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Sequeira C, Oliveira-Santos M, Borges Rosa J, Silva Marques J, Oliveira Santos E, Norte G, Gonçalves L. Three-dimensional simulation for interventional cardiology procedures: Face and content validity. Rev Port Cardiol 2024; 43:389-396. [PMID: 38401705 DOI: 10.1016/j.repc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/29/2023] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Three-dimensional (3D) model simulation provides the opportunity to manipulate real devices and learn intervention skills in a realistic, controlled, and safe environment. To ensure that simulators provide a realistic surrogate to real procedures they must undergo scientific validation. We aimed to evaluate the 3D-printed simulator SimulHeart® for face and content validity to demonstrate its value as a training tool in interventional cardiology (IC). METHODS Health professionals were recruited from sixteen Portuguese IC units. All participants received a 30-minute theoretical introduction, 10-minute demonstration of each task and then performed the intervention on a 3D-printed simulator (SimulHeart®). Finally, a post-training questionnaire focusing on the appearance of the simulation, simulation content, and satisfaction/self-efficacy was administered. RESULTS We included 56 participants: 16 "experts" (general and interventional cardiologists), 26 "novices" (cardiology residents), and 14 nurses and allied professionals. On a five-point Likert scale, the overall mean score of face validity was 4.38±0.35 and the overall mean score of content validity was 4.69±0.32. There was no statistically significant difference in the scores provided by "experts" and "novices". Participants reported a high level of satisfaction/self-efficacy with 60.7% considering it strongly improved their skills. The majority (82.1%) "agreed" or "strongly agreed" that after the simulation they felt confident to perform the procedure on a patient. CONCLUSION The 3D-printed simulator (SimulHeart®) showed excellent face and content validity. 3D simulation may play an important role in future IC training programs. Further research is required to correlate simulator performance with clinical performance in real patients.
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Affiliation(s)
| | - Manuel Oliveira-Santos
- Faculty of Medicine, University of Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 3D CardioSolutions, Coimbra, Portugal
| | - João Borges Rosa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Silva Marques
- 3D CardioSolutions, Coimbra, Portugal; Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal; Structural and Coronary Heart Disease Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | - Gustavo Norte
- Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal
| | - Lino Gonçalves
- Faculty of Medicine, University of Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Ravi P, Burch MB, Giannopoulos AA, Liu I, Kondor S, Chepelev LL, Danesi TH, Rybicki FJ, Panza A. Desktop 3D printed anatomic models for minimally invasive direct coronary artery bypass. 3D Print Med 2024; 10:19. [PMID: 38864937 PMCID: PMC11167900 DOI: 10.1186/s41205-024-00222-1] [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: 12/06/2023] [Accepted: 06/06/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Three-dimensional (3D) printing technology has impacted many clinical applications across medicine. However, 3D printing for Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) has not yet been reported in the peer-reviewed literature. The current observational cohort study aimed to evaluate the impact of half scaled (50% scale) 3D printed (3DP) anatomic models in the pre-procedural planning of MIDCAB. METHODS Retrospective analysis included 12 patients who underwent MIDCAB using 50% scale 3D printing between March and July 2020 (10 males, 2 females). Distances measured from CT scans and 3DP anatomic models were correlated with Operating Room (OR) measurements. The measurements were compared statistically using Tukey's test. The correspondence between the predicted (3DP & CT) and observed best InterCostal Space (ICS) in the OR was recorded. Likert surveys from the 3D printing registry were provided to the surgeon to assess the utility of the model. The OR time saved by planning the procedure using 3DP anatomic models was estimated subjectively by the cardiothoracic surgeon. RESULTS All 12 patients were successfully grafted. The 3DP model predicted the optimal ICS in all cases (100%). The distances measured on the 3DP model corresponded well to the distances measured in the OR. The measurements were significantly different between the CT and 3DP (p < 0.05) as well as CT and OR (p < 0.05) groups, but not between the 3DP and OR group. The Likert responses suggested high clinical utility of 3D printing. The mean subjectively estimated OR time saved was 40 min. CONCLUSION The 50% scaled 3DP anatomic models demonstrated high utility for MIDCAB and saved OR time while being resource efficient. The subjective benefits over routine care that used 3D visualization for surgical planning warrants further investigation.
