Feasibility and Validity of Printing 3D Heart Models from Rotational Angiography

Abstract

Rotational angiography (RA) has proven to be an excellent method for evaluating congenital disease (CHD) in the cardiac cath lab, permitting acquisition of 3D datasets with superior spatial resolution. This technique has not been routinely implemented for 3D printing in CHD. We describe our case series of models printed from RA and validate our technique. All patients with models printed from RA were selected. RA acquisitions from a Toshiba Infinix-I system were postprocessed and printed with a Stratasys Eden 260. Two independent observers measured 5-10 points of interest on both the RA and the 3D model. Bland Altman plot was used to compare the measurements on rotational angiography to the printed model. Models were printed from RA in 5 patients (age 2 months-1 year). Diagnoses included (a) coronary artery aneurysm, (b) Glenn shunt, (c) coarctation of the aorta, (d) tetralogy of Fallot with MAPCAs, and (e) pulmonary artery stenosis. There was no significant measurement difference between RA and the printed model (r = 0.990, p < 0.01, Bland Altman p = 0.987). There was also no significant inter-observer variability. The MAPCAs model was referenced by the surgeon intraoperatively and was accurate. Rotational angiography can generate highly accurate 3D models in congenital heart disease, including in small vascular structures. These models can be extremely useful in patient evaluation and management.

Personalized Three-Dimensional Printed Models in Congenital Heart Disease

“…The most important part of creating 3D printed models is to ensure that 3D models accurately delineate anatomical structures and pathologies since the model accuracy is essential for treatment planning [15]. Current research evidence indicates that 3D printed heart models are generally accurate [16], and this has been validated by other studies, either based on case reports/series or single- or multi-center studies [17,18,19,20,21,22,23]. In most of the studies, model accuracy is determined by the degree of agreement between the measured dimensions of the 3D printed model and the dimensions of original source images, usually using cardiac CT, MRI, and sometimes using rotational angiography or echocardiography [16,17,18,22], or intraoperative findings [19].…”

“…Currently, there is no standardized method to measure the dimensions of the 3D printed heart models. Most of the studies carried out measurement using calipers on the physical 3D printed models [17,20,21]. Only a few studies conducted measurement on the standard tessellation language (STL) file [18] and conducted CT scan on the 3D printed model for measurement [16].…”

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

“…A short case series has been recently published, suggesting that this option may spread the opportunity to create 3D models to a larger number of centres. 24…”

Advanced Medical Use of Three-Dimensional Imaging in Congenital Heart Disease: Augmented Reality, Mixed Reality, Virtual Reality, and Three-Dimensional Printing

“…In this regard, cardiac CT is the most commonly used 3D medical imaging modality for CHD 3D printing (2). Less frequently, 3D cardiac MRI (33), 3D echocardiography (34), or rotational angiography (35) Thresholding, region growing, and manual editing are used for segmentation. Exceptional expertise in the field of CHD is required for accurate and relevant segmentation.…”