1
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Tsai AY, Greene AC. 3D printing in pediatric surgery. Semin Pediatr Surg 2024; 33:151385. [PMID: 38242062 DOI: 10.1016/j.sempedsurg.2024.151385] [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] [Indexed: 01/21/2024]
Abstract
Pediatric surgery presents a unique challenge, requiring a specialized approach due to the intricacies of compact anatomy and the presence of distinct congenital features in young patients. Surgeons are tasked with making decisions that not only address immediate concerns but also consider the evolving needs of children as they grow. The advent of three-dimensional (3D) printing has emerged as a valuable tool to facilitate a personalized medical approach. This paper starts by outlining the basics of 3D modeling and printing. We then delve into the transformative role of 3D printing in pediatric surgery, elucidating its applications, benefits, and challenges. The paper concludes by envisioning the future prospects of 3D printing, foreseeing advancements in personalized treatment approaches, improved patient outcomes, and the continued evolution of this technology as an indispensable asset in the pediatric surgical arena.
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Affiliation(s)
- Anthony Y Tsai
- Division of Pediatric Surgery, Assistant Professor of Surgery and Pediatrics, Penn State Children's Hospital, 500 University Drive, Hershey, PA 17033, United States.
| | - Alicia C Greene
- Division of Pediatric Surgery, Assistant Professor of Surgery and Pediatrics, Penn State Children's Hospital, 500 University Drive, Hershey, PA 17033, United States
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2
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Cardoso CB, Brandão CVS, Juliani PS, Filadelpho AL, Pereira GJ, Lourenço MLG, Hataka A, Padovani CR. Morphogeometric Evaluation of the Left Ventricle and Left Atrioventricular Ring in Dogs: A Computerized Anatomical Study. Animals (Basel) 2023; 13:1996. [PMID: 37370507 DOI: 10.3390/ani13121996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
In veterinary, there is scarce availability of morphogeometric studies in normal and remodeled hearts; furthermore, ventricular geometry acts as an indicator of cardiac function. It is a highly necessary field of knowledge for the development of therapeutic protocols, especially surgical ones. The objectives of this study were: to obtain measurements of the left atrioventricular valve ring and left ventricle, to analyze the proportionality between the segments of the left cardiac chamber of normal hearts and to describe reference values for morphogeometric analysis of the left ventricle. For this, 50 hearts from small (Group 1-G1) and medium to large (Group 2-G2) dogs were laminated in the apical, basal and equatorial segments, and submitted to computer analysis to identify the perimeter of each segment and the left atrioventricular ring, wall thickness and distance from the atrioventricular sulcus to the apex. The largest internal perimeter was that of the equatorial. The basal segment had the highest mean for ventral parietal wall thickness, suggesting greater contractile reserve at that location. Considering the proportionality relationships, there was no statistical difference between the intersegmental perimeter indices for the two groups. This suggests that despite the animals' weight variations, the proportions between the left ventricular segments are maintained. Therefore, it is concluded that the data can be used as a standard of comparison for cardiac geometric assessments, as well as a basis for the development of therapeutic measures in the context of adverse cardiac remodeling.
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Affiliation(s)
- Catarina Borges Cardoso
- School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Cláudia Valéria Seullner Brandão
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Paulo Sérgio Juliani
- Cardiovascular Surgery Service, WeVets Veterinary Hospital, São Paulo 02511-000, SP, Brazil
| | - André Luis Filadelpho
- Institute of Biosciences, Department of Anatomy-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Geovane José Pereira
- School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Maria Lúcia Gomes Lourenço
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Alessandre Hataka
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Carlos Roberto Padovani
- Institute of Biosciences, Department of Biostatistics-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
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3
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Caro-Domínguez P, Secinaro A, Valverde I, Fouilloux V. Imaging and surgical management of congenital heart diseases. Pediatr Radiol 2023; 53:677-694. [PMID: 36334120 DOI: 10.1007/s00247-022-05536-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/01/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
Congenital heart disease affects approximately 1% of live births per year. In recent years, there has been a decrease in the morbidity and mortality of these cases due to advances in medical and surgical care. Imaging plays a key role in the management of these children, with chest radiography, echocardiography and chest ultrasound the first diagnostic tools, and cardiac computed tomography, catheterization and magnetic resonance imaging reserved to assess better the anatomy and physiology of the most complex cases. This article is a beginner's guide to the anatomy of the most frequent congenital heart diseases (atrial and ventricular septal defects, abnormal pulmonary venous connections, univentricular heart, tetralogy of Fallot, transposition of the great arteries and coarctation of the aorta), their surgical management, the most common postsurgical complications, deciding which imaging modality is needed, and when and how to image gently.
