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Sequeira C, Oliveira-Santos M, Borges Rosa J, Silva Marques J, Oliveira Santos E, Norte G, Gonçalves L. Three-dimensional simulation for interventional cardiology procedures: Face and content validity. Rev Port Cardiol 2024; 43:389-396. [PMID: 38401705 DOI: 10.1016/j.repc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/29/2023] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Three-dimensional (3D) model simulation provides the opportunity to manipulate real devices and learn intervention skills in a realistic, controlled, and safe environment. To ensure that simulators provide a realistic surrogate to real procedures they must undergo scientific validation. We aimed to evaluate the 3D-printed simulator SimulHeart® for face and content validity to demonstrate its value as a training tool in interventional cardiology (IC). METHODS Health professionals were recruited from sixteen Portuguese IC units. All participants received a 30-minute theoretical introduction, 10-minute demonstration of each task and then performed the intervention on a 3D-printed simulator (SimulHeart®). Finally, a post-training questionnaire focusing on the appearance of the simulation, simulation content, and satisfaction/self-efficacy was administered. RESULTS We included 56 participants: 16 "experts" (general and interventional cardiologists), 26 "novices" (cardiology residents), and 14 nurses and allied professionals. On a five-point Likert scale, the overall mean score of face validity was 4.38±0.35 and the overall mean score of content validity was 4.69±0.32. There was no statistically significant difference in the scores provided by "experts" and "novices". Participants reported a high level of satisfaction/self-efficacy with 60.7% considering it strongly improved their skills. The majority (82.1%) "agreed" or "strongly agreed" that after the simulation they felt confident to perform the procedure on a patient. CONCLUSION The 3D-printed simulator (SimulHeart®) showed excellent face and content validity. 3D simulation may play an important role in future IC training programs. Further research is required to correlate simulator performance with clinical performance in real patients.
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Affiliation(s)
| | - Manuel Oliveira-Santos
- Faculty of Medicine, University of Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 3D CardioSolutions, Coimbra, Portugal
| | - João Borges Rosa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Silva Marques
- 3D CardioSolutions, Coimbra, Portugal; Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal; Structural and Coronary Heart Disease Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | - Gustavo Norte
- Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal
| | - Lino Gonçalves
- Faculty of Medicine, University of Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Borges-Rosa J, Oliveira-Santos M, Paiva L, Puga L, Botelho A, Costa M, Gonçalves L. Guiding Rescue LAMPOON Through Personalised 3D Simulators: The Role of 3D Printed Models in Complex Cardiac Interventions. Can J Cardiol 2024; 40:707-709. [PMID: 38040090 DOI: 10.1016/j.cjca.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 12/03/2023] Open
Affiliation(s)
- João Borges-Rosa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Manuel Oliveira-Santos
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Luís Paiva
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Luís Puga
- Cardiology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Ana Botelho
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marco Costa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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Zhang X, Yi K, Xu JG, Wang WX, Liu CF, He XL, Wang FN, Zhou GL, You T. Application of three-dimensional printing in cardiovascular diseases: a bibliometric analysis. Int J Surg 2024; 110:1068-1078. [PMID: 37924501 PMCID: PMC10871659 DOI: 10.1097/js9.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Abstract
AIM This paper aimed to explore the application of three-dimensional (3D) printing in cardiovascular diseases, to reach an insight in this field and prospect the future trend. METHODS The articles were selected from the Web of Science Core Collection database. Excel 2019, VOSviewer 1.6.16, and CiteSpace 6.1.R6 were used to analyze the information. RESULTS A total of 467 papers of 3D printing in cardiovascular diseases were identified, and the first included literature appeared in 2000. A total of 692 institutions from 52 countries participated in the relevant research, while the United States of America contributed to 160 articles and were in a leading position. The most productive institution was Curtin University , and Zhonghua Sun who has posted the most articles ( n =8) was also from there. The Frontiers in Cardiovascular Medicine published most papers ( n =25). The Journal of Thoracic and Cardiovascular Surgery coveted the most citations ( n =520). Related topics of frontiers will still focus on congenital heart disease, valvular heart disease, and left atrial appendage closure. CONCLUSIONS The authors summarized the publication information of the application of 3D printing in cardiovascular diseases related literature from 2000 to 2023, including country and institution of origin, authors, and publication journal. This study can reflect the current hotspots and novel directions for the application of 3D printing in cardiovascular diseases.
