Successful Surgical Correction Research Articles

A 20–YEAR FOLLOW–UP OF SUCCESSFUL SURGICAL MANAGEMENT OF DOUBLE–OUTLET RIGHT VENTRICLE WITH PULMONARY STENOSIS: A CASE REPORT

Abstract A 25–year–old man, suffering from worsening exertional dyspnea for 4 months, was referred to our Cardiology Unit. The patient was previously diagnosed with a late diagnosis of double outlet right ventricle (DORV), as well as pulmonary stenosis, VSD, and right–sided aortic arch for which he underwent a first surgical procedure around the age of 2 involving an intersternal anastomosis through a left lateral thoracotomy approach. A second intervention took place 2 years later for a radical correction of the anomaly through a median sternotomy. The patient had sporadic follow–up since then. A baseline ECG was performed, showing evidence of sinus rhythm, normal AV with a bifid P wave in lead II, slight RAD, incomplete RBBB, and asymmetric negative T waves from V1 to V3 and in aVL, and biphasic T waves in V4–V5. We performed an echocardiogram which showed: a dilated RA, a normal–sized LA, an apparently intact interatrial septum without evident shunts; a normal sized LV; EF 60%; a moderately dilated, hypertrophic and hypertrabeculated RV; FAC 33%; normal aortic flow; a minimal MR; a massive residual pulmonary insufficiency; a moderate TR; a dilatated pulmonary trunk; a normal–sized and collapsible IVC upon inspiration; PAPs of 70 mmHg; no pericardial effusion. A maximal exercise stress test appeared to be normal throughout. However, due to the severe pulmonary hypertension he was referred to our PH centre. While these patients are commonly affected by residual early or late left ventricular outflow tract obstruction, fortunately our patient was not. DORV is a relatively common congenital heart defect characterized by an abnormal connection between the ventricles and arteries, in which both the aorta and the pulmonary trunk are connected completely or predominantly to the right ventricle. The anatomical spectrum of this anomaly is quite large, and it can be associated with the presence of a VSD that often extends towards one or both of the arterial valves, allowing the flow of blood from the left ventricle to the aorta. An accurate diagnosis through echocardiography or CMR is essential in order to guide the surgical repair and the appropriate therapeutic approach for individuals affected by this anomaly. A successful surgical correction of DORV is essential, but it is important to be aware of the potential complications of post–operative PH (especially in patients with preoperative PH), which necessitates close surveillance and appropriate therapeutic management.

Double secondary aorto-enteric fistula: a case report

Introduction: Endoprothesis infections (EIs) are rare postoperative complications of endovascular procedures, with incidence ranging from 0.2% to 0.7%. Secondary aorto- enteric fistulas presents a mortality rate of approximately 60%, featuring more prevalence the association with the duodenum (70%) and displays a rare association when endovascular procedures are performed. Case report: This study reports the case of a 72-year-old male patient who developed a duodenal aorto-enteric fistula associated with a fistula in the sigmoid colon and left common iliac artery after undergoing by stent implantation for aortic aneurysm repair. Successful treatment and surgical correction was performed. Conclusion: Aorto-enteric fistulas after endovascular approach correspond to a rare complication with high mortality, being extremely important the early diagnosis and effective therapeutic approach.

Successful surgical correction of caudal duplication syndrome in a dog.

To describe a case of caudal duplication successfully operated with long-term follow-up. A 12-week-old female Chihuahua mix. The dog of this report presented for evaluation of duplicate external organs, including 2 anuses, 2 vulvas, and 2 tails. The dog was clinically normal except for signs of cystitis. Contrast CT identified complete urogenital and anorectal duplication, characterized by duplication of the cecum, descending colon/rectum, urinary bladder, urethra, uterus, and ovaries, with left-sided rectovestibular fistula. Exploratory laparotomy was performed to remove the left cecum and colon, the left ureter was transected and implanted into the right urinary bladder, the left bladder and urethra were removed, and bilateral ovariohysterectomy removed 4 ovaries and 2 uteruses. Following abdominal closure, the left anus and vulva with remaining portions of distal rectum and urethra, respectively, were removed en bloc with both tails. Long-term follow-up at 5 years showed the dog to be clinically normal. Caudal duplication is extremely rare in veterinary medicine, and this report details successful surgical correction with good long-term follow-up.