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Affiliation(s)
- Pablo Caro-Domínguez
- Pediatric Radiology Unit, Department of Radiology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, Seville, Spain.
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Israel Valverde
- Pediatric Cardiology Unit and Cardiovascular Pathology Unit, Hospital Universitario Virgen del Rocio and Institute of Biomedicine of Seville, Seville, Spain
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Virginie Fouilloux
- Department of Congenital and Pediatric Cardiac Surgery, Timone Children Hospital, Marseille, France
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4
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Xu Z, Semple T, Gu H, McCarthy KP, Yen Ho S, Li W. Double outlet ventricles: review of anatomic and imaging characteristics. Heart 2022; 109:905-912. [DOI: 10.1136/heartjnl-2022-321955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Hearts with double outlet ventricles and concordant atrioventricular connections account for about 1%–3% of all cases of congenital heart disease. We review hearts with two ventricles and concordant atrioventricular connections with double outlet right ventricle (DORV), double outlet left ventricle (DOLV) and double outlet both ventricles (DOBV) from the morphological and clinical imaging perspectives. These hearts are a heterogeneous group of congenital cardiac malformations with a wide range of pathophysiologies that require an individualised surgical approach based on a precise understanding of the complex cardiovascular anatomy. Owing to their differing temporal, spatial and contrast resolutions, we propose that multimodality imaging provides optimal characterisation of various intracardiac morphological features of double outlet hearts. This approach aids clinical diagnosis for optimising treatment options across these malformations.
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5
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Pizzuto A, Raimondi F, Celi S, Calabri GB, Spaziani G, Gasparotti E, Capellini K, Clemente A, Amoretti F, Favilli S, Santoro G. Transcatheter Treatment of Native Idiopathic Multiloculated Aortic Aneurysm Guided by 3D Printing Technology. JACC Case Rep 2022; 8:101662. [PMID: 36860559 PMCID: PMC9969546 DOI: 10.1016/j.jaccas.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/12/2022] [Accepted: 09/23/2022] [Indexed: 11/08/2022]
Abstract
Pediatric idiopathic aortic aneurysm is rare. Single saccular malformation can complicate native or recurrent aortic coarctation; however, multiloculated dilatations of the descending thoracic aorta, associated with aortic coarctation, have so far never been described in literature. In our case, printed 3D model technology was crucial in planning transcatheter treatment. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital “G. Pasquinucci,” National Research Council-Tuscany Foundation “G. Monasterio,” Massa, Italy
- Address for correspondence: Dr Alessandra Pizzuto, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Via Via Aurelia Montiscendi, 54100 Massa MS, Italy.
| | - Francesca Raimondi
- Pediatric and Transition Cardiology, Meyer Children’s Hospital, Florence, Italy
| | - Simona Celi
- BioCardioLab-Bioengineering Unit, Heart Hospital “G. Pasquinucci,” National Research Council-Tuscany Foundation “G. Monasterio,” Massa, Italy
| | | | - Gaia Spaziani
- Pediatric and Transition Cardiology, Meyer Children’s Hospital, Florence, Italy
| | - Emanuele Gasparotti
- BioCardioLab-Bioengineering Unit, Heart Hospital “G. Pasquinucci,” National Research Council-Tuscany Foundation “G. Monasterio,” Massa, Italy
| | - Katia Capellini
- BioCardioLab-Bioengineering Unit, Heart Hospital “G. Pasquinucci,” National Research Council-Tuscany Foundation “G. Monasterio,” Massa, Italy
| | - Alberto Clemente
- Radiodiagnostic Unit Heart Hospital “G. Pasquinucci,” National Research Council-Tuscany Foundation “G. Monasterio,” Massa, Italy
| | | | - Silvia Favilli
- Pediatric and Transition Cardiology, Meyer Children’s Hospital, Florence, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital “G. Pasquinucci,” National Research Council-Tuscany Foundation “G. Monasterio,” Massa, Italy
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6
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Spanaki A, Kabir S, Stephenson N, van Poppel MPM, Benetti V, Simpson J. 3D Approaches in Complex CHD: Where Are We? Funny Printing and Beautiful Images, or a Useful Tool? J Cardiovasc Dev Dis 2022; 9:269. [PMID: 36005432 PMCID: PMC9410138 DOI: 10.3390/jcdd9080269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Echocardiography, CT and MRI have a crucial role in the management of congenital heart disease (CHD) patients. All of these modalities can be presented in a 2D or a 3D rendered format. The aim of this paper is to review the key advantages and potential limitations, as well as the future challenges of a 3D approach in each imaging modality. The focus of this review is on anatomic rather than functional assessment. Conventional 2D echocardiography presents limitations when imaging complex lesions, whereas 3D imaging depicts the anatomy in all dimensions. CT and MRI can visualise extracardiac vasculature and guide complex biventricular repair. Three-dimensional printed models can be used in depicting complex intracardiac relationships and defining the surgical strategy in specific lesions. Extended reality imaging retained dynamic cardiac motion holds great potential for planning surgical and catheter procedures. Overall, the use of 3D imaging has resulted in a better understanding of anatomy, with a direct impact on the surgical and catheter approach, particularly in more complex cases.
