Three-Dimensional Printing of a Complex Aortic Anomaly

Congenital aortic anomalies are extremely rare congenital malformations of the aortic arch system. They can be diagnosed either by imaging analysis or by evaluation of entities like dysphagia or subclavian steal¹. In clinical scenarios, it is important to identify the anatomical anomaly in the confined surgical space that has limited visualization during the surgery^2,3. Currently, conventional planar two-dimensional (2-D) imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), are usually presented to surgeons before the surgery. However, it is difficult for surgeons to image the anomaly based on the 2-D imaging. Consequently, they could encounter unpredictable difficulties while trying to separate the complex aortic vessels during surgery. Unpredictable injury to the vessel, the trachea and the esophagus could occur and result in disastrous outcomes.

In the last decade, 3-D imaging modeling has been used in cardiac surgery to help surgeons understand the complex anatomic anomaly^4,5,6,7. Three-dimensional (3-D) printing technology can help convert the modeling data into a physical model. Compared with the digital reconstruction, 3-D printed physical models could present a better understanding of the anatomical details and provide an intuitional view of the malformation. For aortic anomaly surgery, the printed intuitional 3-D model is significant because poor understanding of aortic locations could be disastrous to patients. During the surgery, any mistake could lead to unpredictable bleeding and injury. Using the printed models, surgeons can fully understand the spatial relationships of aortic branches. During the surgery, the surgeons can also perform real-time review of the 3-D models to avoid confusion of the complex vascular locations.

Here, we present a protocol to apply 3-D printed models for pre-operative planning and intra-operative guidance while dealing with congenital aortic diseases. Kommerell's diverticulum, a type of complex congenital aortic anomaly, was selected as a case study. The steps include diagnosis based on computed tomography angiography (CTA) imaging, partitioning regions of interest, building 3-D models, preoperative surgical planning, and intra-operative reviewing of 3-D printed models⁸. This 3-D printing strategy could substantially reduce the risk of unpredictable tissue injury during the surgery.