Does Hallux Valgus Correction with Chevron-Akin Osteotomies Reduce the Length of the First Ray

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Patients who undergo a successful surgical correction of hallux valgus have relieved toe pain and improvements in foot appearance. Prior studies have shown hallux valgus correction using a distal Chevron osteotomy with a concomitant Akin osteotomy has the potential to reduce forefoot width. There are no studies evaluating if similar changes occur in the length of the foot. The objective of this study is to check if similar reduction occurs in the patient's foot length. Methods: The operating room schedule of Dr. Panchbhavi and Dr. Chen were reviewed for Chevron/Akin Osteotomies from 2017-2022. Patient charts were excluded for contaminant operations of the foot. The preoperative and postoperative radiographs were then evaluated by one medical student with oversight from a Board-Certified Foot and Ankle Orthopedic Surgeon. The Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Metatarsal Span (MS), first/second ray of the foot, and difference between first and second ray were all be measured based on predetermined methods. All variables were analyzed utilizing an unpaired t-test. Results: In total 12 Chevron/Akin patients met the criteria. The results indicated that with chevron/akin osteotomy measurements of the foot were affected in HVA, IMA, MS, and length of first ray relative to second ray. The average results for each of these values were a decrease of 9.2 degrees (SD 4.32), 7.93 degrees (SD 4.33), 11.63mm (SD 2.26) respectively. For results of change in difference of first and second ray, average results for those who underwent Chevron/Akin Osteotomy was -2.23mm (SD 2.23, p = 0.0281). Both changes to MS and length were statistically significant (p < 0.05). Conclusion: Our results were consistent with existing evidence, Chevron with contaminant Akin Osteotomy will produce statistically significant changes in width of the foot; however, also a significant decrease in the length of the first ray relative to the second ray. All measurements were done utilizing PACS software and can be reliably used in clinics as a clinical tool to gauge post- operative outcomes alongside providing adequate patient education on the potential changes in foot length and width.

Surgical correction of omphalocele in local goat breed (Beetal) of Jhang, Punjab: A case study

Omphalocele is a rare congenital condition where closure defects in the abdominal wall at the umbilical ring lead to the protrusion of intestinal or other visceral organs, covered by a thin epithelial layer. The developmental mechanism of this condition is not fully understood, and various theories have been proposed to explain it. This study presents a case of omphalocele in a newborn female black goat kid, detailing its clinical presentation, surgical management, and postoperative care. The surgical procedure involved meticulous preparation of the surgical site, administration of local anesthesia, and careful repositioning of the intestines, liver, and a portion of the spleen. Excess skin and the amnion membrane were removed to facilitate safe repositioning, and the umbilical ring was excised to widen the opening. The abdominal wall layers were meticulously closed using appropriate suture materials. The kid’s postoperative recovery was uneventful, with normal vital signs, fecal passage, and feeding behavior observed. The study discusses omphalocele in comparison to other abdominal abnormalities and explores potential developmental mechanisms. The authors emphasize the importance of immediate surgical intervention despite varying prognoses associated with this condition. The study underscores the significance of surgical treatment for omphalocele cases in newborn goat kids, providing hope for affected animals and valuable insights for veterinary professionals. Although the exact prevalence of omphalocele remains uncertain due to unreported cases, this report demonstrates successful surgical correction and the potential for curing the condition if diagnosed and treated promptly. Further research is needed to fully understand the genetic and environmental factors contributing to omphalocele and its impact on livestock.