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Affiliation(s)
- Adriani Spanaki
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - Saleha Kabir
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - Natasha Stephenson
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
| | - Milou P. M. van Poppel
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
| | - Valentina Benetti
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
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7
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Shannon A, O'Sullivan KJ, Clifford S, O'Sullivan L. Assessment and selection of filler compounds for radiopaque PolyJet multi-material 3D printing for use in clinical settings. Proc Inst Mech Eng H 2022; 236:740-747. [PMID: 35296167 DOI: 10.1177/09544119221084819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of this research was to assess a selection of radiopaque filler compounds for increasing radiopacity in a resin suitable for Polyjet multi-material 3D printing. A radiopaque resin has potential applications in medicine to produce patient-specific anatomical models with realistic radiological properties, training aids, and skin contacting components such as surgical or procedural guides that require visibility under fluoroscopy. The desirable filler would have a high level of radiopacity under ionising imaging modalities, such as X-ray, CT, fluoroscopy or angiography. Nine potential filler compounds were selected based on atomic number and handling risk: barium sulphate, bismuth oxide, zirconium oxide, strontium oxide, strontium fluoride, strontium carbonate, iodine, niobium oxide and tantalum oxide. The fillers were evaluated using selected criteria. A weighted material selection matrix was developed to prioritise and select a filler for future 3D printing on a multi-material 3D printer. Zirconium oxide was the highest scoring filler compound in the material selection matrix, scoring 4.4 out of a maximum of 5. MED610TM resin doped with zirconium oxide was shown to be UV curable, and when cured is non-toxic, environmentally friendly, and has the ability to display antimicrobial properties. In terms of radiopacity, a sample with thickness 1.5 mm of MED610™ resin doped with 20 wt.% zirconium oxide produced X-ray radiopacity equivalent to 3 mm of aluminium. Zirconium oxide was selected using the material selection matrix. This radiopaque resin can be used to produce anatomical models with accurate radiological properties, training aids or skin contacting devices that require visibility under ionising imaging modalities. The 3D printing validation run successfully demonstrated that the material selection matrix prioritised a filler suitable for radiopaque multi-material 3D printing.
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Affiliation(s)
- Alice Shannon
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland.,National Children's Research Centre, Gate 5, Our Lady's Children's Hospital, Crumlin, Dublin 12.,Health Research Institute, University of Limerick, Ireland
| | - Kevin J O'Sullivan
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Ireland.,Confirm Smart Manufacturing Centre, University of Limerick, University of Limerick, Ireland
| | - Seamus Clifford
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Leonard O'Sullivan
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Ireland.,Confirm Smart Manufacturing Centre, University of Limerick, University of Limerick, Ireland
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8
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Transcatheter Device Therapy and the Integration of Advanced Imaging in Congenital Heart Disease. CHILDREN 2022; 9:children9040497. [PMID: 35455541 PMCID: PMC9032030 DOI: 10.3390/children9040497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
Transcatheter device intervention is now offered as first line therapy for many congenital heart defects (CHD) which were traditionally treated with cardiac surgery. While off-label use of devices is common and appropriate, a growing number of devices are now specifically designed and approved for use in CHD. Advanced imaging is now an integral part of interventional procedures including pre-procedure planning, intra-procedural guidance, and post-procedure monitoring. There is robust societal and industrial support for research and development of CHD-specific devices, and the regulatory framework at the national and international level is patient friendly. It is against this backdrop that we review transcatheter implantable devices for CHD, the role and integration of advanced imaging, and explore the current regulatory framework for device approval.
