Comparison of 3D Echocardiogram-Derived 3D Printed Valve Models to Molded Models for Simulated Repair of Pediatric Atrioventricular Valves

Abstract

Mastering the technical skills required to perform pediatric cardiac valve surgery is challenging in part due to limited opportunity for practice. Transformation of 3D echocardiographic (echo) images of congenitally abnormal heart valves to realistic physical models could allow patient-specific simulation of surgical valve repair. We compared materials, processes, and costs for 3D printing and molding of patient-specific models for visualization and surgical simulation of congenitally abnormal heart valves. Pediatric atrioventricular valves (mitral, tricuspid, and common atrioventricular valve) were modeled from transthoracic 3D echo images using semi-automated methods implemented as custom modules in 3D Slicer. Valve models were then both 3D printed in soft materials and molded in silicone using 3D printed "negative" molds. Using pre-defined assessment criteria, valve models were evaluated by congenital cardiac surgeons to determine suitability for simulation. Surgeon assessment indicated that the molded valves had superior material properties for the purposes of simulation compared to directly printed valves (p < 0.01). Patient-specific, 3D echo-derived molded valves are a step toward realistic simulation of complex valve repairs but require more time and labor to create than directly printed models. Patient-specific simulation of valve repair in children using such models may be useful for surgical training and simulation of complex congenital cases.

Living the heart in three dimensions: applications of 3D printing in CHD

“…Promising results have been achieved both in combining 3D echo with CT or as isolated datasets. [20][21][22] However, a recent study states that CT may be better than echocardiography when the left atrial appendage is the region of interest, to plan device closure in patients with atrial fibrillation. 23 As this field is still developing, new imaging modalities are emerging as possible options for 3D printing.…”

Three-dimensional printing for cardiovascular diseases: from anatomical modeling to dynamic functionality

“…3 Functional 3D models and their coupling with a mock circulatory system. Images in the figure are from the literature [72][73][74] same two materials to create aortic valve complexes, and confirmed their feasibility for ultrasound imaging. Biglino et al [72] made a blood vessel model using TangoPlus, and demonstrated its suitability for fabricating arteries, although its mechanical properties might not be suitable for modeling softer blood vessels.…”

“…Using a rigid 3D model as a mold, a flexible model can alternatively be obtained by painting it with silicone (such as smooth-on, Echoflex). Scanlan et al [73] compared 3D models of the tricuspid valve obtained by the two methods, and reported that both closely replicated the patient's anatomy, while the silicone model was better at simulating the texture of cutting and stitching. Based on the ultrasound images, a mitral valve prolapse model created by Olivia et al [74] using Echoflex 00-30 also had good fidelity to the preoperative three-dimensional echocardiogram.…”

Ex Vivo Model of Functional Mitral Regurgitation Using Deer Hearts

“…The echocardiographic data were analyzed with opensource software for volumetric data navigation 3D Slicer [21] and SlicerHeart extension [22] to navigate and slice the volume with three orthogonal views. Each dataset was navigated to obtain the following views: (i) short axis MV view ( Fig.…”