyer-Szary J, Wang Z, Sabiniewicz R, Liu Y. Three-dimensional printing in cardiology: current applications and future challenges. <em><a href="https://doi.org/10.5603/CJ.a2017.0056">Cardiol J. 2017;24(4):436-444</a></em>.</li></ol> <p></p>

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