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9
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Mayoral I, Bevilacqua E, Gómez G, Hmadcha A, González-Loscertales I, Reina E, Sotelo J, Domínguez A, Pérez-Alcántara P, Smani Y, González-Puertas P, Méndez A, Uribe S, Smani T, Ordoñez A, Valverde I. Tissue engineered in-vitro vascular patch fabrication using hybrid 3D printing and electrospinning. Mater Today Bio 2022; 14:100252. [PMID: 35509864 PMCID: PMC9059085 DOI: 10.1016/j.mtbio.2022.100252] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022] Open
Abstract
Three-dimensional (3D) engineered cardiovascular tissues have shown great promise to replace damaged structures. Specifically, tissue engineering vascular grafts (TEVG) have the potential to replace biological and synthetic grafts. We aimed to design an in-vitro patient-specific patch based on a hybrid 3D print combined with vascular smooth muscle cells (VSMC) differentiation. Based on the medical images of a 2 months-old girl with aortic arch hypoplasia and using computational modelling, we evaluated the most hemodynamically efficient aortic patch surgical repair. Using the designed 3D patch geometry, the scaffold was printed using a hybrid fused deposition modelling (FDM) and electrospinning techniques. The scaffold was seeded with multipotent mesenchymal stem cells (MSC) for later maturation to derived VSMC (dVSMC). The graft showed adequate resistance to physiological aortic pressure (burst pressure 101 ± 15 mmHg) and a porosity gradient ranging from 80 to 10 μm allowing cells to infiltrate through the entire thickness of the patch. The bio-scaffolds showed good cell viability at days 4 and 12 and adequate functional vasoactive response to endothelin-1. In summary, we have shown that our method of generating patient-specific patch shows adequate hemodynamic profile, mechanical properties, dVSMC infiltration, viability and functionality. This innovative 3D biotechnology has the potential for broad application in regenerative medicine and potentially in heart disease prevention. This study combines multidisciplinary approach for bioprinting patient-specific. We create a 3D scaffold, printed using a hybrid fused deposition modelling and electrospinning techniques. The graft shows adequate resistance to physiological aortic pressure and a porosity gradient. Multipotent mesenchymal stem cells seeded in the scaffold are differentiated to derived vascular smooth muscle cells. dVSMC shows adequate endothelin- 1 induced Ca2+ increase associated with ETA overexpression.
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10
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Avesani M, Kang SL, Jalal Z, Thambo JB, Iriart X. Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging. Front Pediatr 2022; 10:894472. [PMID: 35664875 PMCID: PMC9160663 DOI: 10.3389/fped.2022.894472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Percutaneous interventions have completely refashioned the management of children with congenital heart diseases (CHD) and the use of non-invasive imaging has become the gold standard to plan and guide these procedures in the modern era. We are now facing a dual challenge to improve the standard of care in low-risk patients, and to shift our strategies from the classic open chest surgery to imaging-guided percutaneous interventions in high-risk patients. Such rapid evolution of ultrasound technologies over the last 20 years have permitted the integration of transthoracic, transesophageal and intracardiac echocardiography into the interventional workflow to improve image guidance and reduce radiation burden from fluoroscopy and angiography. Specifically, miniaturization of transesophageal probe and advances in three-dimensional (3D) imaging techniques have enabled real-time 3D image guidance during complex interventional procedure, In addition, multimodality and fusion imaging techniques harness the strengths of different modalities to enhance understanding of anatomical and spatial relationship between different structures, improving communication and coordination between interventionalists and imaging specialists. In this review, we aim to provide an overview of 3D imaging modalities and multimodal fusion in procedural planning and live guidance of percutaneous interventions. At the present times, 3D imaging can no longer be considered a luxury but a routine clinical tool to improve procedural success and patient outcomes.
