Three-dimensional printing in the closure of multiple muscular ventricular septal defects

The closure of multiple muscular ventricular septal defects poses a unique challenge to the surgeon with inherent risks of residual defects, conduction blocks, and ventricular dysfunction. The trabeculations in the right ventricle often make it difficult to identify and visualize the edges of the defects. More recently 3 dimensional (3D) models are increasingly being used in the management of various complex congenital heart defects. We present our technique of closing multiple muscular ventricular septal defects (VSDs) using individualized 3D printed models. The stepwise process requires a multidisciplinary approach between the cardiologist, cardiac surgeon, cardiac radiologist, and 3D engineer. As the 3D model exactly replicates the intracardiac anatomy including that of the trabeculations in the region of the multiple VSDs, this technique facilitates the precise location of the defects and obviates the requirement to ‘search’ for the defects intraoperatively. The defects can be located through a shorter right ventricular incision and the defects can be closed with a shorter myocardial ischemia time. Three-dimensional printing facilitates individualization of surgical management, and we recommend the addition of 3D printing to the armamentarium of surgeons dealing with the challenge of closing multiple muscular VSDs in children.