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Affiliation(s)
- Prashanth Ravi
- Department of Radiology, University of Cincinnati, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH, 45267-0761, USA.
| | - Michael B Burch
- Department of Radiology, University of Cincinnati, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH, 45267-0761, USA
| | | | - Isabella Liu
- Department of Radiology, University of Cincinnati, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH, 45267-0761, USA
| | - Shayne Kondor
- Department of Radiology, University of Cincinnati, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH, 45267-0761, USA
| | | | - Tommaso H Danesi
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank J Rybicki
- Department of Radiology, University of Arizona, Phoenix, AZ, USA
| | - Antonio Panza
- Division of Cardiac Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
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Valvez S, Oliveira-Santos M, Gonçalves L, Amaro AM, Piedade AP. Preprocedural Planning of Left Atrial Appendage Occlusion: A Review of the Use of Additive Manufacturing. 3D PRINTING AND ADDITIVE MANUFACTURING 2024; 11:333-346. [PMID: 38389681 PMCID: PMC10880654 DOI: 10.1089/3dp.2022.0373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Stroke is a significant public health problem, with non-valvular atrial fibrillation (NVAF) being one of its main causes. This cardiovascular arrhythmia predisposes to the production of intracardiac thrombi, mostly formed in the left atrial appendage (LAA). When there are contraindications to treatment with oral anticoagulants, another therapeutic option to reduce the possibility of thrombus formation in the LAA is the implantation of an occlusion device by cardiac catheterization. The effectiveness of LAA occlusion is dependent on accurate preprocedural device sizing and proper device positioning at the LAA ostium, to ensure sufficient device anchoring and avoid peri-device leaks. Additive manufacturing, commonly known as three-dimensional printing (3DP), of LAA models is beginning to emerge in the scientific literature to address these challenges through procedural simulation. This review aims at clarifying the impact of 3DP on preprocedural planning of LAA occlusion, specifically in the training of cardiac surgeons and in the assessment of the perfect adjustment between the LAA and the biomedical implant.
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Affiliation(s)
- Sara Valvez
- Department of Mechanical Engineering, CEMMPRE, ARISE, University of Coimbra, Coimbra, Portugal
| | | | - Lino Gonçalves
- CBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana M. Amaro
- Department of Mechanical Engineering, CEMMPRE, ARISE, University of Coimbra, Coimbra, Portugal
| | - Ana P. Piedade
- Department of Mechanical Engineering, CEMMPRE, ARISE, University of Coimbra, Coimbra, Portugal
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Wilson KJ, Chatterjee AK. Modeling in molecular genetics allows students to make connections between biological scales. BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION : A BIMONTHLY PUBLICATION OF THE INTERNATIONAL UNION OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2024; 52:70-81. [PMID: 37792392 DOI: 10.1002/bmb.21790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
Students often see college courses as the presentation of disconnected facts, especially in the life sciences. Student-created Structure Mechanism/Relationship Function (SMRF) models were analyzed to understand students' abilities to make connections between genotype, phenotype, and evolution. Students were divided into two sections; one section received instructions that included a specific gene as an example related to larger issues like human disease or the environment. The other section was only given generic examples, like gene X and phenotype Y. Coding of exam models and a comprehensive (extensive) model reveled students were able to make links and work within and between biological scales of organization. Modeling provided a way to show and allow students to practice and demonstrate the ability to build step-by-step causal relationships that link ideas together. We also observed a small differing with students receiving the specific prompt performing better than students receiving generic prompt at the point in the semester where linking across many biological scales was required to be successful.
