Abstract

A clear understanding by the patient and family of airway pathology caused by vascular rings can be difficult to achieve. The pathology is three-dimensional in nature, and is a compilation of differing anatomic structures. Patient confusion can lead to misunderstandings regarding the nature of the operation, attendant risks, and the expected post-operative course. In this review we describe our use of 3D printing in the setting of circumflex aorta and double aortic arch to help guide a child and their family through the decision for treatment of what can be a difficult problem in both diagnosis and management. Our patient underwent two operations. First, a thoracoscopic division of a left ligamentum and atretic distal left aortic arch. While symptoms improved somewhat post-operatively, moderate dysphagia and dyspnea persisted. Based on further evaluation we concluded that the circumflex aorta was the etiology of the ongoing symptoms, so an aortic uncrossing procedure under circulatory arrest was recommended and performed. We used a 3D model in the education of the patient and family prior to the second surgery and greatly enhanced their understanding of why a repeat operation was required to address an additional component of this complex vascular ring. The use of 3D printing in preoperative discussions facilitated better understanding of complex three dimensional anatomy for the patient and patient's family. In addition, this communication strategy helped frame expectations regarding the post-operative course and convalescence.