As DORV presents with anatomical and hemodynamic variations, surgical management varies and it is necessary to choose the optimal strategy based on individual cases. BVR is recommended in cases wherein both the right and left ventricles are balanced and well-functioning, as Fontan circulation may not be safe and stable in the long term. However, in cases of DORV involving a complex anatomy, it is difficult to select the optimal surgical strategy.

Bradley et al. [1] reported that BVR, particularly Rastelli-type reconstruction, is associated with higher late mortality and reintervention than Fontan repair. On the other hand, Oladunjoye et al. [2] reported that BVR for DORV with complex anatomy resulted in acceptable midterm outcomes with low mortality. However, freedom from surgical reintervention for LVOTS was low after BVR.

Thus, in patients having DORV with a complex anatomy, it is required to thoroughly understand the precise intracardiac structures and carefully consider an operative plan with preferable consequences and fewer complications. A 3D-printed heart model precisely replicates the anatomical structure of congenital heart disease and enables an easier preoperative evaluation. Shiraishi et al. [3] created a flexible stereolithographic biomodel using rubber-like urethane which enabled preoperative simulation of individual surgical operations. Furthermore, they developed superflexible polyurethane heart models similar to our model in the present case which have realistic flexibility that enables retraction, incision, and suturing for preoperative simulation. Hoashi et al. [4] created 3D-printed heart models for preoperative surgical simulation in 20 patients including those with DORV, and reported that 3D-printed heart models are useful for understanding the relationship between intraventricular communications and great vessels and for simulations to create intracardiac pathways. Zhao et al. [5] reported that surgical planning based on 3D printing could decrease bypass and cross-clamp times during surgery.

In the present case, the use of a 3D-printed heart model facilitated the decision-making of a surgical plan and the performance of UVR that avoids complications after BVR. A 3D-printed heart model can be a useful alternative in patients whose repair strategy (i.e., BVR or UVR) is difficult to judge similar to our case.