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Affiliation(s)
- Xin Zhang
- The First School of Clinical Medicine of Gansu University of Chinese Medicine
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
| | - Kang Yi
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
| | - Jian-Guo Xu
- Evidence-Based Medicine Center, School of BasicMedical Sciences, Lanzhou University
| | - Wen-Xin Wang
- The First School of Clinical Medicine of Gansu University of Chinese Medicine
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
| | - Cheng-Fei Liu
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
- The First Clinical Medical College of Lanzhou University, Lanzhou, People's Republic of China
| | - Xiao-Long He
- The First School of Clinical Medicine of Gansu University of Chinese Medicine
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
| | - Fan-Ning Wang
- The First School of Clinical Medicine of Gansu University of Chinese Medicine
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
| | - Guo-Lei Zhou
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
| | - Tao You
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
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Valvez S, Oliveira-Santos M, Gonçalves L, Amaro AM, Piedade AP. Preprocedural Planning of Left Atrial Appendage Occlusion: A Review of the Use of Additive Manufacturing. 3D PRINTING AND ADDITIVE MANUFACTURING 2024; 11:333-346. [PMID: 38389681 PMCID: PMC10880654 DOI: 10.1089/3dp.2022.0373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Stroke is a significant public health problem, with non-valvular atrial fibrillation (NVAF) being one of its main causes. This cardiovascular arrhythmia predisposes to the production of intracardiac thrombi, mostly formed in the left atrial appendage (LAA). When there are contraindications to treatment with oral anticoagulants, another therapeutic option to reduce the possibility of thrombus formation in the LAA is the implantation of an occlusion device by cardiac catheterization. The effectiveness of LAA occlusion is dependent on accurate preprocedural device sizing and proper device positioning at the LAA ostium, to ensure sufficient device anchoring and avoid peri-device leaks. Additive manufacturing, commonly known as three-dimensional printing (3DP), of LAA models is beginning to emerge in the scientific literature to address these challenges through procedural simulation. This review aims at clarifying the impact of 3DP on preprocedural planning of LAA occlusion, specifically in the training of cardiac surgeons and in the assessment of the perfect adjustment between the LAA and the biomedical implant.
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Affiliation(s)
- Sara Valvez
- Department of Mechanical Engineering, CEMMPRE, ARISE, University of Coimbra, Coimbra, Portugal
| | | | - Lino Gonçalves
- CBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana M. Amaro
- Department of Mechanical Engineering, CEMMPRE, ARISE, University of Coimbra, Coimbra, Portugal
| | - Ana P. Piedade
- Department of Mechanical Engineering, CEMMPRE, ARISE, University of Coimbra, Coimbra, Portugal
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5
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Liao N, Qin Z, Luo LI, Ge L. One-stop procedure of "Atrial fibrillation radiofrequency ablation + left atrial appendage closure" guided by 3D printing technology: A case report. Echocardiography 2023; 40:856-861. [PMID: 37326430 DOI: 10.1111/echo.15572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/24/2023] [Accepted: 04/05/2023] [Indexed: 06/17/2023] Open
Abstract
Left atrial appendage occlusion (LAAO) in the treatment of atrial fibrillation (AF) has become a hot topic in clinical research in recent years. We report a 68-year-old female with a 3-year history of paroxysmal atrial fibrillation refractory to antiarrhythmic therapy and unable to tolerate anticoagulation therapy who underwent successful atrial fibrillation radiofrequency ablation combined with left atrial appendage occlusion guided by 3D printing technology. There was no recurrence of her atrial fibrillation and there was continued complete occlusion of her left atrial appendage at 3-month and 1-year follow-ups.This case supports the potential advantage of 3D printing technology to guide a "one-stop combined AF radiofrequency ablation and left atrial appendage occlusion procedure." But whether it can improve the prognosis and quality of life of patients, further multi-center research and large data statistics are required.