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Affiliation(s)
- Martina Avesani
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Sok-Leng Kang
- Department of Pediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Zakaria Jalal
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Xavier Iriart
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
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11
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Pushparajah K. Non-invasive Imaging in the Evaluation of Cardiac Shunts for Interventional Closure. Front Cardiovasc Med 2021; 8:651726. [PMID: 34222361 PMCID: PMC8253251 DOI: 10.3389/fcvm.2021.651726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Multimodality imaging provides important information to guide patient selection and pre-procedural decision making for shunt lesions in CHD. While echocardiography, CT, and CMR are well-established, 3D printing and now virtual reality imaging are beginning to show promise.
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Affiliation(s)
- Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom.,Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
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Pushparajah K, Chu KYK, Deng S, Wheeler G, Gomez A, Kabir S, Schnabel JA, Simpson JM. Virtual reality three-dimensional echocardiographic imaging for planning surgical atrioventricular valve repair. JTCVS Tech 2021; 7:269-277. [PMID: 34100000 PMCID: PMC8169455 DOI: 10.1016/j.xjtc.2021.02.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To investigate how virtual reality (VR) imaging impacts decision-making in atrioventricular valve surgery. METHODS This was a single-center retrospective study involving 15 children and adolescents, median age 6 years (range, 0.33-16) requiring surgical repair of the atrioventricular valves between the years 2016 and 2019. The patients' preoperative 3-dimesnional (3D) echocardiographic data were used to create 3D visualization in a VR application. Five pediatric cardiothoracic surgeons completed a questionnaire formulated to compare their surgical decisions regarding the cases after reviewing conventionally presented 2-dimesnional and 3D echocardiographic images and again after visualization of 3D echocardiograms using the VR platform. Finally, intraoperative findings were shared with surgeons to confirm assessment of the pathology. RESULTS In 67% of cases presented with VR, surgeons reported having "more" or "much more" confidence in their understanding of each patient's pathology and their surgical approach. In all but one case, surgeons were at least as confident after reviewing the VR compared with standard imaging. The case where surgeons reported to be least confident on VR had the worst technical quality of data used. After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases. CONCLUSIONS The main impact of viewing imaging on VR is the improved clarity of the anatomical structures. Surgeons reported that this would have impacted the surgical approach in the majority of cases. Poor-quality 3D echocardiographic data were associated with a negative impact of VR visualization; thus. quality assessment of imaging is necessary before projecting in a VR format.
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Affiliation(s)
- Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ka Yee Kelly Chu
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Shujie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Gavin Wheeler
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Alberto Gomez
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Saleha Kabir
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Julia A. Schnabel
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - John M. Simpson
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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13
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Raimondi F, Vida V, Godard C, Bertelli F, Reffo E, Boddaert N, El Beheiry M, Masson JB. Fast-track virtual reality for cardiac imaging in congenital heart disease. J Card Surg 2021; 36:2598-2602. [PMID: 33760302 DOI: 10.1111/jocs.15508] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY We sought to evaluate the appropriateness of cardiac anatomy renderings by a new virtual reality (VR) technology, entitled DIVA, directly applicable to raw magnetic resonance imaging (MRI) data without intermediate segmentation steps in comparison to standard three-dimensional (3D) rendering techniques (3D PDF and 3D printing). Differences in post-processing times were also evaluated. METHODS We reconstructed 3D (STL, 3D-PDF, and 3D printed ones) and VR models of three patients with different types of complex congenital heart disease (CHD). We then asked a senior pediatric heart surgeon to compare and grade the results obtained. RESULTS All anatomical structures were well visualized in both VR and 3D PDF/printed models. Ventricular-arterial connections and their relationship with the great vessels were better visualized with the VR model (Case 2); aortic arch anatomy and details were also better visualized by the VR model (Case 3). The median post-processing time to get VR models using DIVA was 5 min in comparison to 8 h (range 8-12 h including printing time) for 3D models (PDF/printed). CONCLUSIONS VR directly applied to non-segmented 3D-MRI data set is a promising technique for 3D advanced modeling in CHD. It is systematically more consistent and faster when compared to standard 3D-modeling techniques.
