Andugala Shalom, Grant Caroline, Powell Jennifer, Marathe Supreet, Venugopal Prem, Alphonso Nelson
Queensland Pediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
Queensland Pediatric Cardiac Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia.
World J Pediatr Congenit Heart Surg. 2025 Jan;16(1):57-63. doi: 10.1177/21501351241278584. Epub 2024 Oct 14.
Multiple muscular ventricular septal defects (VSDs) are often difficult to visualize and access surgically. The main challenge is identifying all defects intraoperatively, without which residual defects are inevitable. Patient-specific three-dimensional (3D) printed models can help accurately demonstrate intracardiac anatomy. We present our experience using this technology to surgically close multiple muscular VSDs .
Data of all patients with multiple VSDs in whom a 3D-printed model was used to aid surgical planning between September 2021 and July 2023 was collected retrospectively. Our approach involved generating a 3D model from a preoperative computerized tomography scan for each patient, which was then used to precisely identify the location of the multiple VSDs and plan surgical intervention.
Six patients underwent closure of multiple VSDs using a 3D model. The mean age at surgery was 3.5 years (SD ± 2.8 years). Five (83.3%) patients had previously undergone pulmonary artery banding. The VSDs were approached through the right atrium in three (50%) and the right ventricle in three (50%) patients. Mean cardiopulmonary bypass and myocardial ischemia times were 185.2 min (SD ± 94.8 min) and 147.5 min (SD ± 86 min), respectively. There was no postoperative heart block or a hemodynamically significant residual VSD. All six patients had normal biventricular function at a median follow-up duration of 1.7 months (interquartile range: 1.2-7.4 months).
3D printing to aid closure of multiple VSDs is safe, reliable, and reproducible. We recommend adding 3D printing to surgeons' armamentarium when faced with the challenge of closing multiple muscular VSDs in children.
多发性肌部室间隔缺损（VSD）在手术中往往难以可视化和触及。主要挑战在于术中识别所有缺损，否则不可避免地会残留缺损。患者特异性三维（3D）打印模型有助于准确展示心脏内解剖结构。我们介绍了使用该技术手术闭合多发性肌部VSD的经验。
回顾性收集2021年9月至2023年7月期间所有使用3D打印模型辅助手术规划的多发性VSD患者的数据。我们的方法包括为每位患者从术前计算机断层扫描生成3D模型，然后用于精确识别多发性VSD的位置并规划手术干预。
6例患者使用3D模型闭合多发性VSD。手术时的平均年龄为3.5岁（标准差±2.8岁）。5例（83.3%）患者此前接受过肺动脉环扎术。3例（50%）患者通过右心房进入VSD，3例（50%）患者通过右心室进入。平均体外循环时间和心肌缺血时间分别为185.2分钟（标准差±94.8分钟）和147.5分钟（标准差±86分钟）。术后无心脏传导阻滞或血流动力学上有意义的残余VSD。所有6例患者在中位随访时间1.7个月（四分位间距：1.2 - 7.4个月）时双心室功能正常。
3D打印辅助闭合多发性VSD是安全、可靠且可重复的。我们建议在面对闭合儿童多发性肌部VSD的挑战时，将3D打印添加到外科医生的装备库中。
