Pediatric Cardiology

, Volume 38, Issue 1, pp 103–114 | Cite as

Utility and Scope of Rapid Prototyping in Patients with Complex Muscular Ventricular Septal Defects or Double-Outlet Right Ventricle: Does it Alter Management Decisions?

  • Puneet BhatlaEmail author
  • Justin T. Tretter
  • Achi Ludomirsky
  • Michael Argilla
  • Larry A. LatsonJr.
  • Sujata Chakravarti
  • Piers C. Barker
  • Shi-Joon Yoo
  • Doff B. McElhinney
  • Nicole Wake
  • Ralph S. Mosca
Original Article


Rapid prototyping facilitates comprehension of complex cardiac anatomy. However, determining when this additional information proves instrumental in patient management remains a challenge. We describe our experience with patient-specific anatomic models created using rapid prototyping from various imaging modalities, suggesting their utility in surgical and interventional planning in congenital heart disease (CHD). Virtual and physical 3-dimensional (3D) models were generated from CT or MRI data, using commercially available software for patients with complex muscular ventricular septal defects (CMVSD) and double-outlet right ventricle (DORV). Six patients with complex anatomy and uncertainty of the optimal management strategy were included in this study. The models were subsequently used to guide management decisions, and the outcomes reviewed. 3D models clearly demonstrated the complex intra-cardiac anatomy in all six patients and were utilized to guide management decisions. In the three patients with CMVSD, one underwent successful endovascular device closure following a prior failed attempt at transcatheter closure, and the other two underwent successful primary surgical closure with the aid of 3D models. In all three cases of DORV, the models provided better anatomic delineation and additional information that altered or confirmed the surgical plan. Patient-specific 3D heart models show promise in accurately defining intra-cardiac anatomy in CHD, specifically CMVSD and DORV. We believe these models improve understanding of the complex anatomical spatial relationships in these defects and provide additional insight for pre/intra-interventional management and surgical planning.


Congenital heart disease Ventricular septal defect Double-outlet right ventricle Magnetic resonance imaging Computed tomography 3D printing Rapid prototyping 


