Integrating 3D Imaging into Clinical Practice for Surgical Planning of Complex Cardiac Defects

Background: Congenital heart defects (CHDs) are among the most common birth defects, often requiring an individualized and multidisciplinary treatment approach depending on their complexity. In particular, comprehensive diagnostics are necessary for the treatment of patients with complex and combined defects. To plan an optimal treatment concept, it is necessary to become aware of the exact anatomy of the respective structures. Therefore, modeling and printing of three-dimensional (3D) models from DICOM (Digital Imaging and COmmunication in Medicine) data allows the surgeon to get an optimal image of the pathologies present. Due to the excellent contrast and spatial resolution, computed tomography (CT) and magnetic resonance imaging (MRI) are the most suitable imaging modalities for 3D imaging.

Method: These 3D models are mostly derived from two-dimensional datasets, typically derived from CT or MRI cross-sectional images. However, datasets from 3D echocardiography can also be integrated, which is particularly useful for visualizing valve structures. For the creation of such 3D models, DICOM datasets are imported into a medical image processing software that enables different segmentation options. The quality of the cross-sectional image has a major impact on the detail and sequencing capabilities of the 3D model. To selectively elaborate individual structures in these cardiac models, a sound knowledge of cardiac anatomy is mandatory. Once the segmentation is completed, the 3D model is converted to an STL (stereolithography or standard tessellation language) file, which is the required data format for 3D printing. Another interesting and for surgical planning very good possibility to visualize the 3D models is the use of virtual reality (VR) goggles, with which the surgeon can virtually navigate through the heart model and thus obtain an optimal spatial idea of the pathology.

Results: For the planning of surgical corrections or palliations of CHD, the use of 3D models, both in the form of 3D printings and with VR glasses, is an integral part of our clinical routine.

Conclusion: Based on different pathologies, various aspects of the successful use of this 3D technology will be described. These include the requirements for imaging modalities, implementation of standardized segmentation, preoperative interdisciplinary evaluation, and immediate perioperative use. We would also like to share our workflow regarding 3D modeling and printing within our clinical routine not only for optimal treatment for each patient but also for educational purposes such as hands-on surgical training and CHD morphology teaching.

Publication History

Article published online:
28 January 2023