The Role of 3D-Printing in a Case of Complex Congenital Heart Disease Undergoing Heart Transplantation

IntroductionPatients with complex congenital heart disease (CHD) who undergo orthotopic heart transplantation (OHT) present technical difficulties due to collateral vessels, unusual anatomy and adhesions. Becoming familiar with the specific anatomy of each individual case prior to surgery is therefore crucial for the surgeon, and all available diagnostic methods should be used before embarking on the procedure. 3D-printing technology may play a pivotal role, as in this case report.Case ReportA 36-year-old male was listed for OHT in the context of a complex cyanotic CHD consisting of a functional univentricular heart with hypoplasia of the right chambers with tricuspid and pulmonary atresia and an intact ventricular septum, palliated by a right Blalock-Taussig (BT) shunt at the age of 2, a left BT shunt at the age of 6 which was stented in the follow-up, and a bidirectional Glenn shunt when he was 21 years old. To depict this complex anatomy and its spatial relationships, a 3D model was printed and used by the surgical team to enhance their understanding of the patient anatomy and reenact the planned surgery beforehand, enabling the team to predict and avoid possible complications during the act (Figure). In March 2021, the patient underwent elective OHT. During the surgery, multiple MAPCAs were ligated due to diffuse bleeding. The left pulmonary artery (PA) ostial stenosis was resected and then distally anastomosed. In addition, an end-to-end anastomosis of the right PA to the right AP of the recipient was performed, proximal to the Glenn anastomosis, which was repaired with a pericardial patch. Ischemia and CBP time were 245 and 253 minutes. The postoperative course was uneventful with no evidence of bleeding complications.Summary3D-printing should be taken into consideration as a tool for planning surgical interventions in patients with complex CHD listed for OHT. The information provided may be useful to avoid improvisation during the procedure and thus, lead to a decrease in the expected ischemic times. Patients with complex congenital heart disease (CHD) who undergo orthotopic heart transplantation (OHT) present technical difficulties due to collateral vessels, unusual anatomy and adhesions. Becoming familiar with the specific anatomy of each individual case prior to surgery is therefore crucial for the surgeon, and all available diagnostic methods should be used before embarking on the procedure. 3D-printing technology may play a pivotal role, as in this case report. A 36-year-old male was listed for OHT in the context of a complex cyanotic CHD consisting of a functional univentricular heart with hypoplasia of the right chambers with tricuspid and pulmonary atresia and an intact ventricular septum, palliated by a right Blalock-Taussig (BT) shunt at the age of 2, a left BT shunt at the age of 6 which was stented in the follow-up, and a bidirectional Glenn shunt when he was 21 years old. To depict this complex anatomy and its spatial relationships, a 3D model was printed and used by the surgical team to enhance their understanding of the patient anatomy and reenact the planned surgery beforehand, enabling the team to predict and avoid possible complications during the act (Figure). In March 2021, the patient underwent elective OHT. During the surgery, multiple MAPCAs were ligated due to diffuse bleeding. The left pulmonary artery (PA) ostial stenosis was resected and then distally anastomosed. In addition, an end-to-end anastomosis of the right PA to the right AP of the recipient was performed, proximal to the Glenn anastomosis, which was repaired with a pericardial patch. Ischemia and CBP time were 245 and 253 minutes. The postoperative course was uneventful with no evidence of bleeding complications. 3D-printing should be taken into consideration as a tool for planning surgical interventions in patients with complex CHD listed for OHT. The information provided may be useful to avoid improvisation during the procedure and thus, lead to a decrease in the expected ischemic times.