Compliance with ethical standards

Conflict of interest



  1. 1.
    Spaeth JP (2014) Perioperative management of DORV. Semin Cardiothorac Vasc Anesth 18:281–289CrossRefPubMedGoogle Scholar
  2. 2.
    Kang SL, Tometzki A, Caputo M, Morgan G, Parry A, Martin R (2015) Longer-term outcome of perventricular device closure of muscular ventricular septal defects in children. Catheter Cardiovasc Interv 85:998–1005CrossRefPubMedGoogle Scholar
  3. 3.
    Prakash A, Powell AJ, Geva T (2010) Multimodality noninvasive imaging for assessment of congenital heart disease. Circ Cardiovasc Imaging 3:112–125CrossRefPubMedGoogle Scholar
  4. 4.
    Chan FP (2009) MR and CT imaging of the pediatric patient with structural heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 12:99–105CrossRefGoogle Scholar
  5. 5.
    Farooqi KM, Uppu SC, Nguyen K, Srivastava S, Ko HH, Choueiter N, Wollstein A, Parness IA, Narula J, Sanz J, Nielsen JC (2015) Application of virtual three-dimensional models for simultaneous visualization of intracardiac anatomic relationships in double outlet right ventricle. Pediatr Cardiol 9:1–9Google Scholar
  6. 6.
    Minns RJ, Bibb R, Banks R, Sutton RA (2003) The use of a reconstructed three-dimensional solid model from CT to aid the surgical management of a total knee arthroplasty: a case study. Med Eng Phys 25:523–526CrossRefPubMedGoogle Scholar
  7. 7.
    Heissler E, Fischer FS, Bolouri S, Lehmann T, Mathar W, Gebhardt A, Lanksch W, Bier J (2005) Custom-made cast titanium implants produced with CAD/CAM for the reconstruction of cranium defects. Int J Oral Maxillofac Surg 63:1006–1015CrossRefGoogle Scholar
  8. 8.
    Winder J, Bibb R (2005) Medical rapid prototyping technologies: state of the art and current limitations for application in oral and maxillofacial surgery. J Oral Maxillofac Surg 63:1006–1015CrossRefPubMedGoogle Scholar
  9. 9.
    Ma XJ, Tao L, Chen X, Li W, Peng ZY, Chen Y, Jin J, Zhang XL, Xiong QF, Zhong ZL, Chen XF (2015) Clinical application of three-dimensional reconstruction and rapid prototyping technology of multislice spiral computed tomography angiography for the repair of ventricular septal defect of tetralogy of Fallot. Genet Mol Res 14:1301–1309CrossRefPubMedGoogle Scholar
  10. 10.
    Mottl-Link S, Boettger T, Krueger JJ, Rietdorf U, Schnackenburg B, Ewert P, Berger F, Nagel E, Meinzer HP, Juraszek A, Kuehne T, Wolf I (2005) Images in cardiovascular medicine. Cast of complex congenital heart malformation in a living patient. Circulation 112:e356–e357CrossRefPubMedGoogle Scholar
  11. 11.
    Farooqi KM, Nielsen JC, Uppu SC, Srivastava S, Parness IA, Sanz J, Nguyen K (2015) Use of 3-dimensional printing to demonstrate complex intracardiac relationships in double-outlet right ventricle for surgical planning. Circ Cardiovasc Imaging 8:5CrossRefGoogle Scholar
  12. 12.
    Yasui H, Kado H, Nakano E, Yonenaga K, Mitani A, Tomita Y, Iwao H, Yoshii K, Mizoguch Y, Sunagawa H (1987) Primary repair of interrupted aortic arch and severe aortic stenosis in neonates. J Thorac Cardiovasc Surg 93:539–545PubMedGoogle Scholar
  13. 13.
    Damus PS (1975) Correspondence. Ann Thorac Surg 20:724–725CrossRefGoogle Scholar
  14. 14.
    Kaye MP (1975) Anatomic correction of transposition of great arteries. May Clin Proc 50:638–640Google Scholar
  15. 15.
    Stansel HC (1975) A new operation for D-loop transposition of the great vessels. Ann Thorac Surg 19:565–567CrossRefPubMedGoogle Scholar
  16. 16.
    Biglino G, Verschueren P, Zegels R, Taylor AM, Schievano S (2013) Rapid prototyping compliant arterial phantoms for in-vitro studies and device testing. J Cardiovasc Magn Reson 15:2CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Dankowski R, Baszko A, Sutherland M, Firek L, Kalmucki P, Wróblewska K, Szyszka A, Groothuis A, Siminiak T (2014) 3D heart model printing for preparation of percutaneous structural interventions: description of the technology and case report. Kardiol Pol 72:546–551CrossRefPubMedGoogle Scholar