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Affiliation(s)
- Kristy J Wilson
- School of Sciences and Mathematics, Marian University, Indianapolis, Indiana, USA
| | - Allison K Chatterjee
- Office of Collaborative Academic Programs, Indiana University, Bloomington, Indiana, USA
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5
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Hozman M, Herman D, Zemanek D, Fiser O, Vrba D, Poloczek M, Varvarovsky I, Obona P, Pokorny T, Osmancik P. Transseptal puncture in left atrial appendage closure guided by 3D printing and multiplanar CT reconstruction. Catheter Cardiovasc Interv 2023; 102:1331-1340. [PMID: 37855202 DOI: 10.1002/ccd.30867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/28/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The presented study investigates the application of bi-arterial 3D printed models to guide transseptal puncture (TSP) in left atrial appendage closure (LAAC). AIMS The objectives are to (1) test the feasibility of 3D printing (3DP) for TSP guidance, (2) analyse the distribution of the optimal TSP locations, and (3) define a CT-derived 2D parameter suitable for predicting the optimal TSP locations. METHODS Preprocedural planning included multiplanar CT reconstruction, 3D segmentation, and 3DP. TSP was preprocedurally simulated in vitro at six defined sites. Based on the position of the sheath, TSP sites were classified as optimal, suboptimal, or nonoptimal. The aim was to target the TSP in the recommended position during the procedure. Procedure progress was assessed post hoc by the operator. RESULTS Of 68 screened patients, 60 patients in five centers (mean age of 74.68 ± 7.64 years, 71.66% males) were prospectively analyzed (3DP failed in one case, and seven patients did not finally undergo the procedure). In 55 patients (91.66%), TSP was performed in the optimal location as recommended by the 3DP. The optimal locations for TSP were postero-inferior in 45.3%, mid-inferior in 45.3%, and antero-inferior in 37.7%, with a mean number of optimal segments of 1.34 ± 0.51 per patient. When the optimal TSP location was achieved, the procedure was considered difficult in only two (3.6%) patients (but in both due to complicated LAA anatomy). Comparing anterior versus posterior TSP in 2D CCT, two parameters differed significantly: (1) the angle supplementary to the LAA ostium and the interatrial septum angle (160.83° ± 9.42° vs. 146.49° ± 8.67°; p = 0.001), and (2) the angle between the LAA ostium and the mitral annulus (95.02° ± 3.73° vs. 107.38° ± 6.76°; p < 0.001), both in the sagittal plane. CONCLUSIONS In vitro TSP simulation accurately determined the optimal TSP locations for LAAC and facilitated the procedure. More than one-third of the optimal TSP sites were anterior.
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Affiliation(s)
- Marek Hozman
- Cardiocenter, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Dalibor Herman
- Cardiocenter, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - David Zemanek
- Second Department of Internal Medicine, Charles University, Prague, Czech Republic
| | - Ondrej Fiser
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Prague, Czech Republic
| | - David Vrba
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Prague, Czech Republic
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic
| | | | - Peter Obona
- Cardiocenter, University Hospital Nitra, Nitra, Slovakia
| | - Tomas Pokorny
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Prague, Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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Fidvi S, Holder J, Li H, Parnes GJ, Shamir SB, Wake N. Advanced 3D Visualization and 3D Printing in Radiology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1406:103-138. [PMID: 37016113 DOI: 10.1007/978-3-031-26462-7_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Since the discovery of X-rays in 1895, medical imaging systems have played a crucial role in medicine by permitting the visualization of internal structures and understanding the function of organ systems. Traditional imaging modalities including Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Ultrasound (US) present fixed two-dimensional (2D) images which are difficult to conceptualize complex anatomy. Advanced volumetric medical imaging allows for three-dimensional (3D) image post-processing and image segmentation to be performed, enabling the creation of 3D volume renderings and enhanced visualization of pertinent anatomic structures in 3D. Furthermore, 3D imaging is used to generate 3D printed models and extended reality (augmented reality and virtual reality) models. A 3D image translates medical imaging information into a visual story rendering complex data and abstract ideas into an easily understood and tangible concept. Clinicians use 3D models to comprehend complex anatomical structures and to plan and guide surgical interventions more precisely. This chapter will review the volumetric radiological techniques that are commonly utilized for advanced 3D visualization. It will also provide examples of 3D printing and extended reality technology applications in radiology and describe the positive impact of advanced radiological image visualization on patient care.
