Evaluating the morphology of the left atrial appendage by a transesophageal echocardiographic 3-dimensional printed model

Abstract

The novel 3-dimensional printing (3DP) technique has shown its ability to assist personalized cardiac intervention therapy. This study aimed to determine the feasibility of 3D-printed left atrial appendage (LAA) models based on 3D transesophageal echocardiography (3D TEE) data and their application value in treating LAA occlusions.Eighteen patients with transcatheter LAA occlusion, and preprocedure 3D TEE and cardiac computed tomography were enrolled. 3D TEE volumetric data of the LAA were acquired and postprocessed for 3DP. Two types of 3D models of the LAA (ie, hard chamber model and flexible wall model) were printed by a 3D printer. The morphological classification and lobe identification of the LAA were assessed by the 3D chamber model, and LAA dimensions were measured via the 3D wall model. Additionally, a simulation operative rehearsal was performed on the 3D models in cases of challenging LAA morphology for the purpose of understanding the interactions between the device and the model.Three-dimensional TEE volumetric data of the LAA were successfully reprocessed and printed as 3D LAA chamber models and 3D LAA wall models in all patients. The consistency of the morphological classifications of the LAA based on 3D models and cardiac computed tomography was 0.92 (P < .01). The differences between the LAA ostium dimensions and depth measured using the 3D models were not significant from those measured on 3D TEE (P > .05). A simulation occlusion was successfully performed on the 3D model of the 2 challenging cases and compared with the real procedure.The echocardiographic 3DP technique is feasible and accurate in reflecting the spatial morphology of the LAA, which may be promising for the personalized planning of transcatheter LAA occlusion.

Translating Imaging Into 3D Printed Cardiovascular Phantoms

“…Another 24 studies (11.3%) applied a mixture of modalities across included patients (CCT and CMR, n = 21; CCT and 3D TEE, n = 2; and CCT, CMR, and 3D TEE, n = 1), while 2 studies (<1%) merged data from several modalities; 4 papers (1.9%) did not provide information on the sources of images. Echocardiography-derived 3DPSPs were limited to the depiction of cardiac valves (n = 16), 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ventricular or atrial septal defects (n = 3), 26 , 35 , 36 the left atrial appendage (n = 3), 17 , 37 , 38 or fetal hearts (n = 1). 39 …”

A systematic review of the use of 3D printing in left atrial appendage occlusion procedures

“…Most studies (Table 1) included 3DP in their preprocedural planning process to assess its predictive accuracy in sizing LAAO devices. Data from either 3D-TEE 13,20,25 or MDCT 4,18,30 were used to create and print 3D models of the LAA and at times of the entire left atrium, as well. 27 LAAO devices of different size were fitted in vitro into these 3D printed LAA models for proceduralists to qualitatively evaluate fulfillment of the PASS (position, anchor, size, and seal) criteria.…”

“…Two lobes separated by a thick muscular crest (managed with a double device closure technique). 25,33 Aside from its application in cases of complex LAA anatomy, 3DP could play a role in procedural training. It has been shown…”

Three-dimensional printing in structural heart disease and intervention

“…For tissue structures surrounded by blood pool, such as valves and the atrial septum, direct thresholding to create a tissue mask is sufficient to create 3D models (17). For hollow structures such as the LAA, indirect segmentation of blood pool can separate the region of interest from the surroundings (30). Blood volume of the hollow structure is segmented first, and then a geometric surface mesh model of the hollow cast is refined to extract the internal structures.…”