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Mohanadas HP, Nair V, Doctor AA, Faudzi AAM, Tucker N, Ismail AF, Ramakrishna S, Saidin S, Jaganathan SK. A Systematic Analysis of Additive Manufacturing Techniques in the Bioengineering of In Vitro Cardiovascular Models. Ann Biomed Eng 2023; 51:2365-2383. [PMID: 37466879 PMCID: PMC10598155 DOI: 10.1007/s10439-023-03322-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
Additive Manufacturing is noted for ease of product customization and short production run cost-effectiveness. As our global population approaches 8 billion, additive manufacturing has a future in maintaining and improving average human life expectancy for the same reasons that it has advantaged general manufacturing. In recent years, additive manufacturing has been applied to tissue engineering, regenerative medicine, and drug delivery. Additive Manufacturing combined with tissue engineering and biocompatibility studies offers future opportunities for various complex cardiovascular implants and surgeries. This paper is a comprehensive overview of current technological advancements in additive manufacturing with potential for cardiovascular application. The current limitations and prospects of the technology for cardiovascular applications are explored and evaluated.
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Affiliation(s)
| | - Vivek Nair
- Computational Fluid Dynamics (CFD) Lab, Mechanical and Aerospace Engineering, University of Texas Arlington, Arlington, TX, 76010, USA
| | | | - Ahmad Athif Mohd Faudzi
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
| | - Nick Tucker
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Ahmad Fauzi Ismail
- School of Chemical and Energy Engineering, Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology Initiative, National University of Singapore, Singapore, Singapore
| | - Syafiqah Saidin
- IJNUTM Cardiovascular Engineering Centre, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Saravana Kumar Jaganathan
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia.
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia.
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK.
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Jani V, Li L, Craft M, Veronesi F, Khoo N, Danford D, Muraru D, Kutty S. Semi-automated quantification of tricuspid valve dynamics and structure in tetralogy of Fallot and hypoplastic left heart syndrome using three-dimensional echocardiography. Echo Res Pract 2023; 10:10. [PMID: 37408077 DOI: 10.1186/s44156-023-00023-y] [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: 04/13/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
Anomalies of the tricuspid valve (TV) are associated with worsened prognosis in congenital heart disease (CHD). Here, we present a descriptive study examining changes in TV morphology in two CHD conditions-repaired tetralogy of Fallot (rTOF) and hypoplastic left heart syndrome (HLSH), using three-dimensional echocardiography. Full volume acquisitions of the TV and right ventricle (RV) were performed from an RV-focused apical view using ECG gating over 2-5 consecutive cardiac cycles using 3D echocardiography, from which TV annulus and leaflet parameters were quantified. A total of 40 rTOF patients (age 14 ± 9.8 years), 40 HLHS patients (age1.0 ± 1.5 years) and 80 age and gender matched controls were included. Among leaflet parameters, antero-posterior and posterior-septal TV coaptation heights were smaller in rTOF (p < 0.001) vs. control. Conversely, only the short-axis TV height was different in HLHS vs. controls (HLHS 1.6 ± 0.4 cm vs. control 1.4 ± 0.3 cm). TV leaflet parameters tended to be larger in HLHS, while leaflet coaptation distances were similar between groups. We demonstrate that 3D echocardiography for assessment of the TV is feasible in rTOF and HLHS patients and identifies unique differences in TV morphology. Future studies should clarify the clinical significance of TV morphology in these patient populations.
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Affiliation(s)
- Vivek Jani
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ling Li
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Mary Craft
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Federico Veronesi
- Department of Electrical, Electronic and Information Engineering, University of Bologna, Bologna, Italy
| | - Nee Khoo
- Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - David Danford
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Shelby Kutty
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA.
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Jost ZT, Nooli NP, Ali AE, Jaganathan V, Nanda NC. Three-dimensional echocardiography of the tricuspid valve. Front Cardiovasc Med 2023; 10:1114715. [PMID: 37020521 PMCID: PMC10067886 DOI: 10.3389/fcvm.2023.1114715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/24/2023] [Indexed: 03/22/2023] Open
Abstract
Due to the proportionally high mortality rates associated with isolated tricuspid valve surgery, the invasive treatment of such pathology, historically, has been left largely unaddressed. Recently, there has been an appreciation for the mortality and morbidity of tricuspid valve disease, giving rise to the movement towards identifying less invasive, transcatheter approaches for treatment. Due to the technical complexity of these procedures along with the uniqueness and variability of tricuspid valve anatomy, a better appreciation of the tricuspid valve anatomy and pathology is required for pre-procedural planning. While two-dimensional echocardiography serves as the initial non-invasive modality for tricuspid valve evaluation, three-dimensional echocardiography provides a complete en face view of the tricuspid valve and surrounding structures, as well contributes further information regarding disease etiology and severity. In this review, we discuss the utility of three-dimensional echocardiography as a supplement to two-dimensional imaging to better assess tricuspid valve disease and anatomy to aide in future innovative therapies.
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Affiliation(s)
- Zachary T. Jost
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Correspondence: Zachary T. Jost Navin C. Nanda
| | - Nishank P. Nooli
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ahmed E. Ali
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vijayadithyan Jaganathan
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Navin C. Nanda
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Correspondence: Zachary T. Jost Navin C. Nanda
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Escabia C, Bayes-Genis A, Delgado V. Three-Dimensional Echocardiography for Tricuspid Valve Assessment. Curr Cardiol Rep 2022; 24:1611-1618. [PMID: 36048305 DOI: 10.1007/s11886-022-01780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW This review article provides an overview of the various roles of 3-dimensional (3D) echocardiography in the evaluation of the tricuspid valve (TV) with specific focus on tricuspid regurgitation (TR) and its treatment. RECENT FINDINGS The prognostic implications of TR and the advent of new transcatheter therapies have underscored the need of accurate assessment of the TV. 3D echocardiography is key to assess the anatomy and function of TV and has provided new insights that have led to new classifications of the type of TR. Furthermore, 3D echocardiography is superior to 2-dimensional echocardiography to assess the right ventricle, an important parameter to select the patients with severe TR who may benefit from intervention. Finally, the use of 3D echocardiography during the guidance of transcatheter interventions is pivotal to ensure procedural success and minimize the complications. Three-dimensional echocardiography provides the soft tissue resolution that fluoroscopy does not provide.