КОРРЕКЦИЯ ДЕФОРМАЦИИ ПЯТОГО ПАЛЬЦА СТОПЫ

Introduction. The analysis of literature data on the surgical treatment of fifth toe static deformity, as well as unsatisfactory results, was carried out. The disadvantages of the known methods were identified and a method for correcting the fifth finger varus deviation was proposed. Aim. The purpose of this article is to present own clinical observation of the fifth toe varus deviation operative correction by a proposed method with a detailed description of its methodology. Material and methods. A clinical case of successful surgical correction of isolated fifth toe varus deformity of the foot is presented. Results and discussion. A 22-year-old patient with a painful fifth toe varus deformity, which was diagnosed by a clinical and radiological examination and requiring surgical correction. Surgical treatment, by proposed method, included performing a diaphyseal osteotomy of the fifth metatarsal bone with formation of two bone «steps» on plantar fragment along precisely marked lines, medial displacement of the plantar fragment by a predetermined distance, interlocking fragments of the metatarsal bone and fixing them with one screw. The proposed method allows to shift the plantar fragment as much as possible, straighten the fifth finger, restore the congruence of the articular surfaces of the fifth metatarsophalangeal joint, eliminate pain, and tightly stabilize the plantar and dorsal fragments. The patient was observed for 1 year. The result of the treatment was the elimination of fifth toe varus deviation. Conclusion. Surgical treatment of fifth toe varus deformity by using new method with special markings and simple surgical techniques, ensures the achievement of a positive result, good fixation and consolidation of osteotomized fragments of the fifth metatarsal, relief of pain, restoration of the anatomical condition and statodynamic function of the foot, reducing the risk of fracture of the fifth metatarsal and recurrence of varus deformity the fifth toe.

The correction of venous stasis in delayed breast reconstruction with a free tram-flap after mastectomy

The presented case contains a successful surgical correction of venous stasis of an autograft that occurred in the early postoperative period during the delayed reconstruction of the left breast with a free TRAM flap in a patient after radical surgical treatment of stage 3A pT2N2M0 breast cancer. Using the microsurgical technique, two venous anastomoses were sequentially applied, which made it possible to keep the transplanted flap completely viable and, thus, to ensure a successful outcome of the reconstructive surgery.

Computed tomographic features of double aortic arch in six dogs.

Double aortic arch (DAA) is a rare, congenital anomaly in small animals, resulting in a complete vascular ring encircling the esophagus and trachea, and subsequent compression of these organs. Few studies have reported utilizing CT angiography (CTA) for diagnosing DAA in dogs; thus, the imaging features are currently lacking in the literature. The objectives of this retrospective, multicenter, descriptive case series were to report the clinical and CTA characteristics of DAA in surgically treated cases. Medical records and CTA images were reviewed. Six juvenile dogs met the inclusion criteria (median age: 4.2 months; range: 2-5 months). The most common clinical signs included chronic regurgitation (100%), decreased body condition (67%), and coughing (50%). Common CTA features of DAA included a dominant left aortic arch (median diameter: 8.1mm) and minor right aortic arch (median diameter: 4.3mm; 83%), an aberrant right subclavian artery arising directly from the right aortic arch (83%), segmental esophageal constriction (100%), and variable degrees of dilation cranial to the heart base, and marked tracheal luminal compression (median percent change: -55%; 100%) and leftward curvature of the trachea at the level of the bifurcation of the aortic arches (100%). All dogs underwent successful surgical correction with only minor postoperative complications. Due to the similarity of clinical and imaging characteristics described to that of other forms of vascular ring anomalies (VRA), CTA is vital for the specific diagnosis of DAA in dogs.