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Affiliation(s)
- Shabnam Fidvi
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA.
| | - Justin Holder
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Hong Li
- Department of Radiology, Jacobi Medical Center, Bronx, NY, USA
| | | | | | - Nicole Wake
- GE Healthcare, Aurora, OH, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York, NY, USA
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Mendez K, Kennedy DG, Wang DD, O’Neill B, Roche ET. Left Atrial Appendage Occlusion: Current Stroke Prevention Strategies and a Shift Toward Data-Driven, Patient-Specific Approaches. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100405. [PMID: 39131471 PMCID: PMC11308563 DOI: 10.1016/j.jscai.2022.100405] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 08/13/2024]
Abstract
The left atrial appendage (LAA) is a complex structure with unknown physiologic function protruding from the main body of the left atrium. In patients with atrial fibrillation, the left atrium does not contract effectively. Insufficient atrial and LAA contractility predisposes the LAA morphology to hemostasis and thrombus formation, leading to an increased risk of cardioembolic events. Oral anticoagulation therapies are the mainstay of stroke prevention options for patients; however, not all patients are candidates for long-term oral anticoagulation. Percutaneous occlusion devices are an attractive alternative to long-term anticoagulation therapy, although they are not without limitations, such as peri-implant leakage and device-related thrombosis. Although efforts have been made to reduce these risks, significant interpatient heterogeneity inevitably yields some degree of device-anatomy mismatch that is difficult to resolve using current devices and can ultimately lead to insufficient occlusion and poor patient outcomes. In this state-of-the-art review, we evaluated the anatomy of the LAA as well as the current pathophysiologic understanding and stroke prevention strategies used in the management of the risk of stroke associated with atrial fibrillation. We highlighted recent advances in computed tomography imaging, preprocedural planning, computational modeling, and novel additive manufacturing techniques, which represent the tools needed for a paradigm shift toward patient-centric LAA occlusion. Together, we envisage that these techniques will facilitate a pipeline from the imaging of patient anatomy to patient-specific computational and bench-top models that enable customized, data-driven approaches for LAA occlusion that are engineered specifically to meet each patient's unique needs.
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Affiliation(s)
- Keegan Mendez
- Harvard/MIT Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Darragh G. Kennedy
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Biomedical Engineering, Columbia University, New York, New York
| | | | | | - Ellen T. Roche
- Harvard/MIT Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Tarabanis C, Klapholz J, Zahid S, Jankelson L. A systematic review of the use of 3D printing in left atrial appendage occlusion procedures. J Cardiovasc Electrophysiol 2022; 33:2367-2374. [PMID: 35989544 DOI: 10.1111/jce.15658] [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] [Received: 02/18/2022] [Revised: 08/09/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Abstract
The placement of a left atrial appendage occlusion (LAAO) device can be a technically challenging transcatheter-based procedure. Key challenges include accurate pre-procedural device sizing and proper device positioning at the LAA ostium to ensure sufficient device anchoring and avoid peri-device leaks. To address these challenges, 3D printing (3DP) of LAA models has recently emerged in the literature, first being described in 2015. We present a review of the benefits and drawbacks of employing this technology for LAAO procedures. Pre-procedurally the use of 3DP can consistently and accurately determine LAAO device size over standard of care approaches. Intra-procedurally 3DP's impact entailed a statistically significant decrease in the number of devices used per procedure, as well as in the fluoroscopic time and dose. Post-procedurally, there is some evidence that 3DP could reduce the rate of peri-device leaks, with limited data on its effect on complication rates. Based on existing evidence, we recommend the focused application of 3DP to cases of complex LAA anatomy and for the training of proceduralists. Lastly, we address the emergence of next generation LAAO devices and AR/VR systems that could limit even this narrow window of clinical benefit afforded by 3DP. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Constantine Tarabanis
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Jonah Klapholz
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sohail Zahid
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
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Bernhard B, Illi J, Gloeckler M, Pilgrim T, Praz F, Windecker S, Haeberlin A, Gräni C. Imaging-Based, Patient-Specific Three-Dimensional Printing to Plan, Train, and Guide Cardiovascular Interventions: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022; 31:1203-1218. [PMID: 35680498 DOI: 10.1016/j.hlc.2022.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To tailor cardiovascular interventions, the use of three-dimensional (3D), patient-specific phantoms (3DPSP) encompasses patient education, training, simulation, procedure planning, and outcome-prediction. AIM This systematic review and meta-analysis aims to investigate the current and future perspective of 3D printing for cardiovascular interventions. METHODS We systematically screened articles on Medline and EMBASE reporting the prospective use of 3DPSP in cardiovascular interventions by using combined search terms. Studies that compared intervention time depending on 3DPSP utilisation were included into a meta-analysis. RESULTS We identified 107 studies that prospectively investigated a total of 814 3DPSP in cardiovascular interventions. Most common settings were congenital heart disease (CHD) (38 articles, 6 comparative studies), left atrial appendage (LAA) occlusion (11 articles, 5 comparative, 1 randomised controlled trial [RCT]), and aortic disease (10 articles). All authors described 3DPSP as helpful in assessing complex anatomic conditions, whereas poor tissue mimicry and the non-consideration of physiological properties were cited as limitations. Compared to controls, meta-analysis of six studies showed a significant reduction of intervention time in LAA occlusion (n=3 studies), and surgery due to CHD (n=3) if 3DPSPs were used (Cohen's d=0.54; 95% confidence interval, 0.13 to 0.95; p=0.001), however heterogeneity across studies should be taken into account. CONCLUSIONS 3DPSP are helpful to plan, train, and guide interventions in patients with complex cardiovascular anatomy. Benefits for patients include reduced intervention time with the potential for lower radiation exposure and shorter mechanical ventilation times. More evidence and RCTs including clinical endpoints are needed to warrant adoption of 3DPSP into routine clinical practice.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joël Illi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Swiss MedTech Center, Switzerland Innovation Park Biel/Bienne AG, Switzerland
| | - Martin Gloeckler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland.