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Affiliation(s)
- Claudia Escabia
- Department of Cardiology, Heart Institute, Hospital University Germans Trias I Pujol, Carretera de Canyet, 08916, Badalona, Spain
| | - Antoni Bayes-Genis
- Department of Cardiology, Heart Institute, Hospital University Germans Trias I Pujol, Carretera de Canyet, 08916, Badalona, Spain
| | - Victoria Delgado
- Department of Cardiology, Heart Institute, Hospital University Germans Trias I Pujol, Carretera de Canyet, 08916, Badalona, Spain. .,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Muraru D, Gavazzoni M, Heilbron F, Mihalcea DJ, Guta AC, Radu N, Muscogiuri G, Tomaselli M, Sironi S, Parati G, Badano LP. Reference ranges of tricuspid annulus geometry in healthy adults using a dedicated three-dimensional echocardiography software package. Front Cardiovasc Med 2022; 9:1011931. [PMID: 36176994 PMCID: PMC9513148 DOI: 10.3389/fcvm.2022.1011931] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTricuspid annulus (TA) sizing is essential for planning percutaneous or surgical tricuspid procedures. According to current guidelines, TA linear dimension should be assessed using two-dimensional echocardiography (2DE). However, TA is a complex three-dimensional (3D) structure.AimIdentify the reference values for TA geometry and dynamics and its physiological determinants using a commercially available three-dimensional echocardiography (3DE) software package dedicated to the tricuspid valve (4D AutoTVQ, GE).MethodsA total of 254 healthy volunteers (113 men, 47 ± 11 years) were evaluated using 2DE and 3DE. TA 3D area, perimeter, diameters, and sphericity index were assessed at mid-systole, early- and end-diastole. Right atrial (RA) and ventricular (RV) end-diastolic and end-systolic volumes were also measured by 3DE.ResultsThe feasibility of the 3DE analysis of TA was 90%. TA 3D area, perimeter, and diameters were largest at end-diastole and smallest at mid-systole. Reference values of TA at end-diastole were 9.6 ± 2.1 cm2 for the area, 11.2 ± 1.2 cm for perimeter, and 38 ± 4 mm, 31 ± 4 mm, 33 ± 4 mm, and 34 ± 5 mm for major, minor, 4-chamber and 2-chamber diameters, respectively. TA end-diastolic sphericity index was 81 ± 11%. All TA parameters were correlated with body surface area (BSA) (r from 0.42 to 0.58, p < 0.001). TA 3D area and 4-chamber diameter were significantly larger in men than in women, independent of BSA (p < 0.0001). There was no significant relationship between TA metrics with age, except for the TA minor diameter (r = −0.17, p < 0.05). When measured by 2DE in 4-chamber (29 ± 5 mm) and RV-focused (30 ± 5 mm) views, both TA diameters resulted significantly smaller than the 4-chamber (33 ± 4 mm; p < 0.0001), and the major TA diameters (38 ± 4 mm; p < 0.0001) measured by 3DE. At multivariable linear regression analysis, RA maximal volume was independently associated with both TA 3D area at mid-systole (R2 = 0.511, p < 0.0001) and end-diastole (R2 = 0.506, p < 0.0001), whereas BSA (R2 = 0.526, p < 0.0001) was associated only to mid-systolic TA 3D area.ConclusionsReference values for TA metrics should be sex-specific and indexed to BSA. 2DE underestimates actual 3DE TA dimensions. RA maximum volume was the only independent echocardiographic parameter associated with TA 3D area in healthy subjects.
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Affiliation(s)
- Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- *Correspondence: Mara Gavazzoni
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Diana J. Mihalcea
- University of Medicine and Pharmacy Carol Davila Bucharest, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Andrada C. Guta
- Department of Cardiology, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, TX, United States
| | - Noela Radu
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- University of Medicine and Pharmacy Carol Davila Bucharest, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Giuseppe Muscogiuri
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sandro Sironi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Radiology Department, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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Zhai M, Mao Y, Ma Y, Liu Y, Yang J. Transcatheter Double Valve Replacement to Treat Aortic Stenosis and Severe Tricuspid Regurgitation with 3D Printing Guidance after Mechanical Mitral Valve Replacement. J Cardiovasc Dev Dis 2022; 9:jcdd9090296. [PMID: 36135441 PMCID: PMC9501933 DOI: 10.3390/jcdd9090296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Transcatheter treatments of tricuspid regurgitation (TR) have been emerging as alternatives for high-risk patients. In contrast to the immobilization of the common transcatheter tricuspid device, using a radial force-independent stent valve device at the native tricuspid annular site has several distinct advantages. Case summary: A 76-year-old patient with renal insufficiency who underwent mechanical mitral valve replacement in 2001 and transcatheter aortic valve replacement in 2021 due to severe aortic stenosis presented with chest pain and shortness of breath. Echocardiography suggested that the flow velocities of the mitral mechanical valve and aortic prosthetic valve were both within the normal range, with no significant paravalvular regurgitation; the tricuspid valve exhibited massive regurgitation (VMAX 258 cm/s, PGMAX 27 mmHg). Due to the high surgical risk, we simulated the procedure with a three-dimensional (3D)-printed model and performed transcatheter tricuspid valve replacement using a LuX-Valve (Ningbo Jenscare Biotechnology Co., Ningbo, China). Discussion: We describe transcatheter tricuspid valve replacement using the LuX-Valve and preprocedural guidance with 3D printing. Postprocedural TR was significantly reduced, indicating that 3D printing plays an important role in preprocedural guidance and that the LuX-Valve was safe and practicable for tricuspid valve replacement.
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Affiliation(s)
| | | | | | - Yang Liu
- Correspondence: (Y.L.); (J.Y.); Tel.: +86-135-1913-5591 (Y.L.); +86-138-9282-8016 (J.Y.)
| | - Jian Yang
- Correspondence: (Y.L.); (J.Y.); Tel.: +86-135-1913-5591 (Y.L.); +86-138-9282-8016 (J.Y.)
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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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Lindquist EM, Gosnell JM, Khan SK, Byl JL, Zhou W, Jiang J, Vettukattil JJ. 3D printing in cardiology: A review of applications and roles for advanced cardiac imaging. ANNALS OF 3D PRINTED MEDICINE 2021. [DOI: 10.1016/j.stlm.2021.100034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Sturgeon GM, Andersen ND, Campbell MJ, Barker PCA. Three-dimensional modeling of the mitral valve for surgical planning in a pediatric patient: A case-based discussion of the technical challenges of segmentation and printing from 3D transthoracic echocardiographic datasets. Echocardiography 2021; 38:1978-1983. [PMID: 34719050 DOI: 10.1111/echo.15239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/20/2021] [Accepted: 10/16/2021] [Indexed: 12/22/2022] Open
Abstract
Abnormal atrioventricular valve present great challenges to the surgeon in achieving a successful repair, and thus present a great opportunity for enhanced 3D imaging to guide pre- and intra-operative management. Spatial and temporal resolution of 3D echocardiography enables 3D printing of valve morphology. However, non-linearity, angle dependence, speckle, blur, and resampling complicate segmentation compared to computed tomography (CT) and magnetic resonance imaging (MRI). A case of complex mitral valve disease in a pediatric patient is therefore presented to illustrate the technical challenges of segmentation and 3D printing from echocardiographic data.