ИЗБЫТОЧНЫЙ ОТНОСИТЕЛЬНЫЙ РИСК КАТАРАКТОГЕННЫХ НАРУШЕНИЙ ХРУСТАЛИКА У РАБОТНИКОВ ЯДЕРНОЙ ИНДУСТРИИ: СИСТЕМАТИЧЕСКИЙ ОБЗОР И МЕТА-АНАЛИЗ

The lens cells are the most radiosensitive cells in the body, surpassing even lymphocytes in key parameters. Radiation damages in the lens can be observed at relatively low doses, in connection with which a number of authors attribute to these effects not a deterministic, but a stochastic nature. Although cataractogenic consequences do not always affect visual acuity, and lens undergo successful surgical correction, when irradiating various professional groups, including workers in the nuclear industry, these consequences are regarded in importance immediately after malignant neoplasms and diseases of the circulatory system. The presented study showed that there are very few publications on the lens disorders in nuclear workers – only 20 sources were identified (1967–2022), and no data were found on the effects of low doses (0.1 Gy for low LET radiation). When conducting a meta-analysis for ERR at 1 Gy/Sv for radiation damage in the lens of nuclear workers, three cohorts turned out to be relevant: a small group in the American study of transuranium elements processing, Mayak personnel and ROSATOM workers – liquidators of the Chernobyl accident. The sample was homogeneous, publication bias was unlikely, and, according to the results of a meta-analysis (Fixed effect model), ERR per 1 Gy/Sv was 0.30 (95 % confidence intervals: 0.25; 0.35). Based on the earlier work (Koterov A.N. et al, 2022) of the mean cumulative dose of external exposure for nuclear workers as a world professional category, which amounted to 31.1 mSv, the calculation showed that with ERR = 0.3 per 1 Gy/Sv excess prevalence of cataracts for a group of ‘average’ workers is 0.0093. This corresponds to an increase in prevalence of 0.096 % over a background level of 10.3 % for potentially radiogenic cataracts (last value taken from a meta analysis by Hashemi H. et al., 2020). Such an increase is unlikely to have practical significance. Although for some cohorts (Sellafield, PO ‘Mayak’) there may be groups with significant cumulative doses and, therefore, with increased risks. The importance of the risks of cataractogenic disorders in the lens in radiation workers may be due to a decrease in professional suitability, since the artificial lens, as a rule, is poorly capable of accommodation.

Surgical Management of Giant Left Atrium during Mitral Valve Surgery

Rheumatic mitral valve disease, a preventable and eradicable condition, remains the primary indication of mitral valve surgery in developing countries. Delayed surgery is the main cause of giant left atrium (LA). This extreme dilatation of LA causes various complications compromising hemodynamic stability. We describe herein a patient with severe mitral stenosis and giant LA who had successful surgical correction by mitral valve replacement with reduction of the size of a LA.

Anomalous Origin of Left Circumflex Coronary Artery From Right Pulmonary Artery: An Unusual Cause of Sudden Cardiac Arrest

Anomalous origin of the left circumflex coronary artery from the right pulmonary artery is an extremely rare coronary anomaly out of the group of anomalous coronary arteries arising from the pulmonary artery. We present the case of a 27-year-old male, in whom the diagnosis of an anomalous left circumflex coronary artery from the pulmonary artery was made after sudden cardiac arrest. The diagnosis was confirmed by multimodal imaging and the patient underwent successful surgical correction. Abnormal origins of a coronary artery may become symptomatic later in life and may occur as an isolated cardiac malformation. Due to a potentially unfavorable clinical course, surgical correction should be considered as soon as a diagnosis is made.

