Domain expert evaluation of advanced visual computing solutions and 3D printing for the planning of the left atrial appendage occluder interventions

Mill, Jordi; Montoliu, Helena; Moustafa, Abdel H.; Olivares, Andy L.; Albors, Carlos; Aguado, Ainhoa M.; Medina, Elodie; Ceresa, Mario; Freixa, Xavier; Arzamendi, Dabit; Cochet, Hubert; Cámara, Óscar

doi:10.18063/ijb.v9i1.640

Cited by 6 publications

(3 citation statements)

References 38 publications

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“…Mill et al . ( 4 ) analyzed the utility of different computer-based technologies for preprocedural planning of LAAC. The authors underlined different strengths of each modality.…”

Section: Discussionmentioning

confidence: 99%

“…Advances in multimodal imaging have been a cornerstone for the evolution of minimally invasive interventional procedures (1). Virtual reality (VR) visualization of the heart is a novel technique in planning of interventional procedures such as left atrial appendage closure (LAAC), promising a better understanding of patient-specific complex anatomy and an increase in precision of depth and scaling (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

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Left atrial appendage sizing for percutaneous closure in virtual reality—a feasibility study

Heidari,

Kanschik,

Erkens

et al. 2023

Front. Cardiovasc. Med.

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Background and aimsThe complex and highly variable three-dimensional anatomy of the left atrial appendage (LAA) makes planning and device sizing for interventional occlusion procedures (LAAC) challenging. Several imaging modalities [e.g. echocardiography, multi-slice computed tomography (MSCT)] are used for this purpose. Virtual reality (VR) is an emerging imaging technique to immerse into a three-dimensional left atrium and appendage, offering unprecedented options of visualization and measurement. This study aimed to investigate the feasibility, accuracy and reproducibility of visualizing the LAA in VR for preprocedural planning of LAAC.Methods and resultsTwenty-one patients (79 ± 7 years, 62% male) who underwent LAAC at University Hospital Düsseldorf were included in our study. A dedicated software generated three-dimensional VR models from preprocedural MSCT imaging data. Conventional measurements of LAA dimensions (ostium, landing zone and depth) using a commercially available software were compared to measurements in VR: MSCT and VR ostium min. (r = 0.93), max. (r = 0.80) and mean (r = 0.88, all p < 0.001) diameters as well as landing zone (LZ) min. (r = 0.84), max. (r = 0.86) and mean diameters (r = 0.90, all p < 0.001) showed strong correlations. Three-dimensional orientation was judged superior by physicians in VR compared to MSCT (p < 0.05).ConclusionVirtual reality visualization of the left atrium and appendage based on MSCT data is feasible and allows precise and reproducible measurements in planning of LAA occlusion procedures with enhanced 3D orientation. Further studies need to explore additional benefits of three-dimensional visualization for operators in preprocedural planning.

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“…Mill et al . ( 4 ) analyzed the utility of different computer-based technologies for preprocedural planning of LAAC. The authors underlined different strengths of each modality.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Left atrial appendage sizing for percutaneous closure in virtual reality—a feasibility study

Heidari,

Kanschik,

Erkens

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…Furthermore, adequate preprocedural imaging may reduce deployment attempts and the average number of devices used per patient (8). Advanced technologies offering true 3D visualization of the LAA have gained attention recently (9)(10)(11). Among these, 3D printing may precisely visualize patient-specific anatomy of the left atrium and LAA (12) and has shown to improve procedural parameters in LAAC (13).…”

Section: Introductionmentioning

confidence: 99%

A comparison of conventional and advanced 3D imaging techniques for percutaneous left atrial appendage closure

Heidari,

Kanschik,

Maier

et al. 2024

Front. Cardiovasc. Med.