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Affiliation(s)
- Gregory M Sturgeon
- Duke Children's Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicholas D Andersen
- Duke Children's Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, North Carolina, USA.,Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael J Campbell
- Duke Children's Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Piers C A Barker
- Duke Children's Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, North Carolina, USA
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Caravita S, Figliozzi S, Florescu DR, Volpato V, Oliverio G, Tomaselli M, Torlasco C, Muscogiuri G, Cernigliaro F, Parati G, Badano L, Muraru D. Recent advances in multimodality imaging of the tricuspid valve. Expert Rev Med Devices 2021; 18:1069-1081. [PMID: 34617481 DOI: 10.1080/17434440.2021.1990753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The tricuspid valve (TV) and the right heart chambers are complex three-dimensional structures that are difficult to assess using tomographic imaging techniques. The progressive aging of the general population and the advancements in treating left-sided heart diseases by transcatheter procedures have contributed to the tricuspid regurgitation (TR) becoming a major public health problem associated with progression to refractory heart failure and poor outcome. Recent advances in multimodality cardiac imaging allow a better understanding of the pathophysiology of TR that may translate in better management of patients. AREAS COVERED Three-dimensional echocardiography, cardiac magnetic resonance, and computed tomography provide complementary information to i. assess the TV complex; ii. identify the etiology and the mechanisms of TR; iii. evaluate its severity and hemodynamic consequences; iv. explore the remodeling of the right heart chambers; and v. properly plan, guide, and monitor the transcatheter interventions aimed to reduce the severity of TR. EXPERT OPINION We need thorough understanding of both the TV and the right heart chamber geometry and function to understand the pathophysiology of TR. The integrated use of multimodality cardiac imaging is pivotal to assess patients with TR and to identify tailored and timely treatment of TR in properly selected patients.
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Affiliation(s)
- Sergio Caravita
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy
| | - Stefano Figliozzi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Diana-Ruxandra Florescu
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Valentina Volpato
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Giorgio Oliverio
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Michele Tomaselli
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Franco Cernigliaro
- Department of Radiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luigi Badano
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Denisa Muraru
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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11
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Johnson EL, Laurence DW, Xu F, Crisp CE, Mir A, Burkhart HM, Lee CH, Hsu MC. Parameterization, geometric modeling, and isogeometric analysis of tricuspid valves. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2021; 384:113960. [PMID: 34262232 PMCID: PMC8274564 DOI: 10.1016/j.cma.2021.113960] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Approximately 1.6 million patients in the United States are affected by tricuspid valve regurgitation, which occurs when the tricuspid valve does not close properly to prevent backward blood flow into the right atrium. Despite its critical role in proper cardiac function, the tricuspid valve has received limited research attention compared to the mitral and aortic valves on the left side of the heart. As a result, proper valvular function and the pathologies that may cause dysfunction remain poorly understood. To promote further investigations of the biomechanical behavior and response of the tricuspid valve, this work establishes a parameter-based approach that provides a template for tricuspid valve modeling and simulation. The proposed tricuspid valve parameterization presents a comprehensive description of the leaflets and the complex chordae tendineae for capturing the typical three-cusp structural deformation observed from medical data. This simulation framework develops a practical procedure for modeling tricuspid valves and offers a robust, flexible approach to analyze the performance and effectiveness of various valve configurations using isogeometric analysis. The proposed methods also establish a baseline to examine the tricuspid valve's structural deformation, perform future investigations of native valve configurations under healthy and disease conditions, and optimize prosthetic valve designs.
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Affiliation(s)
- Emily L. Johnson
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Devin W. Laurence
- School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, Oklahoma 73019, USA
| | - Fei Xu
- Ansys Inc., 807 Las Cimas Parkway, Austin, Texas 78746, USA
| | - Caroline E. Crisp
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Arshid Mir
- Division of Pediatric Cardiology, Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Harold M. Burkhart
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Chung-Hao Lee
- School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, Oklahoma 73019, USA
- Institute for Biomedical Engineering, Science and Technology (IBEST), The University of Oklahoma, Norman, Oklahoma 73019, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
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Abstract
PURPOSE OF REVIEW Despite the prevalence of tricuspid valve regurgitation disorders, isolated interventions on tricuspid valves were previously infrequent due to high mortality rates and lack of advanced clinical imaging technology. Due to advancements in cardiovascular imaging and interventional technologies tricuspid valve repairs and replacement interventions became increasingly more attainable. RECENT FINDINGS Noninvasive clinical imaging of the tricuspid valve can be challenging, providing anincomplete assessment of unique tricuspid anatomy. 3D printing technology represents an additional tool for more comprehensive preprocedural planning of tricuspid interventions and observation of tricuspid valve geometry. Patient-specific 3D printed replicas of tricuspid valve apparatus are especially useful in highly complicated cases, where physiological tricuspid replicas allow benchtop observation of individual patient's anatomy, device implantation in physiological tricuspid valves and interactions of devices with native tricuspid tissue, frequently leading to optimization or change in operational strategy. SUMMARY Comprehensive use of clinical imaging including echocardiography, computed tomography, and cardiac magnetic resonance along with 3D printed modeling is key to successful tricuspid repair and replacements. Patient-specific 3D printed models of tricuspid anatomy can facilitate preprocedural planning, educate patients and clinicians, and improve device design, leading to the overall improvement of patients' outcomes and care.
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Volpato V, Badano LP, Figliozzi S, Florescu DR, Parati G, Muraru D. Multimodality cardiac imaging and new display options to broaden our understanding of the tricuspid valve. Curr Opin Cardiol 2021; 36:513-524. [PMID: 34292179 PMCID: PMC9904443 DOI: 10.1097/hco.0000000000000890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The prognostic impact of tricuspid regurgitation (TR) and the subsequent development of percutaneous procedures targeting the tricuspid valve (TV), has brought to the forefront the role of imaging for the assessment of the forgotten valve. As illustrated in several studies and summarized in this review, currently a multimodality imaging approach is required to understand the pathophysiology of TR, due to the complex TV anatomy and the close relationship between the severity of TR and the extent of the remodeling of the right heart chambers. RECENT FINDINGS Recently, the advance in the tranhscatheter treatment of the TV has led to a growing interest in the development of dedicated software packages and new display modalities to increase our understanding of the TV. As a consequence, a transversal knowledge of the different imaging modalities is required for contemporary cardiac-imaging physicians. SUMMARY This review highlights the main features, and the pros and cons of echocardiography, cardiac computed tomography, cardiac magnetic resonance and emerging technologies, as 3D printing and virtual reality, in the assessment of patients with TR.
