Three-Dimensional Printing-Guided Precise Surgery for Complex Pulmonary Arteriovenous Malformation

IntroductionThree-dimensional (3D) printing is a new modality which makes a true-to-life 3D model using sophisticated technology. The authors report its first use in a complex case of a large pulmonary arteriovenous (AV) malformation.Case SummaryA 23-year-old patient presented with severe central cyanosis and clubbing. His echocardiogram was normal. A chest computed tomography (CT) and pulmonary angiogram revealed a large AV malformation. A repeat echocardiogram with injection of agitated saline into a peripheral vein showed appearance of the saline in the left ventricle. Since the CT showed a complex anatomy, a 3D print of the lesion was made. The print helped the authors in counseling the patient and his relatives, and in planning the operation. Plan A was for a device closure, and the hardware for this was ordered. Plan B was for open surgery. While waiting for the endovascular equipment to be obtained, the patient had hemoptysis, and so semiurgent open surgery was performed. A standard posterolateral thoracotomy was performed and a right lower lobectomy done.ResultsThe 3D print gave an excellent understanding of the lesion. Because of the 3D print, an accurate understanding of the intricate pathology allowed for a very precise surgery. A lower lobe resection was done.Conclusion3D printing is a useful modality for complex cardiac and vascular lesions. It adds to the armamentarium of the surgeon, and it helps allow for a precise and quick surgery. Its use is very likely to increase in the future.Summary of AdvantagesMakes planning repair of a complex lesion much more precise.One can plan multiple operative approaches.Avoids emergency planning during operation and refines approach.Better preoperative counselling of patient and relatives.Good for training.Like a batting practice, allows for a trial run.Allows surgeon to see around corners.Allows surgeon to ‘see’ through blood.Reduced operative time, reduced cardiopulmonary bypass time in open heart procedures.Less chances of residual lesion.Less chances for reintervention.Assess hemodynamics by putting in a virtual valve, close a hole, etc.Suggested ReadingLuo H, Meyer-Szary J, Wang Z, Sabiniewicz R, Liu Y. Three-dimensional printing in cardiology: current applications and future challenges. Cardiol J. 2017;24(4):436-444.