Interventional treatment using a 3D model of a right pulmonary artery to left atrial fistula in an infant

We present the case of a 3-month-old boy with a large right pulmonary artery to left atrial fistula successfully treated by percutaneous closure. The 3D printing model was useful for planning and simulating the procedure and device selection.
The boy was born in good general condition with a weight of 3670 g and 10 points on the Apgar scale. No abnormalities were found in prenatal examinations. On the first day of life central cyanosis was found, with saturation of about 70%, and a heart murmur was heard. Based on the echocardiographic examination, the diagnosis of right pulmonary artery to left atrial fistula was made. To confirm the above diagnosis and exclude the coexistence of other vascular malformations, angio-computed tomography (angio-CT) with 3D reconstruction was performed.
This examination confirmed abnormal division of the right pulmonary artery into 2 vessels: the proper pulmonary artery and the vessel leading to a 21 × 10 mm reservoir, which then in the place of the lower right pulmonary vein escaped through a wide opening (11 mm) into the left atrium. (Figure 1 A).
In the subsequent observation the child remained in a good general condition. Apart from slight desaturation (88–89% saturation) and a quiet murmur over the heart, he did not present any abnormalities. For this reason, the treatment decision was postponed to 3 months, then child’s body weight was 7.2 kg. The desaturation and the potential risk of neurological complication (high risk of paradoxical embolism) were the indications to perform percutaneous closure of the fistula.
To choose the most optimal access, type, and size of device, we decided to simulate a malformation closure using a printed 3D model. Based on the CT scan of the heart, we prepared 3D printed models: model No. 1 was a solid print representative of a full volume heart and vessels anatomy (Figure 1 B), and model No. 2 was a hollow print for simulation representing chambers and vessels in the region of interest. Using model No. 2, made of semi-flexible material visible under fluoroscopy, we performed a simulation of malformation closure from the pulmonary artery with the 6 mm Amplatzer Duct Occluder I device. The position of the device was stable and did not hinder the free insertion of the catheter into the right pulmonary artery (Figures 2 A–C).
Finally, from the right femoral vein, a 6 × 6 mm Amplatzer Vascular Plug II was implanted [1–5]. The final choice of an Amplatzer...


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