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.
