3D printed models for planning endovascular stenting in transverse aortic arch hypoplasia

Abstract

Objectives To evaluate whether three‐dimensional (3D) printed models can be used to improve interventional simulation and planning in patients with aortic arch hypoplasia. Background: Stenting of a hypoplastic transverse arch is technically challenging, and complications such as stent migration and partial obstruction of the origin of the head and neck vessels are highly dependent on operator skills and expertise. Methods: Using magnetic resonance imaging (MRI) data, a 3D model of a repaired aortic coarctation of a 15‐year‐old boy with hypoplastic aortic arch was printed. Simulation of the endovascular stenting of the hypoplastic arch was carried out under fluoroscopic guidance in the 3D printed model, and subsequently in the patient. A Bland–Altman analysis was used to evaluate the agreement between measurements of aortic diameter in the 3D printed model and the patient's MRI and X‐ray angiography. Results: The 3D printed model proved to be radio‐opaque and allowed simulation of the stenting intervention. The assessment of optimal stent position, size, and length was found to be useful for the actual intervention in the patient. There was excellent agreement between the 3D printed model and both MRI and X‐ray angiographic images (mean bias and standard deviation of 0.36 ± 0.45 mm). Conclusions: 3D printed models accurately replicate patients' anatomy and are helpful in planning endovascular stenting in transverse arch hypoplasia. This opens a door for potential simulation applications of 3D models in the field of catheterization and cardiovascular interventions. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Utilisation of three-dimensional printed heart models for operative planning of complex congenital heart defects

“…The 3D heart models can also facilitate transcatheter interventions in patients with congenital heart defects [1,8,12]. We successfully used 3D models for catheter interventional planning in two patients with aortopulmonary collaterals and abnormalities of pulmonary artery branches.…”

“…Three-dimensional model printing has become an established complementary imaging technique in paediatric cardiology in recent years, as well [3,4]. The high accuracy of 3D printing in paediatric cardiology has been already acknowledged by the perfect correlation between the calliper model measurements and the patient's MRI measurements at analogous anatomical locations, with mean differences of only 0.18 ± 0.38 mm, and 0.12 ± 1.40 mm, respectively [3,8]. We certified the precise accuracy of cardiovascular 3D printing in our study by a high correlation of dimension measurements between 3D heart models and digital images (+0.19 ± 0.38 mm, mean bias ± standard deviation), as well as between in vivo surgery and a 3D heart model at analogous anatomical locations (+0.13 ± 0.26 mm, mean bias ± standard deviation).…”

Trends in Congenital Heart Disease

“…Three-dimensional printing techniques are already being used in demonstration for planning of complex surgical maneuvers in CHD (Figure 4), 39 and the development of anatomically specific valve and vascular prostheses will also likely make use of this technology. 40 Such innovation in this area will be further advanced and supported by exploration of the use of volume imaging technologies such as MRI for computational assessment of ventricular function, 41 hemodynamics, [42][43][44] outcome risk 41,45 and possibly even as a direct navigational tool for cardiac intervention 46 We also expect to see further development of novel robotic tools and augmented reality platforms for catheter-based and other less invasive cardiac interventions.…”

Three-dimensional printing in cardiology: Current applications and future challenges

“…3D TTE/TEE Left atrial appendage occlusion [14], postoperative hemodynamic testing following MitraClip procedure [41] MRI TGA, VSD, PS [42], DORV [43], hypoplastic aortic arch [44], aortic arch aneurysm [45], pulmonary atresia, ASD, tricuspid regurgitation, dextrocardia [46], retroesophageal LSA + right aortic arch [47] MSCT ASD [48,49], VSD [50], LAA occlusion [51], severe AS [52], extensive AA [53], severe mitral valve regurgitation [54], neopulmonary stenosis [55], primary dilated cardiomyopathy [56], primary cardiac schwannoma [57], double-chambered right ventricle [58], severe pulmonary venous stenosis [59], complex aortic obstruction [60], juxtarenal AA [61], DOLV, VSD, PS [62], left atrium osteosarcoma [63], hypertrophic cardiomyopathy [64], prosthetic MV perivalvular leak [65], ventricular aneurysm [66], pulmonary venous baffle to the systemic right ventricle [67], tricuspid atresia [67], His bundle pacing [68] AA -atherosclerotic aneurysm; rest abbreviations are the same with the Table 1 www.cardiologyjournal.org three challenges are discussed which need to be addressed in the future.…”