Surgical correction of a ventricular septal defect in a child with spinal muscular atrophy type 2 treated with nusinersen sodium: a case report

IntroductionSpinal muscular atrophy (SMA) is a severe, inherited neuromuscular disorder characterized by progressive muscle weakness and atrophy. Cardiac pathology co-existence is reported more frequently in the severely affected patient groups. Structural heart anomalies, mainly septal, and outflow tract defects are commonly observed pathologies.Case presentationWe herein report the case of a 23 days-old female patient with the diagnosis of spinal muscular atrophy type 2 complicated with structural heart defects. Successful pulmonary banding, and at the age of 17 months, subsequent surgical atrial and ventricular septal defect closure were performed on our patient who was under treatment of Nusinersen Sodium. Post-operative recovery was uncomplicated. Cardiac assessments were normal, and the patient was neurologically improving in her recent follow-up.ConclusionIn the literature, there are no reported cases of successful surgical repair of heart defects in spinal muscular atrophy patients. These patients can be perceived as risky surgical candidates with suboptimal postoperative recovery given the unfavorable disease prognosis of SMA in untreated patients. We report our promising experience with a SMA type 2 patient undergoing a disease-modifying medical treatment. The SMA patients under treatment may be potential candidates for successful surgical cardiac correction given their overall improved prognosis.

Combined Repair of Upper Sternal Cleft and Pectus Excavatum in a Child

Sternal cleft accompanied by pectus excavatum is a rare type of congenital anomaly of the chest wall. Surgical correction is a suitable approach to restore the heart, large vessels, and respiratory dynamics early. This is a report of the successful surgical correction of upper sternal cleft anomaly accompanied by pectus excavatum in a child. The pectus excavatum was corrected without the use of any prosthesis. The cleft was closed by primary approximation with enough dissected pectoralis major muscle and partial thymectomy, mobility, and flexibility ensured by pectus correction. The integrity of the sternum and the chest wall was normal at the end of the 12-month follow-up period.

Emergency Hybrid Correction in a Newborn with Critical Aortic Valve Stenosis with Acute Pulmonary Edema in the First Hour after Birth

Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth. We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life. The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum (aortic and mitral valves stenosis variant), that led to the cardiogenic shock and acute pulmonary edema. The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum. The surgery was performed through a median sternotomy.

Segmental necrosis of the outlet of the stomach and duodenum in a premature newborn baby

Introduction. Gastric perforation in newborns is a polyetiological, severe disease that combines a number of destructive conditions, such as: isolated pinpoint perforations, wall necrosis and gastric rupture. The first description of this pathology in a premature infant was made by Siebold in 1825, and only in 1968, G. Reams reported a case of successful diagnosis and surgical correction of this disease. Currently, the frequency of gastric perforation occurs from 1 to 6 cases per 30 thousand live births, and the mortality rate is within 40–70%.In all infants, disorders in the integrity of stomach wall can be divided into iatrogenic and “idiopathic” which are caused, in most cases, by intrauterine hypoxia. Therefore, while examining such patients, differential diagnostics between gastric perforation and necrotizing enterocolitis is often made.Clinical case. The authors present their experience in diagnosing and treating segmental necrosis of the stomach and duodenum outlet in a child with an extremely low body weight of 800 gr. Predisposing factors in the antenatal period were considered to be manifestations of hereditary thrombophilia, severe preeclampsia, placental insufficiency, and intrauterine growth retardation. As far as the discussed pathology had a subacute course, clinical changes were registered only on the 21st day of infant’s life, when pneumoperitoneum was detected at the plain X-ray image. When the patient’s condition was stabilized, median laparotomy was performed, at which radial necrosis with detachment in the gastroduodenal junction was seen. An end-to-end gastroduodenoanastomosis was put at the defect zone. In the postoperative period, the course was complicated with bronchopulmonary dysplasia, oblique femoral fracture with angular fragment displacement because of premature osteopenia as well as cholestatic hepatitis. The patient was discharged from the hospital in satisfactory condition in 80 days.Conclusions. Thus, better understanding of specific features in the clinical picture of the discussed pathology and of the mechanisms of perforation development in hollow organs of the abdominal cavity will reduce the number of complications and adverse outcomes in patients with extremely low body weight.

