We report a case of iatrogenic left pulmonary artery–left atrial appendage fistula following percutaneous transluminal angioplasty for residual pulmonary artery stenosis in an 11-year-old boy. This rare complication could have been predicted by understanding the anatomical relationship of these structures. In this study, simulation using three-dimensional printing greatly contributed to successful stent placement.

Before the COVID-19 pandemic erupted onto the world stage, a new narrative was apparently beginning to emerge about the impact of i4.0 and new technologies in general, and three-dimensional printing in particular, on the future of work and employment. This was to have particular geographical implications for the manufacturing sector in particular. Proponents of i4.0 also suggested that this process, particularly in manufacturing, would promote the re-emergence of patterns of clustering. Developments in advanced manufacturing, particularly three-dimensional printing, would accelerate and reinforce these tendencies. This article looks at the role that three-dimensional printing is supposed to play in the new world, and in particular, critically evaluates its role in reinforcing the trend towards deglobalisation on the one hand, and, on the other, new clusters of manufacturing industry.

Innovation Concept: High-acuity, low-occurrence (HALO) procedures require skilled performance as they treat life-threatening conditions and are associated with significant morbidity when performed incorrectly. Simulation has proven useful for deliberate practice in a low stake setting. Tube thoracostomy is amendable to this approach. Commercially available trainers exist but often have limited realism and are prohibitively expensive particularly to non-academic centers. Three-dimensional (3D) printing produces models suitable for simulation, but no current simulator has been developed and validated for tube thoracostomy. The aim of this study was to develop such, a 3D-printed low-fidelity simulator validated for the simulation-based instruction of tube thoracostomy. Methods: The development of the simulator followed an iterative design cycle with collaboration between a design team and an emergency medicine expert. Its validity (face and content) was tested through hands-on practice and surveys completed by 15 acute-care practitioners. Participants performed the procedure on the simulator and then provided feedback through a mixed quantitative/qualitative product evaluation survey on appearance, realism (face validity) and value in procedural training (content validity). Mean values for overall appearance and content validity as a training tool were 4/5 and 4.3/5 respectively. All respondents felt the model was a useful adjunct. All but one stated it was a good replacement for pre-existing trainers. Curriculum, Tool, or Material: The model was initially printed in three parts using an Ultimaker 3 and Axiom Airwolf Dual 3D-printer. The ribcage was created using polylactic acid with polyvinyl alcohol support material. Printed sections were bonded using glue at interfaces requiring no flexibility. Flexible joints were made of varying amounts of thermoplastic polyurethane and thermoplastic elastomer. Skin overlay for the whole model was created with a cut out area for replaceable sections that subjects would incise to insert the chest tube. Skin was casted using platinum cured silicone in a 3D-printed mold. Total cost of all materials was roughly 80 CAD. Conclusion: The simulator was found to be a useful adjunct for the simulation-based practice of tube thoracostomy. As well, users found the model anatomically realistic and avoided high-cost and ethical issues. Further research will focus on optimization based on feedback and development into a multi-functional simulator for other HALO procedures.

A ubiquitous manufacturing (UM) system is used in manufacturing for obtaining the Internet of things solutions and provides location-based manufacturing services. Human-induced uncertainty and early termination are two complications that hamper the effectiveness of an UM system based on three-dimensional (3D) printing. To resolve these complications, several solutions were considered in this study. First, fuzzy-valued parameters were defined to determine uncertainty. Subsequently, slack was derived to determine whether to restart an early terminated 3D printing process in the same 3D printing facility. Consequently, two optimization models – a fuzzy mixed-integer linear programming model and a fuzzy mixed-integer quadratic programming model – were developed in this study. Based on the two optimization models, a fuzzy 3D printing-based UM system that considers uncertainty and early termination was developed. The effectiveness of the proposed methodology was tested by conducting a regional experiment. The experimental results revealed that the proposed methodology could shorten the average cycle time by 9% and could enable 3D printing facilities to make real-time, online reprinting decisions.

Pulmonary artery sling is a congenital cardiovascular disease and is usually accompanied by tracheobronchial stenosis. Generally, infants diagnosed with pulmonary artery sling should have surgery. However, the treatment of tracheobronchial stenosis is still controversial. Our team developed a customised, degradable, three-dimensional printed splint and successfully applied it in the treatment of pulmonary artery sling associated with severe bilateral bronchus stenosis. We suggested that three-dimensional printing may be a novel and effective way to treat tracheobronchial stenosis and other diseases in children.

Recently, three-dimensional printing of heart models is being used to plan percutaneous and surgical interventions in patients with CHD. We describe a case where we used a three-dimensional print model to plan a complex percutaneous intervention in a patient with coarctation of the aorta.

We used three-dimensional printing technology to create an anatomical three-dimensional model of a very rare and complex cyanotic CHD in a newborn, consisting of double-outlet left ventricle, ventricular septal defect, and pulmonary stenosis. This case demonstrates how this new innovative technology allows better understanding of the anatomy in complex CHDs and permits to better plan the surgical repair.