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Affiliation(s)
- Valentina Volpato
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Stefano Figliozzi
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Diana R. Florescu
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
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Vieira MLC, Branco CEDB, Gazola ASL, Vieira PPAC, Benvenuti LA, Demarchi LMMF, Gutierrez PS, Aiello VD, Tarasoutchi F, Sampaio RO. 3D Echocardiography for Rheumatic Heart Disease Analysis: Ready for Prime Time. Front Cardiovasc Med 2021; 8:676938. [PMID: 34355026 PMCID: PMC8329529 DOI: 10.3389/fcvm.2021.676938] [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: 03/11/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Rheumatic heart disease (RHD) remains to be a very important health issue worldwide, mainly in underdeveloped countries. It continues to be a leading cause of morbidity and mortality throughout developing countries. RHD is a delayed non-suppurative immunologically mediated inflammatory response to the throat infection caused by a hemolytic streptococcus from the A group (Streptococcus pyogenes). RHD keeps position 1 as the most common cardiovascular disease in young people aged <25 years considering all the continents. The disease can lead to valvular cardiac lesions as well as to carditis. Rheumatic fever valvular injuries lead most commonly to the fusion and thickening of the edges of the cusps and to the fusion, thickening, and shortening of the chordae and ultimately to calcification of the valves. Valvular commissures can also be deeply compromised, leading to severe stenosis. Atrial and ventricular remodeling is also common following rheumatic infection. Mixed valvular lesions are more common than isolated valvular disorders. Echocardiography is the most relevant imaging technique not only to provide diagnostic information but also to enable prognostic data. Further, it presents a very important role for the correction of complications after surgical repair of rheumatic heart valvulopathies. Three-dimensional (3D) echocardiography provides additional anatomical and morphofunctional information of utmost importance for patients presenting rheumatic valvopathies. Accordingly, three-dimensional echocardiography is ready for routine use in patients with RHD presenting with valvular abnormalities.
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Affiliation(s)
- Marcelo Luiz Campos Vieira
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Flávio Tarasoutchi
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | - Roney Orismar Sampaio
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
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15
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Michiels C, Jambon E, Sarrazin J, Boulenger de Hauteclocque A, Ricard S, Grenier N, Faessel M, Bos F, Bernhard JC. [Comprehensive review of 3D printing use in medicine: Comparison with practical applications in urology]. Prog Urol 2021; 31:762-771. [PMID: 34154961 DOI: 10.1016/j.purol.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/17/2021] [Accepted: 04/02/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Over the past few years, 3D printing has evolved rapidly. This has resulted in an increasing number of scientific publications reporting on the medical use of 3D printing. These applications can range from patient information, preoperative planning, education, or 3D printing of patient-specific surgical implants. The objective of this review was to give an overview of the different applications in urology and other disciplines based on a selection of publications. METHODS In the current narrative review the Medline database was searched to identify all the related reports discussing the use of 3D printing in the medical field and more specifically in Urology. 3D printing applications were categorized so they could be searched more thoroughly within the Medline database. RESULTS Three-dimensional printing can help improve pre-operative patient information, anatomy and medical trainee education. The 3D printed models may assist the surgeon in preoperative planning or become patient-specific surgical simulation models. In urology, kidney cancer surgery is the most concerned by 3D printing-related publications, for preoperative planning, but also for surgical simulation and surgical training. CONCLUSION 3D printing has already proven useful in many medical applications, including urology, for patient information, education, pre-operative planning and surgical simulation. All areas of urology are involved and represented in the literature. Larger randomized controlled studies will certainly allow 3D printing to benefit patients in routine clinical practice.
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Affiliation(s)
- C Michiels
- Service de chirurgie urologique et transplantation rénale, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux cedex, France.
| | - E Jambon
- Service d'imagerie et radiologie interventionnelle, CHU Bordeaux, France.
| | - J Sarrazin
- Fablab et Technoshop Coh@bit, IUT, Université de Bordeaux, France.
| | - A Boulenger de Hauteclocque
- Service de chirurgie urologique et transplantation rénale, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux cedex, France.
| | - S Ricard
- Service de chirurgie urologique et transplantation rénale, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux cedex, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France
| | - N Grenier
- Service d'imagerie et radiologie interventionnelle, CHU Bordeaux, France
| | - M Faessel
- Fablab et Technoshop Coh@bit, IUT, Université de Bordeaux, France.
| | - F Bos
- Fablab et Technoshop Coh@bit, IUT, Université de Bordeaux, France.
| | - J C Bernhard
- Service de chirurgie urologique et transplantation rénale, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux cedex, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France.
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16
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Mowers KL, Fullerton JB, Hicks D, Singh GK, Johnson MC, Anwar S. 3D Echocardiography Provides Highly Accurate 3D Printed Models in Congenital Heart Disease. Pediatr Cardiol 2021; 42:131-141. [PMID: 33083888 DOI: 10.1007/s00246-020-02462-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/16/2020] [Indexed: 01/22/2023]
Abstract
Cardiac 3D printing is mainly performed from magnetic resonance imaging (MRI) and computed tomography (CT) 3D datasets, though anatomic detail of atrioventricular (AV) valves may be limited. 3D echo provides excellent visualization of AV valves. Thus, we tested the feasibility and accuracy of 3D printing from 3D echo in this pilot series of subjects with congenital heart disease (CHD), with a focus on valve anatomy. Five subjects with CHD were identified. 3D echo data were converted to 3D printable files and printed in collaboration with 3D Systems Healthcare (Golden, Colorado). A novel technique for valve modeling was utilized using commercially available software. Two readers (KM, SA) independently measured valve structures from 3D models and compared to source echo images. 3D printing was feasible for all cases. Table 1 shows measurements comparing 2D echo to 3D models. Bland Altman analysis showed close agreement and no significant bias between 2D and digital 3D models (mean difference 0.0, 95% CI 1.1 to - 1.1) or 2D vs printed 3D models, though with wider limits of agreement (mean difference - 0.3, 95% CI 1.9 to - 2.6). Accuracy of 3D models compared to 2D was within < 0.5 mm. This pilot study shows 3D echo datasets can be used to reliably print AV and semilunar valve structures in CHD. The 3D models are highly accurate compared to the source echo images. This is a novel and value-added technique that adds incremental information on cardiac anatomy over current methods.
