In a development that could reshape how the world’s most delicate heart operations are planned, researchers have shown that fusing three different medical imaging technologies into a single 3D-printed heart model gives pediatric cardiac surgeons a markedly better grasp of complex congenital heart defects than the single-modality models they have relied on until now. The study, published in the journal 3D Printing in Medicine, also arrives at a striking and somewhat counterintuitive conclusion: the biggest beneficiaries of these valve-integrated models are the surgeons who will hold the scalpel, not the imaging cardiologists who interpret the scans.
Congenital heart disease, or CHD, affects roughly one in every hundred newborns worldwide, and the most severe forms involve intricate malformations of the heart’s chambers, great vessels, and valves. Operating on such hearts demands an exhaustive preoperative understanding of anatomy that can vary enormously from one patient to the next. Over the past decade, 3D-printed heart models built from computed tomography (CT) or cardiac magnetic resonance (CMR) scans have become increasingly common tools for surgical planning, allowing surgeons to hold a tangible replica of an individual patient’s heart before ever entering the operating room. The clinical benefit of these models has been established and shown to be reproducible. What has remained elusive, however, is anatomical fidelity at the level of the cardiac valves—structures that are notoriously difficult to capture with traditional cross-sectional imaging because they move with every heartbeat.
The new research, led by Jose Carlos Villalobos-Lizardi and Israel Valverde of The Hospital for Sick Children in Toronto, together with colleagues including Shi-Joon Yoo, Luc Mertens, and a team of cardiovascular surgeons, set out to close that gap. The investigators integrated datasets from three complementary imaging modalities—cardiac CT, cardiac magnetic resonance imaging, and three-dimensional echocardiography—into unified digital models, which were then 3D printed for ten pediatric patients with complex CHD. The inclusion of 3D echocardiographic data was the critical innovation. While CT and CMR excel at depicting static anatomy such as chamber size, vessel course, and surrounding structures, echocardiography is uniquely suited to visualizing the moving apparatus of the atrioventricular valves—the mitral and tricuspid valves—and the subvalvular structures, including the papillary muscles and chordae tendineae that anchor the valve leaflets within the ventricles.
The fusion process required sophisticated image processing. Datasets from each modality were segmented, meaning that the structures of interest were digitally isolated and rendered as three-dimensional surfaces, and then spatially registered to one another so that the valve information derived from echocardiography could be overlaid precisely onto the CT- and CMR-derived anatomy. The result was a composite digital model in which the atrioventricular valve leaflets, annuli, and supporting subvalvular apparatus appeared integrated with the rest of the cardiac anatomy, ready for printing. The researchers report that they successfully generated these multimodality fusion models for all ten patients in the study, demonstrating that the workflow is technically feasible in a clinical setting rather than merely in principle.
To determine whether the added valve detail actually translated into clinical value, the team assembled a panel of ten faculty evaluators: seven pediatric cardiologists with advanced expertise in cardiac imaging and three pediatric cardiothoracic surgeons. Each evaluator assessed the ten patient-specific models using a structured questionnaire based on Likert scales, a survey format in which respondents rate their agreement or satisfaction on a fixed numerical scale. The questions probed two domains in particular: how well the models supported anatomical understanding, and how useful they were for preoperative surgical planning.
The results revealed a clear split between the two professional groups. Surgeons assigned significantly higher ratings than imagers to the valve-integrated fusion models for anatomical understanding, with a median score of 5 out of 5 compared with 4 out of 5 for the imaging cardiologists—a difference the authors report as statistically significant, with a p-value of 0.002. A p-value of this magnitude indicates that the likelihood of observing such a difference by chance alone is less than one percent, lending statistical weight to what the evaluators reported subjectively. The surgeons also rated the models more favorably for surgical planning. The pattern suggests that the incremental valve detail, which adds information beyond what conventional single-modality models provide, carries particular weight for those whose decisions in the operating room depend on seeing the fine structure of the valves and the muscles and tendons beneath them.
Why would imagers be less enthusiastic about the very structures they themselves helped to reconstruct? The authors’ framing of the finding—that the greater incremental benefit accrues to surgeons than to cardiac imagers—points to a plausible explanation embedded in the nature of each profession. Imaging cardiologists already work daily with dynamic echocardiographic displays and cross-sectional scans; they are accustomed to mentally reconstructing valve anatomy from moving images, and for them a static printed replica may represent a modest supplement rather than a revelation. Surgeons, by contrast, traditionally enter the operating room with mental images assembled from multiple two-dimensional sources. For this group, a physical model that renders the valve apparatus in three dimensions—something that previously could only be inferred—offers a genuinely new preoperative experience, one that can influence the choice of surgical technique, the planning of valve repair strategies, and the anticipation of spatial relationships that are difficult to appreciate on a flat screen.
