Three-Dimensional Printing for Diagnosis of Left Ventricular Outflow Obstruction after Bioprosthetic Mitral Valve Replacement

Introduction: Three dimensional tools for reconstructing imaging data from multislice CT (MSCT) or echo are useful to detect and quantify pathologies and evaluate postoperative results. Surgical planning, however, is largely facilitated, if a three dimensional anatomically detailed model of the heart in actual size is available. In this study, we present the use of three-dimensional printing models in diagnosing, preoperative planning and postoperative evaluation of complex complications after mitral valve surgery in a patient with left ventricular outflow tract obstruction after implantation of a biological mitral prosthesis.

Description: A 38-year-old woman with a severe left ventricular outflow tract obstruction caused by the strut of the mitral bio-prosthesis was referred to our center for re-operation. After segmenting endocardium and mitral valve, we were able to transform computed tomography data of the patient to construct a preoperative three-dimensional model of the complex anatomical situation including the mitral and aortic outflow tracts together with the mitral bioprosthesis and the aortic valve. For evaluation of the result after mitral valve re-replacement with a mechanical prosthesis, we reconstructed the postoperative result based on echo data.

Evaluation: Complementing the imaging data provided by MSCT and echo, this model was helpful for the diagnosis of a left outflow tract obstruction caused by a stent of the bioprosthetic mitral heart valve and to support decision-making before redo-surgery. The three-dimensional model largely enhanced understanding of the pathoanatomical situation and facilitated planning of an adequate surgical approach.

Conclusion: Three-dimensional modeling is helpful in preoperative planning and post-operative evaluation of all kinds of complex intracardiac problems. It will be of special importance both in in the field of complex congenital cardiac surgery and for training the spatial sense during the education of young surgeons.