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Affiliation(s)
- K L Mowers
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - D Hicks
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - G K Singh
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - M C Johnson
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - S Anwar
- School of Medicine, University of California, 1975 4th Street Second Floor, Room# A2421, UCSF Box 4029, San Francisco, CA, 94143, USA.
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17
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Wang H, Song H, Yang Y, Cao Q, Hu Y, Chen J, Guo J, Wang Y, Jia D, Cao S, Zhou Q. Three-dimensional printing for cardiovascular diseases: from anatomical modeling to dynamic functionality. Biomed Eng Online 2020; 19:76. [PMID: 33028306 PMCID: PMC7542711 DOI: 10.1186/s12938-020-00822-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
Three-dimensional (3D) printing is widely used in medicine. Most research remains focused on forming rigid anatomical models, but moving from static models to dynamic functionality could greatly aid preoperative surgical planning. This work reviews literature on dynamic 3D heart models made of flexible materials for use with a mock circulatory system. Such models allow simulation of surgical procedures under mock physiological conditions, and are; therefore, potentially very useful to clinical practice. For example, anatomical models of mitral regurgitation could provide a better display of lesion area, while dynamic 3D models could further simulate in vitro hemodynamics. Dynamic 3D models could also be used in setting standards for certain parameters for function evaluation, such as flow reserve fraction in coronary heart disease. As a bridge between medical image and clinical aid, 3D printing is now gradually changing the traditional pattern of diagnosis and treatment.
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Affiliation(s)
- Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hongning Song
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yugang Hu
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jinling Chen
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Juan Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yijia Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dan Jia
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Sheng Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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18
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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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Wang DD, Qian Z, Vukicevic M, Engelhardt S, Kheradvar A, Zhang C, Little SH, Verjans J, Comaniciu D, O'Neill WW, Vannan MA. 3D Printing, Computational Modeling, and Artificial Intelligence for Structural Heart Disease. JACC Cardiovasc Imaging 2020; 14:41-60. [PMID: 32861647 DOI: 10.1016/j.jcmg.2019.12.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 01/19/2023]
Abstract
Structural heart disease (SHD) is a new field within cardiovascular medicine. Traditional imaging modalities fall short in supporting the needs of SHD interventions, as they have been constructed around the concept of disease diagnosis. SHD interventions disrupt traditional concepts of imaging in requiring imaging to plan, simulate, and predict intraprocedural outcomes. In transcatheter SHD interventions, the absence of a gold-standard open cavity surgical field deprives physicians of the opportunity for tactile feedback and visual confirmation of cardiac anatomy. Hence, dependency on imaging in periprocedural guidance has led to evolution of a new generation of procedural skillsets, concept of a visual field, and technologies in the periprocedural planning period to accelerate preclinical device development, physician, and patient education. Adaptation of 3-dimensional (3D) printing in clinical care and procedural planning has demonstrated a reduction in early-operator learning curve for transcatheter interventions. Integration of computation modeling to 3D printing has accelerated research and development understanding of fluid mechanics within device testing. Application of 3D printing, computational modeling, and ultimately incorporation of artificial intelligence is changing the landscape of physician training and delivery of patient-centric care. Transcatheter structural heart interventions are requiring in-depth periprocedural understanding of cardiac pathophysiology and device interactions not afforded by traditional imaging metrics.
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Affiliation(s)
- Dee Dee Wang
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA.
| | - Zhen Qian
- Hippocrates Research Lab, Tencent America, Palo Alto, California, USA
| | - Marija Vukicevic
- Department of Cardiology, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Sandy Engelhardt
- Artificial Intelligence in Cardiovascular Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Arash Kheradvar
- Department of Biomedical Engineering, Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, California, USA
| | - Chuck Zhang
- H. Milton Stewart School of Industrial & Systems Engineering and Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta Georgia, USA
| | - Stephen H Little
- Department of Cardiology, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Johan Verjans
- Australian Institute for Machine Learning, University of Adelaide, Adelaide South Australia, Australia
| | - Dorin Comaniciu
- Siemens Healthineers, Medical Imaging Technologies, Princeton, New Jersey, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mani A Vannan
- Hippocrates Research Lab, Tencent America, Palo Alto, California, USA
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20
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Agricola E, Asmarats L, Maisano F, Cavalcante JL, Liu S, Milla F, Meduri C, Rodés-Cabau J, Vannan M, Pibarot P. Imaging for Tricuspid Valve Repair and Replacement. JACC Cardiovasc Imaging 2020; 14:61-111. [PMID: 32828782 DOI: 10.1016/j.jcmg.2020.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 12/16/2022]
Abstract
Primary or secondary tricuspid regurgitation (TR) represents an important health care burden and challenge which has often been neglected or undertreated in the past. The expansion and reinforcement of the indications for tricuspid valve (TV) intervention in the 2017 editions of the guidelines as well as the introduction of transcatheter tricuspid valve intervention (TTVI) has considerably increased the attention of the community on the TV and the volume of TV interventions in the past years. Depending on the anatomic target, TTVI can be categorized as the following: 1) direct or indirect tricuspid restrictive annuloplasty; 2) direct (edge-to-edge repair) or indirect (coaptation device) restoration of leaflet coaptation; 3) heterotopic tricuspid valve implantation; and 4) transcatheter tricuspid valve replacement. Multimodality imaging has crucial role for the following: 1) patient selection for TTVI and procedure planning; 2) guiding and monitoring the procedure; and 3) assessing and following over time the results of the procedure. The key points for pre-procedural imaging are: 1) accurate quantitation of TR severity; 2) proper identification of the mechanism(s) responsible for the TR; and 3) quantitation of RV dysfunction and pulmonary arterial hypertension. This imaging work-up is essential to select the right type of intervention for the right patient and TV. Transesophageal echocardiography and fluoroscopy imaging is also key for guiding the TTVI procedures and fusion between these 2 modalities may further enhance the quality of procedure guiding.
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Affiliation(s)
| | - Lluis Asmarats
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada
| | | | - João L Cavalcante
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Shizhen Liu
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Federico Milla
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Christopher Meduri
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada
| | - Mani Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada.
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Utility of Three-Dimensional (3D) Modeling for Planning Structural Heart Interventions (with an Emphasis on Valvular Heart Disease). Curr Cardiol Rep 2020; 22:125. [PMID: 32789652 DOI: 10.1007/s11886-020-01354-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Advanced imaging has played a vital role in the contemporary, rapid rise of structural heart interventions. 3D modeling and printing has emerged as one of the most recent imaging tools and the implementation of 3D modeling is expected to increase with further advances in imaging, print hardware, and materials. RECENT FINDINGS 3D modeling can be used to educate patients and clinical teams, provide ex vivo procedural simulation, and improve outcomes. Intra-procedural success rates may be improved, and post-procedural complications can be predicted more robustly with appropriate application of 3D modeling. Recent advances in technology have increased the availability of this tool, such that there can be more ready adoption into a routine clinical workflow. Familiarity with 3D modeling and its current utilization and role in structural interventions will help inform how to approach and adapt this exciting new technology.
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22
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Wilk R, Likus W, Hudecki A, Syguła M, Różycka-Nechoritis A, Nechoritis K. What would you like to print? Students' opinions on the use of 3D printing technology in medicine. PLoS One 2020; 15:e0230851. [PMID: 32240212 PMCID: PMC7117709 DOI: 10.1371/journal.pone.0230851] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/10/2020] [Indexed: 02/08/2023] Open
Abstract
Background Recent advances in 3D printing technology, and biomaterials are revolutionizing medicine. The beneficiaries of this technology are primarily patients, but also students of medical faculties. Taking into account that not all students have full, direct access to the latest advances in additive technologies, we surveyed their opinion on 3D printing and education in this area. The research aimed to determine what knowledge about the use of 3D printing technology in medicine, do students of medical faculties have. Methods The research was carried out in the form of a questionnaire among 430 students of the Medical University of Silesia in Katowice (Poland) representing various fields of medicine and health sciences. The questions included in the survey analyzed the knowledge of the respondents for 3D printing technology and the opportunities it creates in medicine. Results The results indicate that students do have knowledge about 3D printing obtained mainly from the internet. They would be happy to deepen their knowledge at specialized courses in this field. Students appreciated the value of 3D printing in order to obtain accurate anatomical models, helpful in learning. However, they do not consider the possibility of complete abandonment of human cadavers in the anatomy classes. Their knowledge includes basic information about current applications of 3D printing in medicine, but not in all areas. However, they have no ethical doubts regarding the use of 3D printing in any form. The vast majority of students deemed it necessary to incorporate information regarding 3D printing technology into the curriculum of different medical majors. Conclusion This research is the first of its kind, which allows for probing students' knowledge about the additive technologies in medicine. Medical education should be extended to include issues related to the use of 3D printing for medical applications.
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Affiliation(s)
- Renata Wilk
- Department of Anatomy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Wirginia Likus
- Department of Anatomy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
- * E-mail: ,
| | - Andrzej Hudecki
- Łukasiewicz Research Network–Institute of Non-Ferrous Metals, Gliwice, Poland
| | - Marita Syguła
- Department of Anatomy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Konstantinos Nechoritis
- Department of Anatomy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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23
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Guo YT, Hou N, Liang JH, Zhang ZK, Cao TS, Yuan LJ. Three-dimensional printed multicolor normal and abnormal fetal hearts based on ultrasound imaging data. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:421-422. [PMID: 31290180 DOI: 10.1002/uog.20392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Y-T Guo
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
- 3D Printing Center, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - N Hou
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - J-H Liang
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
- 3D Printing Center, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Z-K Zhang
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
- 3D Printing Center, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - T-S Cao
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
- 3D Printing Center, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - L-J Yuan
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
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24
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Muraru D, Hahn RT, Soliman OI, Faletra FF, Basso C, Badano LP. 3-Dimensional Echocardiography in Imaging the Tricuspid Valve. JACC Cardiovasc Imaging 2020; 12:500-515. [PMID: 30846124 DOI: 10.1016/j.jcmg.2018.10.035] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/13/2018] [Accepted: 10/19/2018] [Indexed: 12/22/2022]
Abstract
Tricuspid regurgitation (TR) is an independent predictor of death. Lately, emerging technologies for the treatment of TR have increased the interest of physicians. Due to the complex 3-dimensional (3D) geometry of the tricuspid valve (TV) and its anterior position in the mediastinum, conventional 2D echocardiography is unsuitable to study the anatomy and pathophysiologic mechanisms of the regurgitant TV. 3D echocardiography has emerged as a very cost-effective imaging modality with which to: 1) visualize the TV anatomy; 2) define the mechanism of TR; 3) measure the size and geometry of the tricuspid annulus; 4) analyze the anatomic relationships between TV apparatus and surrounding cardiac structures; 5) assess volumes and function of the right atrium and ventricle; and 6) plan surgical repair or guide and monitor transcatheter interventional procedures.
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Affiliation(s)
- Denisa Muraru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy; IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Rebecca T Hahn
- Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York
| | - Osama I Soliman
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Francesco F Faletra
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Luigi P Badano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy; IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy.
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25
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Imaging Needs in Novel Transcatheter Tricuspid Valve Interventions. JACC Cardiovasc Imaging 2019; 11:736-754. [PMID: 29747849 DOI: 10.1016/j.jcmg.2017.10.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 02/01/2023]
Abstract
The advent of novel transcatheter therapies for severe tricuspid regurgitation (TR) has attracted much attention. Novel 3-dimensional imaging techniques have permitted analysis of the tricuspid valve (TV) anatomy from unparalleled views and better understanding of the underlying pathophysiology of TR. Grading TR and assessment of right ventricular function remain challenging, and although 2-dimensional echocardiography is the mainstay imaging technique to evaluate patients with severe TR the use of 3-dimensional echocardiography and cardiovascular magnetic resonance is increasing. The number of transcatheter interventions for TR is growing, and procedural success relies significantly on the pre-procedural evaluation of the anatomy of the TV, etiology and severity of TR, right ventricular size and function, and importantly, the anatomic relationships of the TV. The role of multimodality imaging in patient selection and procedural planning for transcatheter TV repair is reviewed.
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26
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Biglino G, Milano EG, Capelli C, Wray J, Shearn AI, Caputo M, Bucciarelli-Ducci C, Taylor AM, Schievano S. Three-dimensional printing in congenital heart disease: Considerations on training and clinical implementation from a teaching session. Int J Artif Organs 2019; 42:595-599. [PMID: 31104546 DOI: 10.1177/0391398819849074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In light of growing interest for three-dimensional printing technology in the cardiovascular community, this study focused on exploring the possibilities of providing training for cardiovascular three-dimensional printing in the context of a relevant international congress and providing considerations on the delivery of such courses. As a second objective, the study sought to capture preferences in relation to three-dimensional printing uses and set-ups from those attending the training session. A survey was administered to n = 30 professionals involved or interested in three-dimensional printing cardiovascular models following a specialised teaching session. Survey results suggest the potential for split training sessions, with a broader introduction for those with no prior experience in three-dimensional printing followed by a more in-depth and hands-on session. All participants agreed on the potential of the technology in all its applications, particularly for aiding decision-making around complex surgical or interventional cases. When exploring setting up an in-house three-dimensional printing service, the majority of participants reported that their centre was already equipped with an in-house facility or expressed a desire that such a facility should be available, with a minority preferring consigning models to an external third party for printing.
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Affiliation(s)
- Giovanni Biglino
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Elena G Milano
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Surgery, Dentistry, Paediatrics and Obstetrics/Gynaecology, University of Verona, Verona, Italy
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew Iu Shearn
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew M Taylor
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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27
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Tuncay V, van Ooijen PMA. 3D printing for heart valve disease: a systematic review. Eur Radiol Exp 2019; 3:9. [PMID: 30771098 PMCID: PMC6377684 DOI: 10.1186/s41747-018-0083-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/27/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Current developments showed a fast-increasing implementation and use of three-dimensional (3D) printing in medical applications. Our aim was to review the literature regarding the application of 3D printing to cardiac valve disease. METHODS A PubMed search for publications in English with the terms "3D printing" AND "cardiac valve", performed in January 2018, resulted in 64 items. After the analysis of the abstract and text, 27 remained related to the topic. From the references of these 27 papers, 7 papers were added resulting in a total of 34 papers. Of these, 5 were review papers, thus reducing the papers taken into consideration to 29. RESULTS The 29 papers showed that about a decade ago, the interest in 3D printing for this application area was emerging, but only in the past 2 to 3 years it really gained interest. Computed tomography is the most common imaging modality taken into consideration (62%), followed by ultrasound (28%), computer-generated models (computer-aided design) (7%), and magnetic resonance imaging (3%). Acrylonitrile butadiene styrene (4/14, 29%) and TangoPlus FullCure 930 (5/14, 36%) are the most used printing materials. Stereolithography (40%) and fused deposition modeling (30%) are the preferred printing techniques, while PolyJet (25%) and laser sintering (4%) are used in a minority of cases. The reported time ranges from 30 min to 3 days. The most reported application area is preoperative planning (63%), followed by training (19%), device testing (11%), and retrospective procedure evaluation (7%). CONCLUSIONS In most cases, CT datasets are used and models are printed for preoperative planning.
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Affiliation(s)
- Volkan Tuncay
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
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28
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Farooqi KM, Cooper C, Chelliah A, Saeed O, Chai PJ, Jambawalikar SR, Lipson H, Bacha EA, Einstein AJ, Jorde UP. 3D Printing and Heart Failure: The Present and the Future. JACC-HEART FAILURE 2018; 7:132-142. [PMID: 30553901 DOI: 10.1016/j.jchf.2018.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/05/2018] [Accepted: 09/20/2018] [Indexed: 02/06/2023]
Abstract
Advanced imaging modalities provide essential anatomic and spatial information in patients with complex heart disease. Two-dimensional imaging can be limited in the extent to which true 3-dimensional (3D) relationships are represented. The application of 3D printing technology has increased the creation of physical models that overcomes the limitations of a 2D screen. Many groups have reported the use of 3D printing for preprocedural planning in patients with different causes of heart failure. This paper reviews the innovative applications of this technique to provide patient-specific models to improve patient care.
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Affiliation(s)
- Kanwal M Farooqi
- Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York.
| | - Cathleen Cooper
- Department of Radiology, Columbia University Medical Center, and New York-Presbyterian Hospital, New York, New York
| | - Anjali Chelliah
- Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Omar Saeed
- Department of Internal Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Paul J Chai
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Sachin R Jambawalikar
- Department of Radiology, Columbia University Medical Center, and New York-Presbyterian Hospital, New York, New York
| | - Hod Lipson
- Department of Mechanical Engineering, Columbia University, New York, New York
| | - Emile A Bacha
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Andrew J Einstein
- Department of Radiology, Columbia University Medical Center, and New York-Presbyterian Hospital, New York, New York; Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Ulrich P Jorde
- Department of Internal Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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29
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El Sabbagh A, Eleid MF, Al-Hijji M, Anavekar NS, Holmes DR, Nkomo VT, Oderich GS, Cassivi SD, Said SM, Rihal CS, Matsumoto JM, Foley TA. The Various Applications of 3D Printing in Cardiovascular Diseases. Curr Cardiol Rep 2018; 20:47. [PMID: 29749577 DOI: 10.1007/s11886-018-0992-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To highlight the various applications of 3D printing in cardiovascular disease and discuss its limitations and future direction. RECENT FINDINGS Use of handheld 3D printed models of cardiovascular structures has emerged as a facile modality in procedural and surgical planning as well as education and communication. Three-dimensional (3D) printing is a novel imaging modality which involves creating patient-specific models of cardiovascular structures. As percutaneous and surgical therapies evolve, spatial recognition of complex cardiovascular anatomic relationships by cardiologists and cardiovascular surgeons is imperative. Handheld 3D printed models of cardiovascular structures provide a facile and intuitive road map for procedural and surgical planning, complementing conventional imaging modalities. Moreover, 3D printed models are efficacious educational and communication tools. This review highlights the various applications of 3D printing in cardiovascular diseases and discusses its limitations and future directions.
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Affiliation(s)
- Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mohammed Al-Hijji
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Thomas A Foley
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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30
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Anwar S, Singh GK, Miller J, Sharma M, Manning P, Billadello JJ, Eghtesady P, Woodard PK. 3D Printing is a Transformative Technology in Congenital Heart Disease. JACC Basic Transl Sci 2018; 3:294-312. [PMID: 30062215 PMCID: PMC6059001 DOI: 10.1016/j.jacbts.2017.10.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 12/26/2022]
Abstract
Survival in congenital heart disease has steadily improved since 1938, when Dr. Robert Gross successfully ligated for the first time a patent ductus arteriosus in a 7-year-old child. To continue the gains made over the past 80 years, transformative changes with broad impact are needed in management of congenital heart disease. Three-dimensional printing is an emerging technology that is fundamentally affecting patient care, research, trainee education, and interactions among medical teams, patients, and caregivers. This paper first reviews key clinical cases where the technology has affected patient care. It then discusses 3-dimensional printing in trainee education. Thereafter, the role of this technology in communication with multidisciplinary teams, patients, and caregivers is described. Finally, the paper reviews translational technologies on the horizon that promise to take this nascent field even further.
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Key Words
- 3D printing
- 3D, three-dimensional
- ACHD, adults with congenital heart disease
- APC, aortopulmonary collaterals
- ASD, atrial septal defect
- CHD, congenital heart disease
- CT, computed tomography
- DORV, double outlet right ventricle
- MAPCAs, multiple aortopulmonary collaterals
- MRI, magnetic resonance imaging
- OR, operating room
- VSD, ventricular septal defect
- cardiac imaging
- cardiothoracic surgery
- congenital heart disease
- simulation
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Affiliation(s)
- Shafkat Anwar
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Gautam K. Singh
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jacob Miller
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Monica Sharma
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Peter Manning
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph J. Billadello
- Division of Cardiovascular Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Pirooz Eghtesady
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Pamela K. Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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31
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Scanlan AB, Nguyen AV, Ilina A, Lasso A, Cripe L, Jegatheeswaran A, Silvestro E, McGowan FX, Mascio CE, Fuller S, Spray TL, Cohen MS, Fichtinger G, Jolley MA. Comparison of 3D Echocardiogram-Derived 3D Printed Valve Models to Molded Models for Simulated Repair of Pediatric Atrioventricular Valves. Pediatr Cardiol 2018; 39:538-547. [PMID: 29181795 PMCID: PMC5831483 DOI: 10.1007/s00246-017-1785-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022]
Abstract
Mastering the technical skills required to perform pediatric cardiac valve surgery is challenging in part due to limited opportunity for practice. Transformation of 3D echocardiographic (echo) images of congenitally abnormal heart valves to realistic physical models could allow patient-specific simulation of surgical valve repair. We compared materials, processes, and costs for 3D printing and molding of patient-specific models for visualization and surgical simulation of congenitally abnormal heart valves. Pediatric atrioventricular valves (mitral, tricuspid, and common atrioventricular valve) were modeled from transthoracic 3D echo images using semi-automated methods implemented as custom modules in 3D Slicer. Valve models were then both 3D printed in soft materials and molded in silicone using 3D printed "negative" molds. Using pre-defined assessment criteria, valve models were evaluated by congenital cardiac surgeons to determine suitability for simulation. Surgeon assessment indicated that the molded valves had superior material properties for the purposes of simulation compared to directly printed valves (p < 0.01). Patient-specific, 3D echo-derived molded valves are a step toward realistic simulation of complex valve repairs but require more time and labor to create than directly printed models. Patient-specific simulation of valve repair in children using such models may be useful for surgical training and simulation of complex congenital cases.
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Affiliation(s)
- Adam B Scanlan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alex V Nguyen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Anna Ilina
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, ON, USA
| | - Andras Lasso
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, ON, USA
| | - Linnea Cripe
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Anusha Jegatheeswaran
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Silvestro
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Francis X McGowan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Christopher E Mascio
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas L Spray
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meryl S Cohen
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gabor Fichtinger
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, ON, USA
| | - Matthew A Jolley
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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32
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3D Printing Provides a Precise Approach in the Treatment of Tetralogy of Fallot, Pulmonary Atresia with Major Aortopulmonary Collateral Arteries. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:5. [DOI: 10.1007/s11936-018-0594-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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33
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Zhu Y, Liu J, Wang L, Guan X, Luo Y, Geng J, Geng Q, Lin Y, Zhang L, Li X, Lu Y. Preliminary study of the application of transthoracic echocardiography-guided three-dimensional printing for the assessment of structural heart disease. Echocardiography 2017; 34:1903-1908. [PMID: 29067708 DOI: 10.1111/echo.13715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and diagnostic value of a preoperative transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) for the assessment of structural heart disease (SHD). METHODS Fourty-four patients underwent cardiac surgery at Tianjin Chest Hospital. The patients were preoperatively assessed using TTE-guided 3DPM, which was compared to conventional three-dimensional transthoracic echocardiography (3DTTE) along with direct intraoperative findings, which were considered the "gold standard." Twelve patients had SHD, including four with mitral prolapse, two with partial endocardial cushion defects, two with secondary atrial septal defects, two with rheumatic mitral stenosis, one with tetralogy of Fallot, and one with a ventricular septal defect (VSD). Thirty-two patients who did not have SHDs were designated as the negative control group. RESULTS The sensitivity and specificity of the TTE-guided 3DPM were greater than or equal to those of the 3DTTE. The P-value of the McNemar test of 3DTTE was >.05, which indicates that the difference was not statistically significant (Kappa = 0.745, P < .001). The P-value of the McNemar test of TTE-guided 3DPM was >.05, which indicates that the difference was not statistically significant (Kappa = 0.955, P < .001). A comparison of 3DTTE and TTE-guided 3DPM resulted in a P-value >.05, which indicates that the difference was not statistically significant (Kappa = 0.879, P < .001). TTE-guided 3DPM displayed the 3D structure of SHDs and cardiac lesions clearly and was consistent with the intra-operative findings. CONCLUSION Transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) provides essential information for preoperative evaluation and decision making for patients with SHDs.
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Affiliation(s)
- Yanbo Zhu
- Graduate School of Tianjin Medical University, Tianjin, China.,Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Jianshi Liu
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Lianqun Wang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Xin Guan
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Yongjuan Luo
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Jie Geng
- Cardiac Intensive Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Qingguo Geng
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Yunjia Lin
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Lixia Zhang
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Xixue Li
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Yaping Lu
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
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34
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Edvardsen T, Gerber B, Donal E, Maurovich-Horvat P, Maurer G, Popescu BA. The year 2015–16 in the European Heart Journal—Cardiovascular Imaging. Part II. Eur Heart J Cardiovasc Imaging 2017; 18:1322-1330. [DOI: 10.1093/ehjci/jex237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 09/12/2017] [Indexed: 12/18/2022] Open
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35
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Vukicevic M, Vekilov DP, Grande-Allen JK, Little SH. Patient-specific 3D Valve Modeling for Structural Intervention. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1377363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Marija Vukicevic
- Department of Cardiology, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | | | | | - Stephen H. Little
- Department of Cardiology, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
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36
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Foley TA, El Sabbagh A, Anavekar NS, Williamson EE, Matsumoto JM. 3D-Printing: Applications in Cardiovascular Imaging. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0239-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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