An Innovative Hybrid Process for Realistic Three-Dimensional Heart Modeling and Surgical Simulation of Tetralogy of Fallot

Abstract

Background: Realistic three-dimensional (3D) heart models are essential for understanding complex congenital defects and improving surgical training. However, conventional rigid models lack the tactile and anatomical fidelity required for procedures such as Tetralogy of Fallot (TOF) repair. Objectives: To develop a reproducible, flexible, and anatomically accurate TOF heart model using a computer aided design (CAD)-driven hybrid workflow, validated against magnetic resonance imaging (MRI) data and assessed through hands-on surgical training. Methods: Anonymized MRI datasets were segmented and refined using a three-dimensional (3D) slicer. The resulting stereolithography (STL) files were imported into Autodesk Inventor to design molds, which were produced via 3D printing and silicone casting. Cardiologists and surgeons assessed anatomical fidelity during segmentation and mold design. Models were tested during an international surgical workshop, where participants practiced key TOF procedures. A structured survey evaluated anatomical accuracy, tactile realism, and educational value. Results: Among 125 participants from 60 countries, 100% reported that the model improved their understanding of cardiac anatomy; 91% (113/125) emphasized its educational usefulness; 82% (103/125) to 88% (110/125) confirmed anatomical fidelity; and 75% (94/125) rated tactile realism as comparable with real cardiac tissue. Conclusions: This CAD-silicone workflow produces reproducible, flexible, and anatomically faithful TOF heart models, effectively bridging imaging data and hands-on surgical simulation to enhance both surgical education and preoperative planning.

Keywords

Tetralogy of Fallot 3D printing CAD MRI validation surgical simulation surgical training medical education reproducible models

Get full access to this article

View all access options for this article.

References

Kim

Neira

Sapp

JL Jr

Elkhateeb

. Pilot study on integrating 3D-printed models into undergraduate medical education for congenital heart disease. CJC Pediatric Congenit Heart Dis. 2024;4(2):103–108. 10.1016/j.cjcpc.2024.11.001

Chetan

Valverde

Yoo

S-J

. 3D printed models in cardiology training. JACC: Adv. 2024;3:100893. 10.1016/j.jacadv.2024.100893

Morrison

Lakin

Hoy

, et al. 3D printed models of the major congenital heart defects: integration into the training of nursing students. Proceedings of the 13th International Workshop on Innovative Simulation for Healthcare (IWISH 2024), 2024. Tenerife, Espagne, septembre 2024. https://doi.org/https://doi.org/10.46354/i3m.2024.iwish.004

Tarca

Woo

Bain

Crouchley

McNulty

Yim

. 3D Printed cardiac models as an adjunct to traditional teaching of anatomy in congenital heart disease – A randomised controlled study. Heart Lung Circ. 2023;32(12):1443–1450. https://doi.org/10.1016/j.hlc.2023.09.021

Brunner

B S

Thierij

Jakob

, et al.

3D-printed Heart models for hands-on training in pediatric cardiology – the future of modern learning and teaching?

GMS J Med Educ. 2022;39(2):Doc23. https://doi.org/10.3205/zma001544

Asif

Lee

Caputo

Biglino

Shearn

AIU

. Role of 3D printing technology in paediatric teaching and training: A systematic review. BMJ Paediatr Open. 2021;5(1):e001050. https://doi.org/10.1136/bmjpo-2021-001050

King

WTY

Schrijver

Parimi

. 3D-printed heart valves: Challenges and opportunities [Poster presentation]. Journal of the American College of Cardiology. 75(11 Suppl A):1219–1261.

Guo

H-C

Wang

Dai

Ren

C-W

J-H

Lai

Y-Q

. Application of 3D printing in the surgical planning of hypertrophic obstructive cardiomyopathy and physician-patient communication: A preliminary study. J Thorac Dis. 2018;10(4):2220–2227. https://doi.org/10.21037/jtd.2018.01.55

Nicholls

. Three-dimensional imaging and printing in cardiology. Eur Heart J. 2017;38(4):230–231. 10.1093/eurheartj/ehw668

10.

Vukicevic

Mosadegh

Min

Little

. Cardiac 3D printing and Its future direction. JACC: Cardiovascular Imaging. 2017;10(2):172–183.

11.

Hovis

Ahlers

Dilbone

, et al. Efficacy of utilizing 3D printed models for preoperative surgical planning of open reduction, internal fixation of distal humerus fractures . Ann 3D Print Med. 2022;5:100047.

12.

Michiels

Sarrazin

Faessel

, et al. Apport de l'impression 3D a la chirurgie renale min-invasive: pour l'information preoperatoire specifique - patient et pour l'enseignement de la lecture du scanner. Progre en Urologie. 2018;28(3):674–675.

13.

do Espirito Santo

Coelho

Kunkel

. Advancements in cardiac biomodels using 3D printing and bioprinting. Res Biomed Eng. 2025;41(1):18.

14.

Faza

Harb

Wang

van den Dorpel

MMP

Van Mieghem

Little

. Physical and computational modeling for transcatheter structural heart interventions. JACC: Cardiovasc Imag. 2024;17(4):428–440. https://doi.org/10.1016/j.jcmg.2024.01.014

15.