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Affiliation(s)
- Nuohan Liao
- University of South China Hengyang, Hengyang, Hunan, China
| | - Zuoan Qin
- Department of Cardiology, The First People's Hospital of Changde City, Changde, Hunan, China
| | - L I Luo
- Department of Cardiology, The First People's Hospital of Changde City, Changde, Hunan, China
| | - Liangqing Ge
- Department of Cardiology, The First People's Hospital of Changde City, Changde, Hunan, China
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Oliveira C, Brito J, Rodrigues T, Santiago H, Ricardo D, Cardoso P, Pinto FJ, Silva Marques J. Intravascular imaging modalities in coronary intervention: Insights from 3D-printed phantom coronary models. Rev Port Cardiol 2023:S0870-2551(23)00126-9. [PMID: 36893842 DOI: 10.1016/j.repc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Several studies comparing optical coherence tomography (OCT) and intravascular ultrasound (IVUS) have revealed that OCT consistently provides smaller area and diameter measurements. However, comparative assessment in clinical practice is difficult. Three-dimensional (3D) printing offers a unique opportunity to assess intravascular imaging modalities. We aim to compare intravascular imaging modalities using a 3D-printed coronary artery in a realistic simulator and to assess whether OCT underestimates intravascular dimensions, exploring potential corrections. METHODS A standard realistic left main anatomy with an ostial left anterior descending artery lesion was replicated using 3D printing. After provisional stenting and optimization, IVI was obtained. Modalities included 20 MHz digital IVUS, 60 MHz rotational IVUS (HD-IVUS) and OCT. We assessed luminal area and diameters at standard locations. RESULTS Considering all coregistered measurements, OCT significantly underestimated area, minimal diameter and maximal diameter measurements in comparison to IVUS and HD-IVUS (p<0.001). No significant differences were found between IVUS and HD-IVUS. A significant systematic dimensional error was found in OCT auto-calibration by comparing known reference diameter of guiding catheter (1.8 mm) to measured mean diameter (1.68 mm±0.04 mm). By applying a correction factor based on the reference guiding catheter area to OCT, the luminal areas and diameters became not significantly different compared to IVUS and HD-IVUS. CONCLUSION Our findings suggest that automatic spectral calibration method for OCT is inaccurate, with a systematic underestimation of luminal dimensions. When guiding catheter correction is applied the performance of OCT is significantly improved. These results may be clinically relevant and need to be validated.
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Affiliation(s)
- Catarina Oliveira
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal.
| | - Joana Brito
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - Tiago Rodrigues
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - Helena Santiago
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - Daniela Ricardo
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - Pedro Cardoso
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal; Structural and Coronary Heart Disease Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal; Structural and Coronary Heart Disease Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João Silva Marques
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal; Structural and Coronary Heart Disease Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Xenofontos P, Zamani R, Akrami M. The application of 3D printing in preoperative planning for transcatheter aortic valve replacement: a systematic review. Biomed Eng Online 2022; 21:59. [PMID: 36050722 PMCID: PMC9434927 DOI: 10.1186/s12938-022-01029-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recently, transcatheter aortic valve replacement (TAVR) has been suggested as a less invasive treatment compared to surgical aortic valve replacement, for patients with severe aortic stenosis. Despite the attention, persisting evidence suggests that several procedural complications are more prevalent with the transcatheter approach. Consequently, a systematic review was undertaken to evaluate the application of three-dimensional (3D) printing in preoperative planning for TAVR, as a means of predicting and subsequently, reducing the incidence of adverse events. Methods MEDLINE, Web of Science and Embase were searched to identify studies that utilised patient-specific 3D printed models to predict or mitigate the risk of procedural complications. Results 13 of 219 papers met the inclusion criteria of this review. The eligible studies have shown that 3D printing has most commonly been used to predict the occurrence and severity of paravalvular regurgitation, with relatively high accuracy. Studies have also explored the usefulness of 3D printed anatomical models in reducing the incidence of coronary artery obstruction, new-onset conduction disturbance and aortic annular rapture. Conclusion Patient-specific 3D models can be used in pre-procedural planning for challenging cases, to help deliver personalised treatment. However, the application of 3D printing is not recommended for routine clinical practice, due to practicality issues.
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Affiliation(s)
| | - Reza Zamani
- Medical School, College of Medicine and Health, Exeter, UK
| | - Mohammad Akrami
- Department of Engineering, College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, UK.