The technical achievement underlying the study should not be understated. Atrioventricular valves are complex, dynamic structures whose leaflets billow and coapt with each cardiac cycle. Capturing them requires electrocardiogram-gated 3D echocardiography, which acquires volumetric ultrasound data synchronized to the heart’s motion. Fusing this soft-tissue-rich ultrasound information with the high spatial resolution of CT and the tissue-characterization strengths of CMR demands careful attention to segmentation accuracy and registration alignment. Any misalignment between modalities would produce a misleading model, potentially worse than no model at all. That the team produced usable, valve-integrated models for all ten patients suggests that the fusion pipeline can be reproduced by other centers with the requisite imaging and printing infrastructure.
The findings arrive at a moment when 3D printing in medicine is transitioning from novelty to standard of care in select domains. In complex CHD, printed models have been credited with shortening operative times, reducing the need for intraoperative exploration, and improving communication among members of the surgical team and with families. By shifting the research focus from whether such models help—now treated as established—to how they can be made more anatomically faithful, the Toronto study exemplifies a maturing field turning its attention to refinement. Valve-integrated models may prove especially consequential for lesions in which atrioventricular valve anatomy dictates the surgical approach, such as atrioventricular septal defects, functionally single-ventricle hearts undergoing atrioventricular valve repair, and complex forms of congenital mitral valve disease.
The study does carry limitations inherent to its design. As a feasibility study with ten patients and ten evaluators, it was small, and the imbalance between seven imagers and three surgeons complicates the statistical comparison between groups. The evaluators’ assessments were also subjective perceptions of utility rather than blinded measures of downstream outcomes such as operative time or surgical complications. Future work, the authors and outside observers alike would agree, should test whether these models translate into measurable intraoperative and clinical benefits in larger, ideally multi-institutional cohorts.
Even so, the message of the study is likely to resonate widely among pediatric heart teams. Multimodality fusion 3D printing—once an ambitious engineering exercise—now appears to be a practical reality, and one whose value is felt most keenly by the people standing over the open chest. For children born with the most complex heart defects, whose operations leave little room for surprise, a model that shows not just the shape of the heart but the architecture of its valves may mean the difference between a planned repair and an improvised one. The study, published as an open-access article, signals that the era of the truly complete printed heart—one that includes the structures that make it beat and seal—may be closer than many in the field had dared to expect.
Subject of Research: Multimodality fusion 3D echocardiography–CT/CMR imaging to create atrioventricular valve–integrated 3D-printed heart models for surgical planning in complex congenital heart disease
Subject of Research: Medicine
Article Title: 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
Article References: Villalobos-Lizardi, J. C., Yoo, S.-J., Peel, B., Bertelli, F., Dragulescu, A., Arbic, N., Barron, D., Honjo, O., Haller, C., Daskalo, C., Mertens, L., & Valverde, I. (2026). 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. 3D Printing in Medicine, 12(1), Article 16. https://doi.org/10.1186/s41205-026-00324-y
Image Credits: AI Generated
DOI: 10.1186/s41205-026-00324-y
Keywords: 3D printing, congenital heart disease, 3D echocardiography, CT-CMR fusion, atrioventricular valves, surgical planning, pediatric cardiology, heart models
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Ophelia Keating. (September 5, 2026). Fusion imaging 3D printed heart models aid surgeons more than imagers. Scienmag. https://scienmag.com/fusion-imaging-3d-printed-heart-models-aid-surgeons-more-than-imagers/
Ophelia Keating. “Fusion imaging 3D printed heart models aid surgeons more than imagers.” Scienmag, 5 September 2026, https://scienmag.com/fusion-imaging-3d-printed-heart-models-aid-surgeons-more-than-imagers/. Accessed 5 September 2026.
Ophelia Keating. “Fusion imaging 3D printed heart models aid surgeons more than imagers.” Scienmag. September 5, 2026. https://scienmag.com/fusion-imaging-3d-printed-heart-models-aid-surgeons-more-than-imagers/
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