Skip to main content
SpringerLink
Log in

3D Printing Provides a Precise Approach in the Treatment of Tetralogy of Fallot, Pulmonary Atresia with Major Aortopulmonary Collateral Arteries

  • Pediatric and Congenital Heart Disease (G Singh, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Patients with tetralogy of Fallot, pulmonary atresia, and multiple aortopulmonary collateral arteries (Tet PA MAPCAs) have a wide spectrum of anatomy and disease severity. Management of these patients can be challenging and often require multiple high-risk surgical and interventional catheterization procedures. These interventions are made challenging by complex anatomy that require the proceduralist to mentally reconstruct three-dimensional anatomic relationships from two-dimensional images. Three-dimensional (3D) printing is an emerging medical technology that provides added benefits in the management of patients with Tet PA MAPCAs. When used in combination with current diagnostic modalities and procedures, 3D printing provides a precise approach to the management of these challenging, high-risk patients. Specifically, 3D printing enables detailed surgical and interventional planning prior to the procedure, which may improve procedural outcomes, decrease complications, and reduce procedure-related radiation dose and contrast load.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Jonas RA. Chapter 25: Tetralogy of Fallot with pulmonary atresia. Comprehensive Surgical Management of Congenital Heart Disease. 2004. pp 440–56.

  2. Anwar S, Qureshi AM, Arruda J, Bolen MA. Pulmonary atresia with aortopulmonary and coronary artery collaterals. JACC Elsevier Inc. 2012;59:90.

    Google Scholar 

  3. Liao PK, Edwards WD, Julsrud PR, Puga FJ, Danielson GK, Feldt RH. Pulmonary blood supply in patients with pulmonary atresia and ventricular septal defect. JACC. 1985;6(6):1343–50. https://doi.org/10.1016/S0735-1097(85)80223-0.

    Article  CAS  PubMed  Google Scholar 

  4. Roche SL, Greenway SC, Reddington AN. Tetralogy of Fallot with pulmonary stenosis, pulmonary atresia, and absent pulmonary valve. Moss & Adams’ heart disease in infants, children, and adolescents, including the fetus and young adult. 2017. Chapter 41, 9th edn, pp 1–49.

  5. Nelson JS, Bove EL, Hirsch-Romano JC. Tetralogy of Fallot. Pediatric and congenital cardiology, cardiac surgery and intensive care [Internet]. 3rd ed. London: Springer London; 2014. p. 1505–26. Available from: http://link.springer.com/10.1007/978-1-4471-4619-3_18

    Book  Google Scholar 

  6. • Bauser-Heaton H, Borquez A, Han B, Ladd M, Asija R, Downey L, et al. Programmatic approach to management of tetralogy of Fallot with major aortopulmonary collateral arteries: A 15-year experience with 458 patients. Circ Cardiovasc Interv. 2017;10. A 15-year experience from a single institution on early complete unifocalization and repair with incorporation of all pulmonary vascular supply.

  7. Asija R, Koth AM, Velasquez N, Chan FP, Perry SB, Hanley FL, et al. Postoperative outcomes of children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals undergoing reconstruction of occluded pulmonary artery branches. Ann Thorac Surg. 2016;101(6):2329–34. https://doi.org/10.1016/j.athoracsur.2015.12.049.

    Article  PubMed  Google Scholar 

  8. Loomba RS, Buelow MW, Woods RK. Complete repair of tetralogy of Fallot in the neonatal versus non-neonatal period: a meta-analysis. Pediatr Cardiol Springer US. 2017;38(5):893–901. https://doi.org/10.1007/s00246-017-1579-8.

    Article  Google Scholar 

  9. Liava'a M, Brizard CP, Konstantinov IE, Robertson T, Cheung MM, Weintraub R, et al. Pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals: neonatal pulmonary artery rehabilitation without unifocalization. ATS Elsevier. 2012;93:185–91.

    Google Scholar 

  10. Watanabe N, Mainwaring RD, Reddy VM, Palmon M, Hanley FL. Early complete repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. Ann Thorac Surg. 2014;97(3):909–15–discussion 914–5. https://doi.org/10.1016/j.athoracsur.2013.10.115.

    Article  PubMed  Google Scholar 

  11. Fouilloux V, Bonello B, Kammache I, Fraisse A, Macé L, Kreitmann B. Management of patients with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries and major aorto-pulmonary collaterals: focus on the strategy of rehabilitation of the native pulmonary arteries. Arch Cardiovasc Dis. 2012;105(12):666–75. https://doi.org/10.1016/j.acvd.2012.08.003.

    Article  PubMed  Google Scholar 

  12. Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. BioMedical Engineering OnLine. BioMed Central; 2016; 1–21.

  13. Byrne N, Velasco Forte M, Tandon A, Valverde I, Hussain T. A systematic review of image segmentation methodology, used in the additive manufacture of patient-specific 3D printed models of the cardiovascular system. JRSM Cardiovasc Dis. 2016;5:1–9.

    CAS  Google Scholar 

  14. • Vukicevic M, Mosadegh B, Min JK, Little SH. Cardiac 3D printing and its future directions. J Am Coll Cardiol Img. 2017;10(2):171–84. https://doi.org/10.1016/j.jcmg.2016.12.001. Review of cardiac 3D printing applications in structural heart disease.

    Article  Google Scholar 

  15. Maragiannis D, Jackson MS, Igo SR, Schutt RC, Connell P, Grande-Allen J, et al. Replicating patient-specific severe aortic valve stenosis with functional 3D modeling. Circ Cardiovasc Imaging. 2015;8:e003626.