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8
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DeCampos D, Teixeira R, Saleiro C, Oliveira-Santos M, Paiva L, Costa M, Botelho A, Gonçalves L. 3D printing for left atrial appendage closure: A meta-analysis and systematic review. Int J Cardiol 2022; 356:38-43. [PMID: 35358638 DOI: 10.1016/j.ijcard.2022.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Three-dimensional printing (3D) has emerged as an alternative to imaging to guide left atrial appendage closure (LAAC) device sizing. AIMS We assessed the usefulness of 3D printing compared to a standard imaging-only approach for LAAC. METHODS We identified studies comparing an imaging-only with a 3D printing approach in LAAC. A fixed-effects meta-analysis was performed targeting a co-primary endpoint of disagreement in device sizing and leaks. RESULTS Eight studies that assigned 283 participants to an imaging-only approach and 3D printing approach (145 patients) were included. 3D printing significantly reduced the risk of the co-primary endpoint (risk raio (RR) = 0.19; 95% confidence interval (CI) 0.09-0.37), with consistency across the studies (I2 = 0%). Individually, both device size disagreements [RR 0.13 (95% CI 0.06-0.29), P < 0.001] and leaks [RR 0.24 (95% CI 0.09-0.64) P = 0.004] were reduced under a 3D printing modeling strategy. CONCLUSION Compared with an imaging-only strategy, 3D printing is associated with reduction in device size disagreements and leaks.
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Affiliation(s)
- Diana DeCampos
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal.
| | - Rogério Teixeira
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, R. Larga 2, Diana de Campos, 3000-370 Coimbra. Portugal
| | - Carolina Saleiro
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Manuel Oliveira-Santos
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Luis Paiva
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Marco Costa
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Ana Botelho
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Lino Gonçalves
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, R. Larga 2, Diana de Campos, 3000-370 Coimbra. Portugal
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Onorato EM, Vercellino M, Masoero G, Monizzi G, Sanchez F, Muratori M, Bartorelli AL. Catheter-based Closure of a Post-infective Aortic Paravalvular Pseudoaneurysm Fistula With Severe Regurgitation After Two Valve Replacement Surgeries: A Case Report. Front Cardiovasc Med 2021; 8:693732. [PMID: 34497834 PMCID: PMC8419236 DOI: 10.3389/fcvm.2021.693732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Backgsround: Infective endocarditis (IE) of prosthetic valves is a dire complication of cardiac valve replacement surgery and is associated with high rates of morbidity and mortality. Case Summary: A 72-year-old woman with multiple comorbidities underwent surgical replacement of the aortic valve with a mechanical prosthetic valve after recurrent IE. After 10 years, IE recurred and the mechanical valve was surgically replaced with a bioprosthetic valve. Ten years later, severe heart failure developed due to severe paravalvular leak (PVL) caused by an aortic annulus abscess complicated by a paravalvular pseudoaneurysm fistula (PPF). The patient was deemed at prohibitive surgical risk and a catheter-based PVL closure procedure was planned. However, the interventional procedure was delayed several months due to the Covid-19 pandemic with progressive heart failure worsening. Despite an acute satisfactory result of the PPF transcatheter closure and a significant clinical improvement, the patient died 10 months later due to multiorgan failure. It is likely that this was due, at least in part, to the long treatment delay caused by the unprecedented strain on the healthcare system. Discussion: In patients at high surgical risk, early diagnosis and prompt interventional treatment of severe PVL are crucial for improving expectancy and quality of life. However, the recent outbreak of COVID-19 caused deferral of elective and semi-elective structural heart disease procedures (SHD) as in our case. Thus, a proactive and vigilant stance on managing SHD should be a priority even in the context of the COVID-19 pandemic.