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10
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DeCampos D, Teixeira R, Saleiro C, Oliveira-Santos M, Paiva L, Costa M, Botelho A, Gonçalves L. 3D printing for left atrial appendage closure: A meta-analysis and systematic review. Int J Cardiol 2022; 356:38-43. [PMID: 35358638 DOI: 10.1016/j.ijcard.2022.03.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Three-dimensional printing (3D) has emerged as an alternative to imaging to guide left atrial appendage closure (LAAC) device sizing. AIMS We assessed the usefulness of 3D printing compared to a standard imaging-only approach for LAAC. METHODS We identified studies comparing an imaging-only with a 3D printing approach in LAAC. A fixed-effects meta-analysis was performed targeting a co-primary endpoint of disagreement in device sizing and leaks. RESULTS Eight studies that assigned 283 participants to an imaging-only approach and 3D printing approach (145 patients) were included. 3D printing significantly reduced the risk of the co-primary endpoint (risk raio (RR) = 0.19; 95% confidence interval (CI) 0.09-0.37), with consistency across the studies (I2 = 0%). Individually, both device size disagreements [RR 0.13 (95% CI 0.06-0.29), P < 0.001] and leaks [RR 0.24 (95% CI 0.09-0.64) P = 0.004] were reduced under a 3D printing modeling strategy. CONCLUSION Compared with an imaging-only strategy, 3D printing is associated with reduction in device size disagreements and leaks.
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Affiliation(s)
- Diana DeCampos
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal.
| | - Rogério Teixeira
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, R. Larga 2, Diana de Campos, 3000-370 Coimbra. Portugal
| | - Carolina Saleiro
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Manuel Oliveira-Santos
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Luis Paiva
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Marco Costa
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Ana Botelho
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal
| | - Lino Gonçalves
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801 Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, R. Larga 2, Diana de Campos, 3000-370 Coimbra. Portugal
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11
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Comparison of blood pool and myocardial 3D printing in the diagnosis of types of congenital heart disease. Sci Rep 2022; 12:7136. [PMID: 35505074 PMCID: PMC9065034 DOI: 10.1038/s41598-022-11294-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/12/2022] [Indexed: 12/02/2022] Open
Abstract
The study aimed to evaluate the effectiveness of blood pool and myocardial models made by stereolithography in the diagnosis of different types of congenital heart disease (CHD). Two modeling methods were applied in the diagnosis of 8 cases, and two control groups consisting of experts and students diagnosed the cases using echocardiography with computed tomography, blood pool models, and myocardial models. The importance, suitability, and simulation degree of different models were analyzed. The average diagnostic rate before and after 3D printing was used was 88.75% and 95.9% (P = 0.001) in the expert group and 60% and 91.6% (P = 0.000) in the student group, respectively. 3D printing was considered to be more important for the diagnosis of complex CHDs (very important; average, 87.8%) than simple CHDs (very important; average, 30.8%) (P = 0.000). Myocardial models were considered most realistic regarding the structure of the heart (average, 92.5%). In cases of congenital corrected transposition of great arteries, Williams syndrome, coronary artery fistula, tetralogy of Fallot, patent ductus arteriosus, and coarctation of the aorta, blood pool models were considered more effective (average, 92.1%), while in cases of double outlet right ventricle and ventricular septal defect, myocardial models were considered optimal (average, 80%).