Case Study: Exploring a Variation of Partial Anomalous Pulmonary Venous Return of the Right Upper Pulmonary Vein into the Cephalic Portion of the SVC Causing a Left‐to‐Right Shunt in a 56‐year‐old Asian Female

HypothesisPartial Anomalous Pulmonary Venous Return is the result of aberrant congenital cardiopulmonary development, and can go undiagnosed with late emergent presentation in older adulthood.SummaryPartial Anomalous Pulmonary Venous Return (PAPVR) is a highly variable disease that is often asymptomatic in children and may not present until later in adulthood either symptomatically, or as an incidental finding on radiology or autopsy. When considering the configuration of anatomic congenital anomalies, such as PAPVR in both children and adults, it is important to explore the embryological development. Due to the direct correlation between the cardiology and pulmonology in this case, the embryology of both systems must be understood and discussed to fully recognize the issue at hand and is further explored in detail later. The most common presentation of PAPVR involves the right upper pulmonary vein as it drains into the junction of the Superior Vena Cava (SVC) and right atrium creating a left‐to‐right shunt, and there is almost always an associated Atrial Septal Defect (ASD) present in PAPVR[1]. In the case presented, a 56‐year‐old Asian female was found to have PAPVR of the Right Upper Pulmonary Vein that drained into the cephalic portion of the SVC. A left‐to‐right shunt results in freshly oxygenated blood from the lungs being returned to, and mixed with, deoxygenated systemic blood in the right atrium. While having a right upper pulmonary vein drain into the SVC is the most common PAPVR, this case is rare as it is not associated with an ASD as previously described[2]. The abnormal site of attachment of the right pulmonary vein was noteworthy, because in most cases this vein will attach at the junction of the SVC and right atrium. In this case, the vein was draining into the cephalic portion of the SVC alone. This patient required a modified Warden’s procedure for successful surgical correction. While most cases are asymptomatic and the result of an incidental finding, the patient presented to the emergency department with a life‐threatening right atrial pressure of 80mmHG, which is clinically significant for Pulmonary Arterial Hypertension (PAH) and caused the patient to go into Right‐Sided Heart Failure. The patient also presented with significant right ventricular hypertrophy, as the result of consistent PAH.ConclusionPAPVR is a rare congenital cardiopulmonary defect that can remain undiagnosed and present later in adulthood. The diagnosis and treatment of this disease is particularly difficult due to its ability to remain undetected in childhood, slowly progress to insidious pathology, and present later in adulthood with potentially life‐threatening complications requiring surgical intervention. The variability of PAPVR must be explored further in order to improve the effective diagnosis and treatment of this rare congenital disease.Resources[1] Lyen, S. et al.2017. Anomalous pulmonary venous drainage: a pictorial essay with a CT focus. J Congenit Heart Dis[2] Ishida, N et al.2018. Surgical repair of partial anomalous pulmonary venous return with intact atrial septum in a 65‐year‐old woman: a case report. Journal of medical case reports

Successful surgical correction of ascending aortic dissection in a kidney transplant patient

Cardiovascular disease is the leading cause of death in patients with a transplanted kidney and in graft loss. We present the first clinical case of successful surgical correction of ascending aortic dissection (DeBakey type I) in a young patient with a functioning kidney graft. The patient underwent the first cadaveric kidney transplantation (KTx), which was complicated by acute humoral rejection and suboptimal graft function. High blood pressure, anemia, elevated blood levels of triglycerides, phosphorus, parathyroid hormone, and uric acid were recorded. A repeat KTx was performed five years later; the patient’s condition and kidney function were satisfactory. Three years later,the patient started experiencing severe pain along the thoracic and lumbar spine; his blood creatinine level was 408 μmol/L. Computed tomography and echocardiography diagnosed DeBakey type I aortic dissection (AD) with critical narrowing of the true aortic lumen at certain levels, dissection of aortic branches. Aortic resection surgery with prosthetic replacement of the ascending aorta according to David procedure with reimplantation of coronary artery orifices according to Kouchoukos technique, prosthetic replacement of the aortic arch with debranching of brachiocephalic artery and left common carotid artery were successfully performed as planned under endotracheal anesthesia, cardiopulmonary bypass and selective pharmacological cold cardioplegia. The peculiarities of the course, possible causes and outcomes of surgical correction of thoracic AD in the patient are discussed.

