title: The role of 3D printing in preoperative planning for heart transplantation in complex congenital heart disease.
abstract: BACKGROUND
  The presence of a structural cardiac defect in the setting of dextrocardia is extremely rare. Graspable models allow enhanced appreciation of aberrant structures and vascular relations, particularly in rare and complex cases. This is the first case report of the use of a replica of a patients' anatomy to plan the surgical strategy in the setting of dextrocardia.
  
  
  OBJECTIVE
  We intend to demonstrate the benefit of three-dimensional printing to enhance preoperative planning in complex congenital heart disease undergoing heart transplantation. The anomalous structures encountered include situs inversus dextrocardia, transposition of the great vessels, a single atrium and a dilated double-outlet single right ventricle.
  
  
  METHODS
  Computed Tomography acquisition was performed with the use of ECG multiphase gating technology and contrast enhancement. The structures of interest were segmented and the generated 3D mesh was exported as a stereolithographic (STL) file. The model was printed on a Z-Corp 250 binder jetting printer. Post processing techniques were used to enhance model strength.
  
  
  RESULTS
  Pre-operative 3D visualisation of the patients' anatomy allowed for a more comprehensive surgical strategy to be planned, thus reducing the intra-operative duration and cross-clamp time which are recognised to correlate with reduced patient morbidity.
  
  
  CONCLUSIONS
  The ongoing advances in medical image procurement and 3D processing software and printing technology will continue to enhance preoperative planning and thereby improve patient care. We demonstrate the pivotal role played by such technologies in advancing spatial comprehension of complex aberrant anatomy.
authors.affiliation: Discipline of Anatomy, School of Medicine, University College Dublin, Dublin 4, Ireland. drmichellelouisesmith@gmail.com.
authors.forename: M L
authors.initials: ML
authors.lastname: Smith
authors.affiliation: Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: McGuinness
authors.affiliation: Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
authors.forename: M K
authors.initials: MK
authors.lastname: O'Reilly
authors.affiliation: Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Nolke
authors.affiliation: Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
authors.forename: J G
authors.initials: JG
authors.lastname: Murray
authors.affiliation: Discipline of Anatomy, School of Medicine, University College Dublin, Dublin 4, Ireland.
authors.forename: J F X
authors.initials: JFX
authors.lastname: Jones
mesh_terms: D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D066330:Printing, Three-Dimensional / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Complex Congenital Heart Disease; Congenital Heart Defect; Heart Transplantation; Situs Inversus; Superior Vena Cava