Unifocalization of Major Aortopulmonary Collateral Arteries (MAPCAs) and Native Pulmonary Arteries in Infancy-Application of 3D Printing and Virtual Reality

Abstract

Background: Major aortopulmonary collateral arteries (MAPCAs) are rare remnants of pulmonary circulation embryological development usually associated with complex congenital anomalies of the right ventricular outflow tract and pulmonary arteries. Effective management requires surgical unifocalization of MAPCAs and native pulmonary arteries (NPAs). Traditional imaging may lack the spatial clarity needed for precise surgical planning.

Aim: This study evaluated the feasibility of integrating three-dimensional (3D) printing and virtual reality (VR) into preoperative planning to improve surgical precision, team communication, and parental understanding. In a prospective cohort study, nine infants undergoing MAPCA unifocalization were included. Four patients underwent conventional imaging-based planning (control), while five were additionally assessed using VR and 3D-printed models (intervention). The outcomes measured included operative times, team confidence, collaboration, and parental satisfaction. Statistical analysis was performed using standard tests.

Results: The intervention group had shorter operative and cardiopulmonary bypass times compared to the control group. Intraoperative complications were absent in the VR/3D group but occurred in the control group. Medical staff in the VR/3D group reported significantly improved understanding of anatomy, surgical preparedness, and team collaboration (p < 0.05). Parents also expressed higher satisfaction, with better comprehension of their child's anatomy and surgical plan.

Conclusions: VR and 3D printing enhanced preoperative planning, surgical precision, and communication, proving valuable for complex congenital heart surgery. These technologies offer promising potential to improve clinical outcomes and patient-family experiences, meriting further investigation in larger studies.

Keywords: congenital heart defect; major aortopulmonary collateral artery; unifocalization.

Figure 1

An example of a 3D-printed model of a patient with tetralogy of Fallot and multiple major aortopulmonary collateral arteries (MAPCAs). A prominent circumflex vessel is visible, originating from the right subclavian artery, along with MAPCAs branching from the descending aorta.

Figure 2

Three-dimensional reconstruction of the heart and lungs showcasing the topography of all detected MAPCAs. This model provides a comprehensive view of the vascular pathways, clearly delineating the origins, routes, and connections of each MAPCA with the native pulmonary arteries, offering a precise anatomical map to aid in preoperative planning and intraoperative guidance. L: Refers to “Left”; I: Refers to “Inferior”; R: Refers to “Right”; S: Refers to “Superior”.

Figure 3

Virtual reality model, meticulously constructed from computed tomography images of a patient diagnosed with tetralogy of Fallot (TOF), pulmonary trunk agenesis, multiple MAPCAs, and non-confluent pulmonary arteries following a right-sided modified Blalock–Taussig shunt to the right pulmonary artery (RPA) and stenting of the arterial duct to supply the left pulmonary artery (LPA). (A): Anterior view showing the stented arterial duct that supplies the non-confluent LPA, a key anatomical feature providing crucial blood flow to the left lung; (B): Posterior view highlighting the MAPCAs originating from the descending aorta, which are primarily responsible for the blood supply to the right lung; (C): Anterior view detailing the blood supply to the right lung. [#1] Modified Blalock–Taussig shunt linking the RPA to the proximal segment of the brachiocephalic trunk. [#2] Right-sided MAPCA originating from the proximal left subclavian artery and connecting to the native RPA in the right lung hilum (marked in green). [#3.1] A partially visible MAPCA segment arising from the descending aorta; (D): Anterior view further illustrating the MAPCA from the descending aorta ([#3]), which divides proximally into two right-sided branches ([#3.1] and [#3.2]), supplying the same area as the native RPA. Additionally visible are the following: [#4] A distal segment of an R-MAPCA from the right subclavian artery to the right lung’s upper lobe. [#1] Partially visible native RPA. [#2] MAPCA from the left subclavian artery to the right lung. [#4] Distal segment of the MAPCA from the right subclavian artery to the right lung. (E): Posterior view displaying the MAPCA from the descending aorta ([#3]), dividing into branches ([#3.1] and [#3.2]) that converge at the right hilum, overlapping with the area supplied by the native RPA. Also seen are [#2] MAPCA originating from the left subclavian artery. [#4] Middle and distal segments of the MAPCA from the right subclavian artery. L—left, R—right, S—superior, I—inferior.