Surgical Correction of Spontaneous Outflow Graft Twisting of HeartMate 3 LVAD via a Subcostal Approach.

We present two cases of successful surgical correction of a HeartMate 3 left ventricular assist device (LVAD) outflow graft twisting through a subcostal approach. These twistings were diagnosed with computed tomography or pull-back pressure measurement. Technically, a subcostal approach allowed us to access directly the twisted outflow graft and the device connector in a less invasive fashion as compared with a re-sternotomy. Diagnostic modality and surgical tips that address graft twisting are presented within the discussion of these two case studies. The institutional review board of our institution approved this study and waived the requirement for informed consent.

Creation of Patient-Specific Silicone Cardiac Models with Applications in Pre-surgical Plans and Hands-on Training

Three dimensional models can be a valuable tool for surgeons as they develop surgical plans and medical fellows as they learn about complex cases. In particular, 3D models can play an important role in the field of cardiology, where complex congenital heart diseases occur. While many 3D printers can provide anatomically correct and detailed models, existing 3D printing materials fail to replicate myocardial tissue properties and can be extremely costly. This protocol aims to develop a process for the creation of patient-specific models of complex congenital heart defects using a low-cost silicone that more closely matches cardiac muscle properties. With improved model fidelity, actual surgical procedural training could occur in advance of the procedure. Successful creation of cardiac models begins with the segmentation of radiologic images to generate a virtual blood pool (blood that fills the chambers of the heart) and myocardial tissue mold. The blood pool and myocardial mold are 3D printed in acrylonitrile butadiene styrene (ABS), a plastic dissolvable in acetone. The mold is assembled around the blood pool, creating a negative space simulating the myocardium. Silicone with a shore hardness of 2A is poured into the negative space and allowed to cure. The myocardial mold is removed, and the remaining silicone/blood pool model is submerged in acetone. The described process results in a physical model in which all cardiac features, including intra-cardiac defects, are represented with more realistic tissue properties and are more closely approximated than a direct 3D printing approach. The successful surgical correction of a model with a ventricular septal defect (VSD) using a GORE-TEX patch (standard surgical intervention for defect) demonstrates the utility of the method.

Creation of Patient-Specific Silicone Cardiac Models with Applications in Pre-surgical Plans and Hands-on Training

Three dimensional models can be a valuable tool for surgeons as they develop surgical plans and medical fellows as they learn about complex cases. In particular, 3D models can play an important role in the field of cardiology, where complex congenital heart diseases occur. While many 3D printers can provide anatomically correct and detailed models, existing 3D printing materials fail to replicate myocardial tissue properties and can be extremely costly. This protocol aims to develop a process for the creation of patient-specific models of complex congenital heart defects using a low-cost silicone that more closely matches cardiac muscle properties. With improved model fidelity, actual surgical procedural training could occur in advance of the procedure. Successful creation of cardiac models begins with the segmentation of radiologic images to generate a virtual blood pool (blood that fills the chambers of the heart) and myocardial tissue mold. The blood pool and myocardial mold are 3D printed in acrylonitrile butadiene styrene (ABS), a plastic dissolvable in acetone. The mold is assembled around the blood pool, creating a negative space simulating the myocardium. Silicone with a shore hardness of 2A is poured into the negative space and allowed to cure. The myocardial mold is removed, and the remaining silicone/blood pool model is submerged in acetone. The described process results in a physical model in which all cardiac features, including intra-cardiac defects, are represented with more realistic tissue properties and are more closely approximated than a direct 3D printing approach. The successful surgical correction of a model with a ventricular septal defect (VSD) using a GORE-TEX patch (standard surgical intervention for defect) demonstrates the utility of the method.