Unraveling postoperative alterations after mitral valve replacement with three-dimensional printing

Mitral valve (MV) surgery is the second most performed valve operation in Europe. MV pathology is associated with atrial fibrillation, and, therefore, frequently combined with rhythm surgery and left atrial appendage exclusion (LAAE). Currently, no guidelines exist regarding the follow up after LAAE postoperative. Postoperative imaging with computed tomography (CT), in the absence of complaints, will inherently reveal unsuspected cardiac and noncardiac findings with potential clinical significance. However, poststernotomy alterations are nonspecific and often overlap with normal postoperative changes and could, therefore, not directly be recognized. Virtual three-dimensional (3D) CT reconstructions can help us to visualize 2D structures, especially in areas where structures overlap like coronary arteries or when devices (atrial clip, MV prosthesis) cause scattering artifacts. Advanced imaging reconstructions and 3D printing can enhance understanding of the cardiac anatomy in the postoperative phase and help us to determine follow-up strategies.