Journal Article

Surgical planning aided with 3D technologies for management of complex paracardiac tumors

Sánchez-Posada, Juliana, Vargas-Acevedo, Catalina, Briceño, Juan Carlos, Castro-Páez, Camila, Navarro-Rueda, Javier, Umaña, Juan Pablo, Pérez-Cualtán, Camilo E., Forero-Melo, Julián F., Guerrero-Chalela, Carlos Eduardo, Pérez, Juan Manuel, Gutiérrez-Vargas, Roberto, Medina, Héctor M.

2024

Overview

Background Accurate diagnosis and treatment of complex cardiac tumors poses challenges, particularly when surgical resection is considered. 3D reconstruction and printing appear as a novel approach to allow heart teams for optimal surgical and post operative care. Methods We report two patients with uncommon masses including a cardiac angiosarcoma (CAS) and a IgG4-related disease (IgG4-RD) with exclusive cardiac involvement. In both cases, three-dimensional (3D) reconstruction and 3D-printed models were utilized to aid the surgical team achieve optimal pre-operative planning. Both patients underwent ECG-gated cardiac computed tomography angiography (CCTA) imaging and, due to the complex anatomy of the masses, their large dimensions, proximity to vital cardiac and vascular structures, and unclear etiology, computational and 3D-printed models were created for surgical planning. An exploratory literature review of studies using 3D-printed models in surgical planning was performed. Results In case 1 (CAS), due to the size and extension of the mass to the right ventricular free wall, surgical intervention was not considered curative and, during thoracotomy, an open biopsy confirmed the imaging suspicion of CAS which guided the initiation of optimal medical treatment with chemotherapy and, after clear tumor retraction, the patient underwent a second surgical intervention, and during the 18 months of follow-up showed no signs of recurrence. In Case 2 (IgG4-RD), the patient underwent uncomplicated total surgical resection; this allowed directed treatment and, at 12 months follow-up, there are no signs of recurrence. Computational and 3D-printed models were used to plan the surgery and to confirm the findings. Limited studies have explored the use of 3D printing in the surgical planning of tumors. Conclusions We present two patients with uncommon cardiac tumors, highlighting the significant value of 3D models in the anatomical characterization and assessment of their extension. These models may be essential in surgical planning for complex cardiovascular cases and could provide more information than conventional imaging modalities. Further studies are needed to demonstrate the impact of 3D technologies in studying cardiac tumors.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: 3-D printers / 3-D technology / 3D printing / Anemia / Angiography / Angiosarcoma / Biopsy / Cancer / Cardiac patients / Cardiac Surgery / Cardiac Surgical Procedures - methods / Cardiac tumors / Care and treatment / Chemotherapy / Computed tomography / Computed Tomography Angiography / Computer applications / Computer peripherals industry / Coronary artery disease / Coronary vessels / CT imaging / Development and progression / EKG / Electrocardiogram / Electrocardiography / Health services / Heart / Heart diseases / Heart Neoplasms - diagnostic imaging / Heart Neoplasms - surgery / Hemangiosarcoma - diagnostic imaging / Hemangiosarcoma - surgery / Humans / Image reconstruction / Imaging, Three-Dimensional / Immunoglobulin G / International economic relations / Intervention / Literature reviews / Lymphoma / Medical diagnosis / Medical imaging / Medical treatment / Medicine / Medicine & Public Health / Patients / Printing, Three-Dimensional / Reconstructive surgery / Software / Surgery / Thoracic Surgery / Three dimensional models / Three dimensional printing / Tumors / Veins & arteries