Shabbak

Masoumkhani

Fallah

, et al. 3D Printing for cardiovascular surgery and intervention: A review article. Curr Probl Cardiol. 2023;48(12):102086. https://doi.org/10.1016/j.cpcardiol.2023.102086

16.

Farooqi

Pasumarti

Shah

Crystal

. Use of advanced 3D modelling and printing for congenital heart disease at a large surgical center. Eur Heart J – Cardiovasc Imaging. 2023;24(Supplement_1):jead119.101.

17.

Suvorov

Loboda

Balakina

Kulczycki

. A new three-dimensional (3D) printing prepress algorithm for simulation of planned surgery for congenital heart disease. Congenit Heart Dis. 2023;18(5):491–505. https://doi.org/10.32604/chd.2023.030583

18.

Bharucha

Moore

Carnahan

, et al. Three-dimensional printing in modelling mitral valve interventions. Echo Res Practice. 2023;10:12. https://doi.org/10.1186/s44156-023-00024-x

19.

Chessa

Van De Bruaene

Farooqi

, et al. Three-dimensional printing, holograms, computational modelling, and artificial intelligence for adult congenital heart disease care: An exciting future. Eur Heart J. 2022;43(28):2672–2684. https://doi.org/10.1093

20.

Seckeler

M D

Webber

Fox

K A

. Using 3D printed heart models for surgical and catheterization planning in congenital heart disease. Curr Treat Options Pediatr. 2022;8(3):115–128. https://doi.org/10.1007/s40746-022-00238-x

21.

White

Sedler

Jones

Seckeler

. Utility of three-dimensional models in resident education on simple and complex intracardiac congenital heart defects. Congenit Heart Dis. 2018;13(6):1045–1049. https://doi.org/10.1111/chd.12673

22.

Riggs

Dsouza

Broderick

Moore

Morales

DLS

. 3D-printed Models optimize preoperative planning for pediatric cardiac tumor debulking. Transl Pediatr. 2018;7(3):196–202. https://doi.org/10.21037/tp.2018.06.01

23.

Bartel

Rivard

Jimenez

Mestres

Müller

. Medical three-dimensional printing opens up new opportunities in cardiology and cardiac surgery. Eur Heart J. 2017;38(1):1–9. https://doi.org/10.1093

24.

Vukicevic

Mosadegh

Min

Little

. Cardiac 3D printing and its future directions. JACC: Cardiovasc Imaging. 2017;10(2):201–211.

25.

Crafts

Ellsperman

Wannemuehler

Bellicchi

Shipchandler

Mantravadi

. Three-dimensional printing and its applications in otorhinolaryngology– head and neck surgery. Otolaryngol–Head Neck Surg. 2016;156:999–1010. https://doi.org/10.1177/0194599816678372

26.

Marella

Gil

Fan

, et al. 3D-Printed Cardiac models for fetal counseling: A pilot study and novel approach to improve communication. Pediatr Cardiol. 2023;44(8):1800–1807. https://doi.org/10.1007/s00246-023-03177-y

27.

Awori

Friedman

Chan

, et al. 3D Models improve understanding of congenital heart disease. 3D Print Med. 2021;7:26. https://doi.org/10.1186/s41205-021-00115-7

28.

Lau

Sun

. Three-dimensional printing in congenital heart disease: A systematic review. J Med Radiat Sci. 2018;65:226–236. https://doi.org/10.1002/jmrs.268

29.

Fakhoury

Ellabban

Attia

Sallam

Elsherbiny

. Three-dimensional printing in opthalmology and eye care: current applications and future developments. Ther Adv Ophthalmol. 2022;14. 10.1177/25158414221106682

30.

McGovern

Tretter

Moore

Goldstein

. Simulation to success. JACC: Case Rep. 2020;2:486–487. https://doi.org/10.1016/j.jaccas.2019.11.078

31.

Barboza de Oliveira

dos Santos

Brandi

Botelho

PHH

Braile

. Three-dimensional printing: Is it useful for cardiac surgery? Rev Bras Cir Cardiovasc. 2020;35(4):549–554. DOI: 10.21470/1678-9741-2019-0475

32.

Valverde

Gomez-Ciriza

Hussain

, et al. Three-dimensional printed models for surgical planning of complex congenital heart defects: An international multicentre study. Eur J Cardiothorac Surg. 2017;52(6):1139–1148. https://doi.org/10.1093/ejcts/ezx208

33.

Farooqi

Cooper

Chelliah

, et al. 3D printing and heart failure: The present and the future. JACC Heart Fail. 2019;7(2):132–144.

34.

Anwar

Singh

Varughese

, et al. 3D printing in complex congenital heart disease. JACC: Cardiovasc Imaging. 2017;10:953–956. https://doi.org/10.1016/j.jcmg.2016.03.013

35.

Loke

Y-H

Harahsheh

Krieger

Olivieri

. Usage of 3D models of tetralogy of fallot for medical education: Impact on learning congenital heart disease. BMC Med Educ. 2017;17(1):54. 10.1186/s12909-017-0889-0

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

1.61 MB