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BackgroundUnderstanding complex cardiac anatomy is essential for percutaneous left atrial appendage (LAA) closure. Conventional multi-slice computed tomography (MSCT) and transesophageal echocardiography (TEE) are now supported by advanced 3D printing and virtual reality (VR) techniques for three-dimensional visualization of volumetric data sets. This study aimed to investigate their added value for LAA closure procedures.MethodsTen patients scheduled for interventional LAA closure were evaluated with MSCT and TEE. Patient-specific 3D printings and VR models were fabricated based on MSCT data. Ten cardiologists then comparatively assessed LAA anatomy and its procedure relevant surrounding structures with all four imaging modalities and rated their procedural utility on a 5-point Likert scale questionnaire (from 1 = strongly agree to 5 = strongly disagree).ResultsDevice sizing was rated highest in MSCT (MSCT: 1.9 ± 0.8; TEE: 2.6 ± 0.9; 3D printing: 2.5 ± 1.0; VR: 2.5 ± 1.1; p < 0.01); TEE, VR, and 3D printing were superior in the visualization of the Fossa ovalis compared to MSCT (MSCT: 3.3 ± 1.4; TEE: 2.2 ± 1.3; 3D printing: 2.2 ± 1.4; VR: 1.9 ± 1.3; all p < 0.01). The major strength of VR and 3D printing techniques was a superior depth perception (VR: 1.6 ± 0.5; 3D printing: 1.8 ± 0.4; TEE: 2.9 ± 0.7; MSCT: 2.6 ± 0.8; p < 0.01). The visualization of extracardiac structures was rated less accurate in TEE than MSCT (TEE: 2.6 ± 0.9; MSCT: 1.9 ± 0.8, p < 0.01). However, 3D printing and VR insufficiently visualized extracardiac structures in the present study.ConclusionA true 3D visualization in VR or 3D printing provides an additional value in the evaluation of the LAA for the planning of percutaneous closure. In particular, the superior perception of depth was seen as a strength of a 3D visualization. This may contribute to a better overall understanding of the anatomy. Clinical studies are needed to evaluate whether a more comprehensive understanding through advanced multimodal imaging of patient-specific anatomy using VR may translate into improved procedural outcomes.

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Multiphase patient-specific simulations to study fibrillation-induced thrombosis in the left atrial appendage

Bouchnita,

Volpert,

Kozulinas

et al. 2024

Physics of Fluids

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Thrombosis commonly develops in the left atrial appendage of patients with atrial fibrillation. The formation of blood clots in atrial appendage is a complex process, which depends on the shape of the appendage, the velocity of blood flow, the concentrations of red blood cells, platelets, and coagulation, among other factors. In this work, we present a new methodology to identify the key factors contributing to clot formation in the left atrial appendage during atrial fibrillation. The new methodology combines computed tomography imaging, computational fluid dynamics, mesh processing, and multiphase thrombosis modeling. We begin by running simulations to investigate flow patterns inside the left atrial appendages with realistic geometries. Our simulations suggest that at the entrance of the left atrial appendage, the flow forms vortices, which can intrude inside the appendage depending on the phases of the cardiac cycle. Next, we introduce blood coagulation and consider different scenarios corresponding to physiological values of blood flow velocity, geometry of the left atrial appendage, and hematocrit values. Numerical results suggest that the chances of clot formation are higher in the “cactus” geometry than in the “chicken-wing” one, in agreement with the literature. Furthermore, they suggest that slower flow circulation facilitates the development of a clot in the depth of the left atrial appendage. Slower blood movement also favors the procoagulant activity of platelets, while faster flow circulation enhances the procoagulant effect from erythrocytes. Finally, our simulations show that increased hematocrit upregulates the generation of fibrin polymer, regardless of flow velocity.

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Domain expert evaluation of advanced visual computing solutions and 3D printing for the planning of the left atrial appendage occluder interventions

Cited by 6 publications

References 38 publications

Left atrial appendage sizing for percutaneous closure in virtual reality—a feasibility study

Left atrial appendage sizing for percutaneous closure in virtual reality—a feasibility study

A comparison of conventional and advanced 3D imaging techniques for percutaneous left atrial appendage closure

Multiphase patient-specific simulations to study fibrillation-induced thrombosis in the left atrial appendage

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