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Correcting transposition of the great arteries with the help of a patient-specific anatomical 3D model

Case Study
  • Cardiology

Case

Dr. Nicola Viola is a Cardiac Pediatric Surgeon at University Hospital Southampton NHS Foundation Trust. In one of his recent transposition of the great arteries cases, surgical planning proved challenging due to the size of the patient’s heart.

The patient presented with transposition of the great arteries with stenosis of the pulmonary artery, where the aorta was connected to the right ventricle and the pulmonary artery was connected to the left ventricle. In addition, the pulmonary valve was too small for systemic circulation. As a result, they could not perform an arterial switch operation, which is the usual procedure for these kinds of cases.

An additional challenge was the size and weight of the patient. In the majority of these cases, doctors wait to operate until the child weighs around ten to twelve kilograms. However, the child’s condition was too pressing, so they had to perform the surgery with the child weighing around four and a half kilograms.

Benefits of the 3D model

To gain full visibility of the heart’s structure, Dr. Viola had a 1:1 scale 3D anatomical model created specific to the patient’s anatomy. The model gave a direct and precise representation of the external and internal structures of the heart and was printed with detachable windows that allowed the surgeon to look inside the heart and see the exact relation between the main arteries and ventricles. This allowed Dr. Viola to define the precise location to place the patch.

“In general, every cardiac operation that is supported by 3D technology is an operation that is planned and conceived in a natural condition.”

- Dr. Nicola Viola

The surgical team was also able to recognize the connection between the pulmonary artery and the left ventricle, which prompted the decision to eliminate the pulmonary valve but still use the pulmonary artery to reconstruct the new connection.

Thanks to the optimized pre-operative planning, the time in theater could be cut significantly. Actions that are normally performed during the surgery, like shot sizing and shaping the patch, were already done in advance. The 3D model reassured the correct measuring of the patch, which again saved operating time and led to a successful repair.

Limitations of 2D images

“Before the introduction of 3D modeling, all the planning, designing and executing of a complex cardiac repair had to be done in theater, during the operation. The 3D model allows us to plan the operation on a heart that is in the same condition as the working heart. This gives us a one-to-one representation of the anatomy and the function of the heart at the time of the planning that is easily transferable during the operation.”

- Dr. Nicola Viola

Watch the full video above to learn more about this complex case.

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