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Case Report: Three-Dimensional Printing Model for Surgical Planning of Left Ventricular Aneurysm: Evolution Toward Tailoring Surgery


Case Reports


doi: 10.3389/fcvm.2022.852682.


eCollection 2022.

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Case Reports

Nazario Carrabba et al.


Front Cardiovasc Med.


.

Abstract

A 59-year-old woman was admitted to the emergency department for heart failure (HF), New York Heart Association (NYHA) IV, showing an anterior, evolved myocardial infarction (MI) with a wide apical left ventricular aneurysm (LVA), ejection fraction (EF) 24%, and global longitudinal strain (GLS) -5. 5% by echo. Cardiac magnetic resonance imaging (MRI) confirmed an apical LVA without thrombus, EF 20%, and a transmural delayed enhancement in the myocardium wall. Coronarography showed a three-vessel disease with occluded proximal left anterior descending (LAD) and proximal right coronary artery (RCA). Based on the cardiac CT scan, we decided to generate a three-dimensional (3D) print model of the heart, for better prediction of residual LV volumes. After LVA surgery plus complete functional revascularization, an optimal agreement was found between predicted and surgical residual LV end-diastolic (24.7 vs. 31.8 ml/m2) and end-systolic (54.1 vs. 69.4 ml/m2) volumes, with an improvement of NYHA class, from IV to I. The patient was discharged uneventfully and at 6- and 12-month follow-up, the NYHA class, and LV volumes were found unchanged. This is a second report describing the use of the 3D print model for the preoperative planning of surgical management of LVA; the first report was described by Jacobs et al. among three patients, one with a malignant tumor and the remaining two patients with LVA. This article focused on the use of the 3D print model to optimize surgical planning and individualize treatment of LVA associated with complete functional revascularization, leading to complete recovery of LV function with a favorable outcome.


Keywords:

3D printing model; CAD; heart failure; left ventricular aneurysm; surgical ventricular restoration.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures



Figure 1

2D echo: (A–D) left ventricular aneurysm: systolic and diastolic phase; (E) baseline global longitudinal strain; coronary angiograms; (F) occlusion of the proximal left anterior descending coronary artery; (G) circumflex artery; (H) occlusion of proximal right coronary artery; cardiac MRI; (I–M) transmural delayed enhancement in the myocardium wall supplied by LAD.


Figure 2


Figure 2

3D print model: (A) left ventricular systolic volume, (B) left ventricular diastolic volume before, planned, and after surgery.


Figure 3


Figure 3

CT scan: the geometrical shape of the mitral valve, annulus, and papillary muscle attachment (A) before surgery, (B) after surgery.

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