Congenital heart disease with and without 3D models: What could have been different?
Dr. Jesús Garcia Pinzás
Instituto del Corazón (INCOR) - Jesús María, Perú
✔ Increased detail of the anatomy
✔ Accurate measurement of the ventricular septal defect.
✔ Surgical plan design and preoperative decision-making
✔ Increased safety
✔ Reduced procedure time
2 year old female child diagnosed with double outlet right ventricle.
On follow-up monitoring, the patient showed signs and symptoms of hypoxaemia: agitation, cyanosis, tiredness on feeding, with an oxygen saturation of 70%.
Ultrasound and CT images corroborate the anomalous anatomy and show abnormal flows through the large ventricular septal defect and through the outlets of the great vessels. In addition, they show severe pulmonary stenosis with hypoplasia of the pulmonary annulus.
Surgical plan without biomodel and results in the operating room
Due to the complexity of the clinical case, it was discussed within a medical board of surgery to evaluate the best strategy to address the patient's pathology. Based on the discussion, it was decided to perform an initial biventricular corrective treatment with the possibility of placing a valved prosthesis from the right ventricle to the pulmonary artery.
Due to intraoperative findings, the surgical team decided to change the original plan. Thus, the new approach for the patient consisted of a univentricular management treatment with Glenn surgery being performed at that time, completed with a future and pending Fontan surgery. Leaving the aorta exiting from the right ventricle and keeping the ventricular septal defect intact.
What would have changed if the surgical team had had a 3D model for planning?
3D models allow for a more detailed dimensioning of the abnormal structures and the relationships between them and healthy structures. Hence, in cases such as congenital heart disease, where 2D images leave some uncertainty, biomodels play a fundamental role.
Dr Pinzás, with his knowledge of 3D technology, some time after the patient's surgery, was able to obtain a 3D reconstruction of the pathology.
Reflecting on the case, he believes that having a biomodel prior to surgery would have helped to make a more accurate and appropriate planning for the patient. With the 3D model, they could have seen the exact size of the ventricular septal defect and preoperatively decided not to close it, thus avoiding the decision to change the original surgical plan in the operating room. Or it might even have allowed them to consider another treatment technique. Consequently, this would also have had an impact on reducing surgery time.
3D planning allows decisions to be made with greater certainty, giving peace of mind to the surgical team and patients. This has been demonstrated in a scientific study (I. Valverde et al. 2017) showing that in 19 out of 40 cases 3D models changed the surgical decision of the patients to be treated. Making clear the importance of a thorough understanding of the case prior to surgery and that this increases the likelihood of success and getting the right treatment for each person.
You may be interested in: "3D technology for decision making in complex congenital heart disease", a case by Dr. Norberto Berber where 3D models were very useful to evaluate the possibilities of two patients with complex clinical cases.