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Affiliation(s)
| | - Matteo Vercellino
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giovanni Masoero
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giovanni Monizzi
- Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
| | - Federico Sanchez
- Department Cardiology, Azienda Sanitaria Locale 1 Imperiese, Sanremo, Italy
| | - Manuela Muratori
- Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy.,Department of Biomedical and Clinical Sciences, "Luigi Sacco", University of Milan, Milan, Italy
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Gharleghi R, Dessalles CA, Lal R, McCraith S, Sarathy K, Jepson N, Otton J, Barakat AI, Beier S. 3D Printing for Cardiovascular Applications: From End-to-End Processes to Emerging Developments. Ann Biomed Eng 2021; 49:1598-1618. [PMID: 34002286 PMCID: PMC8648709 DOI: 10.1007/s10439-021-02784-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/24/2021] [Indexed: 12/16/2022]
Abstract
3D printing as a means of fabrication has seen increasing applications in medicine in the last decade, becoming invaluable for cardiovascular applications. This rapidly developing technology has had a significant impact on cardiovascular research, its clinical translation and education. It has expanded our understanding of the cardiovascular system resulting in better devices, tools and consequently improved patient outcomes. This review discusses the latest developments and future directions of generating medical replicas ('phantoms') for use in the cardiovascular field, detailing the end-to-end process from medical imaging to capture structures of interest, to production and use of 3D printed models. We provide comparisons of available imaging modalities and overview of segmentation and post-processing techniques to process images for printing, detailed exploration of latest 3D printing methods and materials, and a comprehensive, up-to-date review of milestone applications and their impact within the cardiovascular domain across research, clinical use and education. We then provide an in-depth exploration of future technologies and innovations around these methods, capturing opportunities and emerging directions across increasingly realistic representations, bioprinting and tissue engineering, and complementary virtual and mixed reality solutions. The next generation of 3D printing techniques allow patient-specific models that are increasingly realistic, replicating properties, anatomy and function.
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Affiliation(s)
- Ramtin Gharleghi
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | | | - Ronil Lal
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | - Sinead McCraith
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | | | - Nigel Jepson
- Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School of Medicine, UNSW, Sydney, Australia
| | - James Otton
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | | | - Susann Beier
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia.
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11
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Cho JS, Park J, Kwon JB, Kim DW, Park MW. 3D Printed Personalized External Aortic Root Model in Marfan Syndrome with Isolated Sinus of Valsalva Aneurysm Caused by a Novel Pathogenic FBN1 p.Gly1127Cys Variant. Diagnostics (Basel) 2021; 11:diagnostics11061057. [PMID: 34201307 PMCID: PMC8227084 DOI: 10.3390/diagnostics11061057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022] Open
Abstract
The major cause of death in Marfan syndrome (MFS) is cardiovascular complications, particularly progressive dilatation of the proximal aorta, rendering these patients at risk of aortic dissection or fatal rupture. We report a 3D printed personalized external aortic root model for MFS with an isolated sinus of Valsalva aneurysm caused by a novel pathogenic FBN1 variant. A 67-year-old female with a history of lens dislocation and retinal detachment in the left eye was admitted for the evaluation of resting dyspnea several months prior. Transesophageal and transthoracic echocardiography revealed severe aortic valve regurgitation and a large left coronary sinus of Valsalva aneurysm in the proband. Sanger sequencing identified a heterozygous p.Gly1127Cys variant in the FBN1 gene; previously, a mutation at this amino acid position was described as pathogenic (p.Gly1127Ser; rs137854468). A 3D printed personalized external aortic root model based on a multidetector computed tomography scan was constructed to illustrate the location of the ostium of the left main coronary artery on the aneurysm of the left coronary artery cusp. Aortic root replacement with the Bentall procedure matched the exact shape of the 3D printed model. Creation of a 3D printed patient-specific model could be useful in facilitating the development of next-generation medical devices and resolving the risks of postoperative complications and aortic root disease.
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Affiliation(s)
- Jung Sun Cho
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.S.C.); (D.-W.K.)
| | - Joonhong Park
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea;
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
| | - Jong Bum Kwon
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Dae-Won Kim
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.S.C.); (D.-W.K.)
| | - Mahn-Won Park
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.S.C.); (D.-W.K.)