  18. 18.
    Kalejs M, von Segesser LK (2009) Rapid prototyping of compliant human aortic roots for assessment of valved stents. Interact CardioVasc Thorac Surg 8:182–186CrossRefPubMedGoogle Scholar
  19. 19.
    Mottl-Link S, Hübler M, Kühne T, Rietdorf U, Krueger JJ, Schnackenburg B, De Simone R, Berger F, Juraszek A, Meinzer H, Karck M, Hetzer R, Wolf I (2008) Physical models aiding in complex congenital heart surgery. Ann Thorac Surg 86:273–277CrossRefPubMedGoogle Scholar
  20. 20.
    Olivieri L, Krieger A, Chen MY, Kim P, Kanter JP (2014) 3D heart model guides complex stent angioplasty of pulmonary venous baffle obstruction in a Mustard repair of D-TGA. Int J Cardiol 172:e297–e298CrossRefPubMedGoogle Scholar
  21. 21.
    Olivieri L, Krieger A, Loke Y, Nath DS, Kim PC, Sable CA (2015) Three-dimensional printing of intracardiac defects from three-dimensional echocardiographic images: feasibility and relative accuracy. J Am Soc Echocardiogr 28:392–397CrossRefPubMedGoogle Scholar
  22. 22.
    Riesenkampff E, Rietdorf U, Wolf I, Schnackenburg B, Ewert P, Huebler M, Alexi-Meskishvili V, Anderson RH, Engel N, Meinzer HP, Hetzer R, Berger F, Kuehne T (2009) The practical clinical value of three-dimensional models of complex congenitally malformed hearts. J Thorac Cardiovasc Surg 138:571–580CrossRefPubMedGoogle Scholar
  23. 23.
    Schievano S, Migliavacca F, Coats L, Khambadkone S, Carminati M, Wilson N, Deanfield JE, Bonhoeffer P, Taylor AM (2007) Percutaneous pulmonary valve implantation based on rapid prototyping of right ventricular outflow tract and pulmonary trunk from MR data. Radiology 242:490–497CrossRefPubMedGoogle Scholar
  24. 24.
    Sodian R, Weber S, Markert M, Rassoulian D, Kaczmarek I, Lueth TC, Reichart B, Daebritz S (2007) Stereolithographic models for surgical planning in congenital heart surgery. Ann Thorac Surg 83:1854–1857CrossRefPubMedGoogle Scholar
  25. 25.
    Valverde I, Gomez G, Suarez-Mejias C, Hosseinpour AR, Hazekamp M, Roest A, Vazquez-Jimenez JF, El-Rassi I, Uribe S, Gomez-Cia T (2015) 3D printed cardiovascular models for surgical planning in complex congenital heart diseases. J Cardiovasc Magn Reson 17(Suppl 1):P196CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Valverde I, Gomez G, Gonzalez A, Suarez-Mejias C, Adsuar A, Coserria JF, Uribe S, Gomez-Cia T, Hosseinpour AR (2015) Three-dimensional patient-specific cardiac model for surgical planning in Nikaidoh procedure. Cardiol Young 25:698–704CrossRefPubMedGoogle Scholar
  27. 27.
    Valverde I, Gomez G, Coserria JF, Suarez-Mejias C, Uribe S, Sotelo J, Velasco MN, Santos De Soto J, Hosseinpour AR, Gomez-Cia T (2015) 3D printed models for planning endovascular stenting in transverse aortic arch hypoplasia. Catheter Cardiovasc Interv 85:1006–1012CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Puneet Bhatla
    • 1
    • 2
    Email author
  • Justin T. Tretter
    • 1
  • Achi Ludomirsky
    • 1
  • Michael Argilla
    • 1
  • Larry A. LatsonJr.
    • 2
  • Sujata Chakravarti
    • 1
  • Piers C. Barker
    • 3
  • Shi-Joon Yoo
    • 4
  • Doff B. McElhinney
    • 1
    • 5
  • Nicole Wake
    • 6
  • Ralph S. Mosca
    • 7
  1. 1.Division of Pediatric CardiologyNew York University Langone Medical CenterNew YorkUSA
  2. 2.Department of RadiologyNew York University Langone Medical CenterNew YorkUSA
  3. 3.Division of Pediatric CardiologyDuke University Medical CenterDurhamUSA
  4. 4.Department of RadiologyThe Hospital of Sick ChildrenTorontoCanada
  5. 5.Lucille Packard Children’s Hospital Stanford Heart Center Clinical and Translational Research Program, Department of Cardiothoracic SurgeryStanford UniversityPalo AltoUSA
  6. 6.Department of Radiology, Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical ImagingNew York University Langone Medical CenterNew YorkUSA
  7. 7.Department of Cardiac SurgeryNew York University Langone Medical CenterNew YorkUSA

Personalised recommendations