    Article  PubMed  Google Scholar 

  16. • Farooqi KM. In: Farooqi KM, editor. Rapid prototyping in cardiac disease. 1st ed. Cham: Springer International Publishing; 2017. Textbook on the applications of cardiac 3D printing, with focus on congenital heart disease.

    Chapter  Google Scholar 

  17. Anwar S, Singh GK, Varughese J, Nguyen H, Billadello JJ, Sheybani EF, et al. 3D printing in complex congenital heart disease: across a spectrum of age, pathology, and imaging techniques. JACC: Cardiovasc Imaging. 2016.

  18. Yoo S-J, Thabit O, Kim EK, Ide H, Yim D, Dragulescu A, et al. 3D printing in medicine of congenital heart diseases. 3D Printing in Medicine; 2016;2:1–12.

  19. Meineri M, Hiansen JQ, Horlick EM. Structural and congenital heart disease interventions: the role of three-dimensional printing. Neth Heart J Bohn Stafleu van Loghum. 2017;25:1–11.

    Article  Google Scholar 

  20. • Anwar S, Singh GH, Miller J, Sharma M, Manning P, Billadello JJ, et al. 3D printing is a transformative technology in congenital heart disease. JACC: Basic Transl Sci. In Press. State-of-the-art review of 3D printing in congenital heart disease.

  21. Ngan EM, Rebeyka IM, Ross DB, Hirji M, Wolfaardt JF, Seelaus R, et al. The rapid prototyping of anatomic models in pulmonary atresia. J Thorac Cardiovasc Surg. 2006;132(2):264–9. https://doi.org/10.1016/j.jtcvs.2006.02.047.

    Article  PubMed  Google Scholar 

  22. Ryan JR, Moe TG, Richardson R, Frakes DH, Nigro JJ, Pophal S. A novel approach to neonatal management of tetralogy of Fallot, with pulmonary atresia, and multiple aortopulmonary collaterals. J Am Coll Cardiol Img. 2015;8(1):103–4. https://doi.org/10.1016/j.jcmg.2014.04.030.

    Article  Google Scholar 

  23. Giannopoulos AA, Mitsouras D, Yoo S-J, Liu PP, Chatzizisis YS, Rybicki FJ. Applications of 3D printing in cardiovascular diseases. Nat Publ Group. 2016;13:701–18.

    CAS  Google Scholar 

  24. Olivieri LJ, Krieger A, Loke Y-H, Nath DS, Kim PCW, Sable CA. Three-dimensional printing of intracardiac defects from three-dimensional echocardiographic images: feasibility and relative accuracy. J Am Soc Echocardiogr. 2015;28(4):392–7. https://doi.org/10.1016/j.echo.2014.12.016.

    Article  PubMed  Google Scholar 

  25. Mashari A, Montealegre-Gallegos M, Knio Z, Yeh L, Jeganathan J, Matyal R, et al. Making three-dimensional echocardiography more tangible: a workflow for three-dimensional printing with echocardiographic data. Echo Res Pract. 2017;3:R57–64.

    Article  Google Scholar 

  26. Muraru D, Veronesi F, Maddalozzo A, Dequal D, Frajhof L, Rabischoffsky A, et al. 3D printing of normal and pathologic tricuspid valves from transthoracic 3D echocardiography data sets. Eur Heart J Cardiovasc Imaging. 2016; jew215–7.

  27. Meinel FG, Huda W, Schoepf UJ, Rao AG, Cho YJ, Baker GH, et al. Diagnostic accuracy of CT angiography in infants with tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. JCCT. 2013;7:367–75.

    Google Scholar 

  28. Jacobs CA, Lin AY. A new classification of three-dimensional printing technologies: systematic review of three-dimensional printing for patient-specific craniomaxillofacial surgery. Plast Reconstr Surg. 2017;139(5):1211–20. https://doi.org/10.1097/PRS.0000000000003232.

    Article  CAS  PubMed  Google Scholar 

  29. Zweifel DF, Simon C, Hoarau R, Pasche P, Broome M. Are virtual planning and guided surgery for head and neck reconstruction economically viable? J Oral Maxillofac Surg. 2015;73(1):170–5. https://doi.org/10.1016/j.joms.2014.07.038.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge Benjamin Johnson and Joseph Fullerton at 3D Systems—Healthcare as collaborators in the creation of the 3D models from Washington University School of Medicine. We also thank Dr. Geetika Khanna, Chief of Pediatric Radiology at Washington University School of Medicine for her expert consultation on some of the cases.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, St. Louis Children’s Hospital, Washington University School of Medicine, Washington University in St. Louis, One Children’s Place, Campus Box 8116 – NWT, St. Louis, MO, 63110, USA

    Shafkat Anwar MD & Toby Rockefeller MD

  2. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA

    Demetrios A. Raptis MD & Pamela K. Woodard MD

  3. Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Pirooz Eghtesady MD, PhD

Authors
  1. Shafkat Anwar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toby Rockefeller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Demetrios A. Raptis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pamela K. Woodard MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pirooz Eghtesady MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shafkat Anwar MD.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pediatric and Congenital Heart Disease

Electronic supplementary material

ESM 1

(MP4 20995 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anwar, S., Rockefeller, T., Raptis, D.A. et al. 3D Printing Provides a Precise Approach in the Treatment of Tetralogy of Fallot, Pulmonary Atresia with Major Aortopulmonary Collateral Arteries. Curr Treat Options Cardio Med 20, 5 (2018). https://doi.org/10.1007/s11936-018-0594-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-018-0594-2

Keywords

Search

Navigation