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Affiliation(s)
- Francesca Raimondi
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes-M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France.,Decision and Bayesian Computation, Computation Biology Department, CNRS, URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris, France.,Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Italy
| | - Charlotte Godard
- Decision and Bayesian Computation, Computation Biology Department, CNRS, URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris, France
| | - Francesco Bertelli
- Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Italy
| | - Elena Reffo
- Pediatric Cardiology Unit, University of Padua, Italy
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | - Mohamed El Beheiry
- Decision and Bayesian Computation, Computation Biology Department, CNRS, URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris, France
| | - Jean-Baptiste Masson
- Decision and Bayesian Computation, Computation Biology Department, CNRS, URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris, France
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14
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Sedlakova V, McTiernan C, Cortes D, Suuronen EJ, Alarcon EI. 3D Bioprinted Cardiac Tissues and Devices for Tissue Maturation. Cells Tissues Organs 2021; 211:406-419. [PMID: 33677445 DOI: 10.1159/000512792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
Cardiovascular diseases are the leading cause of mortality worldwide. Given the limited endogenous regenerative capabilities of cardiac tissue, patient-specific anatomy, challenges in treatment options, and shortage of donor tissues for transplantation, there is an urgent need for novel approaches in cardiac tissue repair. 3D bioprinting is a technology based on additive manufacturing which allows for the design of precisely controlled and spatially organized structures, which could possibly lead to solutions in cardiac tissue repair. In this review, we describe the basic morphological and physiological specifics of the heart and cardiac tissues and introduce the readers to the fundamental principles underlying 3D printing technology and some of the materials/approaches which have been used to date for cardiac repair. By summarizing recent progress in 3D printing of cardiac tissue and valves with respect to the key features of cardiovascular tissue (such as contractility, conductivity, and vascularization), we highlight how 3D printing can facilitate surgical planning and provide custom-fit implants and properties that match those from the native heart. Finally, we also discuss the suitability of this technology in the design and fabrication of custom-made devices intended for the maturation of the cardiac tissue, a process that has been shown to increase the viability of implants. Altogether this review shows that 3D printing and bioprinting are versatile and highly modulative technologies with wide applications in cardiac regeneration and beyond.
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Affiliation(s)
- Veronika Sedlakova
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Histology and Embryology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Christopher McTiernan
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David Cortes
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Erik J Suuronen
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Emilio I Alarcon
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada, .,Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada,
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15
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Mir A, Burkhart HM. Commentary: Complex transposition: Preparing for success. JTCVS Tech 2021; 7:206-207. [PMID: 34318248 PMCID: PMC8311826 DOI: 10.1016/j.xjtc.2021.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Arshid Mir
- Section of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Harold M Burkhart
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
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16
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Yoo SJ, Hussein N, Peel B, Coles J, van Arsdell GS, Honjo O, Haller C, Lam CZ, Seed M, Barron D. 3D Modeling and Printing in Congenital Heart Surgery: Entering the Stage of Maturation. Front Pediatr 2021; 9:621672. [PMID: 33614554 PMCID: PMC7892770 DOI: 10.3389/fped.2021.621672] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/06/2021] [Indexed: 12/05/2022] Open
Abstract
3D printing allows the most realistic perception of the surgical anatomy of congenital heart diseases without the requirement of physical devices such as a computer screen or virtual headset. It is useful for surgical decision making and simulation, hands-on surgical training (HOST) and cardiovascular morphology teaching. 3D-printed models allow easy understanding of surgical morphology and preoperative surgical simulation. The most common indications for its clinical use include complex forms of double outlet right ventricle and transposition of the great arteries, anomalous systemic and pulmonary venous connections, and heterotaxy. Its utility in congenital heart surgery is indisputable, although it is hard to "scientifically" prove the impact of its use in surgery because of many confounding factors that contribute to the surgical outcome. 3D-printed models are valuable resources for morphology teaching. Educational models can be produced for almost all different variations of congenital heart diseases, and replicated in any number. HOST using 3D-printed models enables efficient education of surgeons in-training. Implementation of the HOST courses in congenital heart surgical training programs is not an option but an absolute necessity. In conclusion, 3D printing is entering the stage of maturation in its use for congenital heart surgery. It is now time for imagers and surgeons to find how to effectively utilize 3D printing and how to improve the quality of the products for improved patient outcomes and impact of education and training.
