Three‐dimensional printing assisted transcatheter closure of atrial septal defect with deficient posterior–inferior rim

Abstract

Objective: Though successful transcatheter closure has been reported in secundum atrial septal defect (ASD) with deficient posterior-inferior rim, it is still difficult to screen the appropriate candidates. Three-dimensional printing (3DP) makes in vitro trial occlusion possible, and might provide a feasible method in the prediction of successful closure.Methods: Thirty-five consecutive ASD patients (10M/25F, age, 47.7 AE 11.8 years) with deficient posterior-inferior rim (≤3 mm) were referred for attempted transcatheter closure, and personalized heart model (elastic rubber) was produced based on end-systolic MSCT images. The in vitro measurement and trial occlusion were performed for preoperative evaluation (in vitro successful/unsuccessful group), and the results were compared with postoperative outcomes. Results: Successful in vitro occlusion was achieved in 30 patients (7M/23F), and the size of ASD was 27.1 AE 4.4 mm. The posterior-inferior rim was 0.95 AE 1.22 mm (rim defect in 17 patients), and 12 patients were associated with aortic rim deficiency. The subsequent transcatheter closure was performed successfully in 29 patients, and the occluder-diameter was identical to that of in vitro occlusion (35.0 AE 4.4 mm). The follow-up (1.4 AE 0.58 years) showed no residual shunt and related-complications. In unsuccessful in vitro group (n = 5), the range of rim deficiency was wider (P = 0.019) and the rim to inferior vena cava was shorter (4.60 AE 2.07 mm vs. 10.71 AE 5.28 mm, P = 0.016). Furthermore, transcatheter closure failed in all patients.Conclusions: In ASD with deficient posterior-inferior rim, 3DP allows accurate determination of the size and surrounding rims of ASD. Based on personalized heart model, in vitro trial occlusion is an effective method to identify the appropriate candidates for transcatheter closure. K E Y W O R D Spersonalized heart model, secundum atrial septal defect, transcatheter closure

Transcatheter closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim under echocardiography only: a feasibility and safety analysis

“…13,26,27 For instance, Amedro et al reported an overall success rate of only 44% in an observational retrospective study, and Mathewson et al showed that device dislodgement had a significant impact on the pulmonary vein, inferior vena cava, and mitral valve. 12 In contrast, Chen et al 10 used minithoracotomy to effectively close the atrial septal defect with inferior vena cava rim deficiency, and Yan et al 28 used a 3D printing model to evaluate the feasibility of atrial septal defect closure before the procedure. According to the design of the double-disc occluder, the radius of the left and right discs differs by 2-3 mm.…”

Three-dimensional printing of atrial septal defect from echocardiographic images: feasibility, fidelity and potential applications

“…This study showed a high correlation between the ASD parameters measured from the 3D printed ASD models and the size parameters of intraoperative occluders, among which the circumference of 3D printed models resulted to be most relevant to the occluder device size. 3D printed ASD models can mimics the "en face" view for evaluating the morphological characteristics of an ASD comprehensively and provide reference for determine individualized plans in ASD occlusion 26 .…”

5 Three-dimensional printing in preoperative and intraoperative decision making

“…Surprisingly, arterial and ventricular septal defects scored very low, between 2 and 5, although 3D printed models have been proven to be very useful in simulating closure procedures. Flexible models of septal defects can be used to perform mock transcatheter procedures and may help in choosing proper device size, improving the safety of surgery [14]. They help to understand spatial relationships between structures normally seen by cardiologists in echocardiography and learn how to proceed with the catheter delivery system.…”