1. The role of imaging, deliberate practice, structure, and improvisation in approaching surgical perfection 
Joseph A. Dearani, MD, Michael Gold, PhD, Bradley C. Leibovich, MD, K. Anders Ericsson, PhD, Kamal R. Khabbaz, MD, Thomas A. Foley, MD, Paul R. Julsrud, MD, Jane M. Matsumoto, MD, Richard C. Daly, MD 
The Journal of Thoracic and Cardiovascular Surgery 
Volume 154, Issue 4, Pages (October 2017)
DOI: /j.jtcvs
Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

2. Figure 1
3D virtual printed model of a heart with Ebstein anomaly. RV, Right ventricle.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

3. Figure 2
A, 3D printed model of a normal MV (shown in blue) obtained from CT imaging data. B, 3D TEE of the MV from the left atrial perspective. The black arrow is pointing at a flail middle scallop of the anterior mitral leaflet (A2) with several torn chordae tendineae also seen attached to the flail scallop.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

4. Figure 3
Using 3D printed MV in a hemodynamic testing chamber. A, Data from the 3D TEE machine are obtained and converted to Cartesian DICOMs using Philips Qlab (Philips Medical Systems, Andover, Mass). B, The data are then imported into Mimics (Materialise, Leuven, Belgium) for segmentation of the MV. Once segmented, the data are exported as a stereo lithography file to 3matic (Materialise, Leuven, Belgium) and loaded onto a flange (C) that is used to generate a flexible silicone model of the MV (D), which could then be used for hemodynamic testing in the pulse duplicator (E).
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

5. Figure 4 The effect of DP for a professional violinist.1
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

6. Figure 5 Contrast of the structure/improvisation continuum.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

7. Figure 6
The structure/improvisation continuum in music, sports, and life. Some professions are intrinsically more structured, whereas others require more improvisation.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

8. Figure 7
Structure/improvisation continuum with cardiac surgical procedures. Some are predictable and reproducible, and others are more variable. Advanced imaging and DP can facilitate moving the operation more leftward. VSD, Ventricular septal defect; CABG, coronary artery bypass grafting; Tx, transplant; DCM, dilated cardiomyopathy; PA, pulmonary atresia; MAPCA, major aortopulmonary collateral; PV, prosthetic valve; AVSD, atrioventricular septal defect.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

9. When art meets science…the overlap of practice, surgery, structure and improvisation.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions