Nikhil Tiwari1, H Ravi Ramamurthy2, Vivek Kumar3, Alok Kumar4, B Dhanalakshmi5, Gaurav Kumar6. 1. Senior Advisor (Surgery) & Cardiothoracic Surgeon, Army Hospital (R&R), Delhi Cantt, India. 2. Senior Advisor (Paediatrics) & Pediatric Cardiologist, Army Hospital (R&R), Delhi Cantt, India. 3. Senior Advisor (Paediatrics) & Pediatric Cardiologist, Command Hospital (Air Force), Bangalore, India. 4. Classified Specialist (Anaesthesia) & Cardiothoracic Anaesthesiologist, Army Hospital (R&R), Delhi Cantt, India. 5. Classified Specialist (Radiodiagnosis), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India. 6. Professor & Director, Consultant Paediatric Cardiothoracic Surgeon, Fortis-Escorts Heart Institute, Okhla Road, New Delhi, India.
Abstract
BACKGROUND: Three-dimensional printing is a process enabling computer-assisted conversion of imaging data from patients into physical "printed" replicas. This has been extrapolated to reconstructing patient-specific cardiac models in congenital heart diseases. The aim of this study was to analyze the impact of three-dimensional printing in surgical decision making in selected cases of complex congenital heart disease by creating patient-specific printed models. METHODS: Patients with complex congenital heart diseases with unresolved management decisions after evaluation by echocardiography, cardiac catheterization, and cardiac computed tomography were included with intent to aid in surgical decision making. Three-dimensional models were created from computed tomographic images by an outsourced firm using computer applications. All cases were reviewed by the same team before and after the cardiac models were prepared. The management decisions were grouped as either "corrective surgery" or "no surgery or palliation" The impact of the surgical decision pre and post three-dimensional cardiac model was analyzed by applying Cohen's kappa test of agreement. RESULTS: Ten patients were included, of which five were of increased pulmonary blood flow, and five were of decreased pulmonary flow. The commonest indication for three-dimensional printed models was to establish the routability of the aorta and pulmonary artery to their respective ventricles (in five patients). The nonagreement between the decision taken before and after the cardiac model was 80%, with kappa -0.37 and P value 0.98. CONCLUSIONS: Three-dimensional printed cardiac models contribute to better decision making in complex congenital heart diseases enabling safer execution of any complex congenital heart surgery.
BACKGROUND: Three-dimensional printing is a process enabling computer-assisted conversion of imaging data from patients into physical "printed" replicas. This has been extrapolated to reconstructing patient-specific cardiac models in congenital heart diseases. The aim of this study was to analyze the impact of three-dimensional printing in surgical decision making in selected cases of complex congenital heart disease by creating patient-specific printed models. METHODS: Patients with complex congenital heart diseases with unresolved management decisions after evaluation by echocardiography, cardiac catheterization, and cardiac computed tomography were included with intent to aid in surgical decision making. Three-dimensional models were created from computed tomographic images by an outsourced firm using computer applications. All cases were reviewed by the same team before and after the cardiac models were prepared. The management decisions were grouped as either "corrective surgery" or "no surgery or palliation" The impact of the surgical decision pre and post three-dimensional cardiac model was analyzed by applying Cohen's kappa test of agreement. RESULTS: Ten patients were included, of which five were of increased pulmonary blood flow, and five were of decreased pulmonary flow. The commonest indication for three-dimensional printed models was to establish the routability of the aorta and pulmonary artery to their respective ventricles (in five patients). The nonagreement between the decision taken before and after the cardiac model was 80%, with kappa -0.37 and P value 0.98. CONCLUSIONS: Three-dimensional printed cardiac models contribute to better decision making in complex congenital heart diseases enabling safer execution of any complex congenital heart surgery.
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