Three-dimensional (3D) printing anatomical models of complex heart diseases are precious for preoperative planning, anatomical relationships and intraoperative guidance. Pulmonary atresia with ventricular septal defect (PA-VSD) and major aortopulmonary collateral arteries (MAPCAs) is one of the most challenging surgical conditions to manage because of the timing and the technical complexity of the surgery. This complex congenital heart disease has still a poor prognosis, generally less than 50% survival at 2 years. We describe the impact of computerized tomography scan and 3D printing model for decision making in surgical procedure strategy in a newborn with PA-VSD and MAPCAs, underwent to palliative surgery.

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We present a case of a one-day-old newborn, without prenatal diagnosis, referred to our cardiologic intensive care unit in critical condition presenting sub-cyanosis and peripheral oxygen saturation of 80%. Echocardiography diagnosis was tricuspid valve dysplasia with severe regurgitation, functional pulmonary valve atresia with intact ventricular septum and reversal flow in the large patent ductus arteriosus (PDA). Chest X-ray showed severe cardiomegaly and wall to wall heart. Prostaglandin E1 infusion was started once after birth. After few days, clinical conditions progressively worsened because of right heart failure; a first pharmacological approach to close PDA failed and surgery ligation of PDA was necessary to restore anterograde pulmonary flow and heart size.

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