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Affiliation(s)
- Shi Joon Yoo
- Department of Diagnostic Imaging, The University of Toronto, Toronto, ON, Canada
- Department of Paediatrics–Division of Cardiology, The University of Toronto, Toronto, ON, Canada
- Center for Image Guided Innovation and Therapeutic Intervention, The University of Toronto, Toronto, ON, Canada
| | - Nabil Hussein
- Center for Image Guided Innovation and Therapeutic Intervention, The University of Toronto, Toronto, ON, Canada
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Brandon Peel
- Center for Image Guided Innovation and Therapeutic Intervention, The University of Toronto, Toronto, ON, Canada
| | - John Coles
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Glen S. van Arsdell
- Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Department of Surgery, Mattel Children's Hospital at UCLA, Los Angeles, CA, United States
| | - Osami Honjo
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Christoph Haller
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Christopher Z. Lam
- Department of Diagnostic Imaging, The University of Toronto, Toronto, ON, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, The University of Toronto, Toronto, ON, Canada
- Department of Paediatrics–Division of Cardiology, The University of Toronto, Toronto, ON, Canada
| | - David Barron
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
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17
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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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18
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Arcieri L, Provost B, Charbonneau P, Fournier E, Hascoet S, Le Bret E. Three-dimensional printing for surgical planning of a double aortic arch case. J Card Surg 2020; 35:912-915. [PMID: 32092176 DOI: 10.1111/jocs.14479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Over the past years, three-dimensional (3D) models of patient-specific anatomical conditions are being used to improve the comprehension and surgical management of a variety of diseases. It is an additional diagnostic tool that aids clinical decision-making. Furthermore, this technology is still not routinely used in the medical field since its availability is limited by cost and complex process. METHODS AND RESULTS We describe a patient with a balanced-type double aortic arch encircling trachea and esophagus. Considering the clinical symptoms, surgical decompression of these structures and defined aortic arch reconstruction was indicated. The 3D printed model revealed narrowing of the left aortic arch at the junction of the descending thoracic aorta that did not clearly appear on the conventional images reconstruction. The left aortic arch was divided and the symptoms completely disappeared. No immediate or late complications occurred. CONCLUSION 3D printed models can be helpful in surgical planning of congenital heart malformations. It should be strongly considered as an additional tool in complex cases.
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Affiliation(s)
- Luigi Arcieri
- Pediatric Heart Surgery Unit, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Bastien Provost
- Pediatric Heart Surgery Unit, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Philippe Charbonneau
- Pediatric Heart Surgery Unit, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Emmanuelle Fournier
- Pediatric Cardiology Unit, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Sebastien Hascoet
- Pediatric Cardiology Unit, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Emanuel Le Bret
- Pediatric Heart Surgery Unit, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
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19
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Pushparajah K, Duong P, Mathur S, Babu-Narayan SV. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Cardiovascular MRI and CT in congenital heart disease. Echo Res Pract 2019; 6:ERP-19-0048. [PMID: 31730044 PMCID: PMC6893312 DOI: 10.1530/erp-19-0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular MRI and CT are useful imaging modalities complimentary to echocardiography. This review article describes the common indications and consideration for the use of MRI and CT in the management of congenital heart disease.
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Affiliation(s)
- Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Evelina London Children’s Hospital, London, UK
| | - Phuoc Duong
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Evelina London Children’s Hospital, London, UK
| | | | - Sonya V Babu-Narayan
- Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
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20
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XU J, SHU Q. [Application of 3D printing techniques in treatment of congenital heart disease]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:573-579. [PMID: 31901034 PMCID: PMC8800709 DOI: 10.3785/j.issn.1008-9292.2019.10.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/07/2019] [Indexed: 01/24/2023]
Abstract
Congenital heart disease (CHD) is the most common birth defect at present. In recent years, the application of 3D printing in the diagnosis and treatment of CHD has been widely recognized, which presents CHD lesions in 3D solid model and provides a better understanding of the anatomy of CHD. In the future, 3D printing technology would improve the surgical proficiency, shorten the operation time, reduce the occurrence of perioperative complications, and create more personalized cardiovascular implants, therefore promote the precision of diagnosis and treatment for congenital heart disease. This article reviews the application of 3D printing technology in preoperative planning, intraoperative navigation and personalized implants of CHD, in surgical training and medical education, as well as in promoting doctor-patient communication and better understanding their condition for patients.
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Affiliation(s)
| | - Qiang SHU
- 舒强(1965-), 男, 博士, 教授, 博士生导师, 主要从事出生缺陷防治和小儿心胸外科研究; E-mail:
;
https://orcid.org/0000-0002-4106-6255
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