Feasibility of 3D echocardiography–CT/CMR fusion to create atrioventricular valve–integrated 3D printed heart models in complex congenital heart disease: greater incremental benefit for surgeons than cardiac imagers

BACKGROUND: Given the established and reproducible benefit of 3D-printed models in complex congenital heart disease (CHD) surgical planning, the focus has shifted from validating their utility to refining anatomical fidelity through enhanced imaging integration. The purpose of this study is to evaluate the perceived clinical utility of multimodality fusion 3D-printed cardiac models and to determine whether inclusion of valve structures confers incremental benefit over conventional single-modality 3D models in enhancing anatomical understanding and preoperative surgical planning among pediatric cardiac surgeons and imaging cardiologists in complex CHD. METHODS: In this feasibility study, multimodality fusion 3D models were successfully generated by integrating cross-sectional imaging (cardiac computed tomography and magnetic resonance) with 3D echocardiographic datasets to reproduce atrioventricular valve apparatus and subvalvular structures in 10 pediatric patients with complex CHD. Ten faculty members (7 pediatric cardiologists with advanced imaging expertise and 3 pediatric cardiothoracic surgeons) evaluated 10 patient-specific models using a structured Likert questionnaire. RESULTS: Surgeons assigned significantly higher ratings than imagers for anatomical understanding (median 5 vs 4; p = 0.002) and surgical planning (p < 0.001). Participants agreed that multimodality models are most valuable in complex congenital heart disease, particularly in cases requiring ventricular septal defect patching or intraventricular baffle repair involving the subvalvular apparatus. CONCLUSION: Multimodality imaging fusion for 3D printing is technically feasible and produces high-quality models with strong intraoperative correlation. Incorporation of atrioventricular valve anatomy provides meaningful incremental benefit-particularly for surgeons-enhancing operative planning in complex CHD.