In this paper, the digital design and manufacturing of a post-tensioned concrete girder is presented. We bring together two emerging technologies that show great potential for realizing highly-efficient concrete structures: topology optimization for simulation-driven design and 3D concrete printing (3DCP) for manufacturing of optimized shapes. While this is not the first-ever 3D-printed concrete structure, it is the first demonstration of how topological design in combination with 3D concrete extrusion printing allows for creating efficient structures with reduced use of materials. As the implementation of a specific optimization procedure for post-tensioned concrete structures is so far available in 2D only, some design post-processing was...