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A 32-year-old, lean-built female presented with major complaints of heart failure (class II-III) ongoing for 4 months. She had experienced palpitations for 3 months, which was predominantly exertional, lasting for about 2 to 3 minutes, associated with dyspnea and sweating. No history of presyncope/syncope or cyanotic spells was observed, and no significant past medical history or family history was noted. Elsewhere, she had been diagnosed with severe PAH at 31 years of age, and was referred for further evaluation and management. A physical examination yielded normal vital signs. An electrocardiogram revealed biventricular hypertrophy with right atrial enlargement. A chest X-ray showed cardiomegaly with bilaterally-dilated pulmonary arteries. A transthoracic echocardiogram revealed a dilated right atrium, right ventricle, and main pulmonary artery; severe tricuspid regurgitation; a pulmonary artery systolic pressure of 125 mm Hg; severe PAH (pulmonary vascular resistance index: 20 dyn.s/cm5.m2) with good left ventricular systolic function; and an intact interventricular/interatrial septum. Multi-detector computed tomography (CT) with CT pulmonary angiography of the chest revealed no evidence of pulmonary thromboembolism, but showed the presence of a large APW with severe PAH (Fig. 1a, 1b, Fig. 2a). Subsequent cardiac magnetic resonance imaging (CMRI) revealed a large APW (3 cm, type I Mori classification) with severe PAH and right ventricular dysfunction (Fig. 2b, 2c). Flow studies from the CMRI revealed a predominant left-to-right shunt. The patient was scheduled for a catheterization study, followed by device/surgical closure. To more precisely evaluate the anatomical defect and to assess the feasibility of device closure/surgical closure, 3-dimensional (3D) printing technology (Anatomiz3D Healthcare, Mumbai, India) was utilized. The solid 3D anatomical model of the patient’s heart (Fig. 3a, 3b) revealed that the anatomical defect did not have an inner rim (Fig. 3c) and was not ideal for device closure. This was of use in the decision to consider surgical closure. Accordingly, a catheterization study was done. However, the patient was not considered suitable for surgical closure, as she exa

A case of asymptomatic large aortopulmonary window in an adult: Role of cardiac CT, CMRI, and 3D printing technology