- Correspondence: ; Tel.: +82-42-220-9505
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12
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Colbert CM, Shao J, Hollowed JJ, Currier JW, Ajijola OA, Fishbein GA, Duarte-Vogel SM, Dharmakumar R, Hu P, Nguyen KL. 3D-Printed Coronary Implants Are Effective for Percutaneous Creation of Swine Models with Focal Coronary Stenosis. J Cardiovasc Transl Res 2020; 13:1033-1043. [PMID: 32394352 PMCID: PMC9667863 DOI: 10.1007/s12265-020-10018-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/28/2020] [Indexed: 01/17/2023]
Abstract
Reliable, closed-chest methods for creating large animal models of acute myocardial hypoperfusion are limited. We demonstrated the feasibility and efficacy of using magnetic resonance (MR)-compatible 3D-printed coronary implants for establishing swine models of myocardial hypoperfusion. We designed, manufactured, and percutaneously deployed implants in 13 swine to selectively create focal coronary stenosis. To test the efficacy of the implants to cause hypoperfusion or ischemia in the perfused territory, we evaluated regional wall motion, myocardial perfusion, and infarction using MR imaging. The overall swine survival rate was 85% (11 of 13). The implant retrieval rate was 92% (12 of 13). Fluoroscopic angiography confirmed focal stenosis. Cine and perfusion MRI showed regional wall motion abnormalities and inducible ischemia, respectively. Late gadolinium enhancement and histopathology showed no myocardial infarction. Our minimally invasive technique has promising applications for validation of new diagnostic methods in cardiac MR. Graphical abstract Our new minimally invasive, percutaneous method for creating swine models of acute focal coronary stenosis can be used for magnetic resonance imaging studies of myocardial ischemia. Comparable to existing methods in its efficacy and reliability, this rapid prototyping technique will allow researchers to more easily conduct translational cardiac imaging studies of coronary artery disease in large animal models.
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Affiliation(s)
- Caroline M Colbert
- Physics and Biology in Medicine Graduate Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jiaxin Shao
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John J Hollowed
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90073, USA
| | - Jesse W Currier
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90073, USA
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center and Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gregory A Fishbein
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sandra M Duarte-Vogel
- Division of Laboratory Animal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peng Hu
- Physics and Biology in Medicine Graduate Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kim-Lien Nguyen
- Physics and Biology in Medicine Graduate Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90073, USA.
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13
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Ali A, Ballard DH, Althobaity W, Christensen A, Geritano M, Ho M, Liacouras P, Matsumoto J, Morris J, Ryan J, Shorti R, Wake N, Rybicki FJ, Sheikh A. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions. 3D Print Med 2020; 6:24. [PMID: 32965536 PMCID: PMC7510265 DOI: 10.1186/s41205-020-00078-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Medical 3D printing as a component of care for adults with cardiovascular diseases has expanded dramatically. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness criteria for adult cardiac 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with a number of adult cardiac indications, physiologic, and pathologic processes. Each study was vetted by the authors and graded according to published guidelines. RESULTS Evidence-based appropriateness guidelines are provided for the following areas in adult cardiac care; cardiac fundamentals, perioperative and intraoperative care, coronary disease and ischemic heart disease, complications of myocardial infarction, valve disease, cardiac arrhythmias, cardiac neoplasm, cardiac transplant and mechanical circulatory support, heart failure, preventative cardiology, cardiac and pericardial disease and cardiac trauma. CONCLUSIONS Adoption of common clinical standards regarding appropriate use, information and material management, and quality control are needed to ensure the greatest possible clinical benefit from 3D printing. This consensus guideline document, created by the members of the RSNA 3D printing Special Interest Group, will provide a reference for clinical standards of 3D printing for adult cardiac indications.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Waleed Althobaity
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Michelle Ho
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Jane Matsumoto
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Justin Ryan
- Rady Children's Hospital, San Diego, CA, USA
| | - Rami Shorti
- Intermountain Healthcare, South Jordan, UT, USA
| | - Nicole Wake
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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14
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Fernández Cisnal A, Redondo Diéguez A, Hakim Moustafa A. Look, Simulate, Treat: Multimodality Imaging Guiding Bivalve Complex Transcatheter Replacement. JACC Case Rep 2020; 2:1448-1450. [PMID: 34316993 PMCID: PMC8302179 DOI: 10.1016/j.jaccas.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Agustín Fernández Cisnal
- Cardiology Department, Hospital Clínic i Universitari de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Alfredo Redondo Diéguez
- Interventional Cardiology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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15
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Sun Z. 3D Printed Coronary Models Offer Potential Value in Visualising Coronary Anatomy and Coronary Stents for Investigation of Coronary CT Protocols. Curr Med Imaging 2020; 16:625-628. [PMID: 32723233 DOI: 10.2174/157340561606200523215058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences Curtin University Perth, Australia
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