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Illi J, Bernhard B, Nguyen C, Pilgrim T, Praz F, Gloeckler M, Windecker S, Haeberlin A, Gräni C. Translating Imaging Into 3D Printed Cardiovascular Phantoms. JACC Basic Transl Sci 2022; 7:1050-1062. [PMID: 36337920 PMCID: PMC9626905 DOI: 10.1016/j.jacbts.2022.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
3D printed patient specific phantoms can visualize complex cardiovascular anatomy Common imaging modalities for 3D printing are CCT and CMR Material jetting/PolyJet and stereolithography are widely used printing techniques Standardized validation is warranted to compare different 3D printing technologies
Translation of imaging into 3-dimensional (3D) printed patient-specific phantoms (3DPSPs) can help visualize complex cardiovascular anatomy and enable tailoring of therapy. The aim of this paper is to review the entire process of phantom production, including imaging, materials, 3D printing technologies, and the validation of 3DPSPs. A systematic review of published research was conducted using Embase and MEDLINE, including studies that investigated 3DPSPs in cardiovascular medicine. Among 2,534 screened papers, 212 fulfilled inclusion criteria and described 3DPSPs as a valuable adjunct for planning and guiding interventions (n = 108 [51%]), simulation of physiological or pathological conditions (n = 19 [9%]), teaching of health care professionals (n = 23 [11%]), patient education (n = 3 [1.4%]), outcome prediction (n = 6 [2.8%]), or other purposes (n = 53 [25%]). The most common imaging modalities to enable 3D printing were cardiac computed tomography (n = 131 [61.8%]) and cardiac magnetic resonance (n = 26 [12.3%]). The printing process was conducted mostly by material jetting (n = 54 [25.5%]) or stereolithography (n = 43 [20.3%]). The 10 largest studies that evaluated the geometric accuracy of 3DPSPs described a mean bias <±1 mm; however, the validation process was very heterogeneous among the studies. Three-dimensional printed patient-specific phantoms are highly accurate, used for teaching, and applied to guide cardiovascular therapy. Systematic comparison of imaging and printing modalities following a standardized validation process is warranted to allow conclusions on the optimal production process of 3DPSPs in the field of cardiovascular medicine.
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Pour-Ghaz I, Heckle MR, Maturana M, Seitz MP, Zare P, Khouzam RN, Kabra R. Percutaneous Left Atrial Appendage Closure: Review of Anatomy, Imaging, and Outcomes. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00958-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Borracci RA, Ferreira LM, Alvarez Gallesio JM, Tenorio Núñez OM, David M, Eyheremendy EP. Three-dimensional virtual and printed models for planning adult cardiovascular surgery. Acta Cardiol 2021; 76:534-543. [PMID: 33283655 DOI: 10.1080/00015385.2020.1852754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objective of this study was to explore the usefulness of virtual models and three-dimensional (3D) printing technologies for planning complex non-congenital cardiovascular surgery. METHODS Between July 2018 and December 2019, adult patients with different cardiovascular structural diseases were included in a clinical protocol to explore the usefulness of Standard Tessellation Language (STL)-based virtual models and 3D printing for prospectively planning surgery. A qualitative descriptive analysis from the surgeon's viewpoint was done based on the characteristics, advantages and usefulness of 3D models for guiding, planning and simulating the surgical procedures. RESULTS A total of 14 custom 3D-printed heart and great vessel replicas with their corresponding 3D virtual models were created for preoperative surgical planning. Six of 14 models helped to redefine the surgical approach, 3 were useful to verify device delivery, while the rest did not change the surgical decision. In all open surgery cases, cardiac and vascular anatomy accuracy of virtual and physical 3D replicas was validated by direct visualisation of the organs during surgery. Printing was achieved through an external provider associated with the Hospital, who printed the final prototype in 5-7 days. Printed production cost was between 100 and 500 USD per model. CONCLUSIONS In the current study, the selected 3D printed models presented different advantages (visual, tactile, and instrumental) over the traditional flat anatomical images when simulating and planning some complex types of surgery. Notwithstanding 3D printing advantages, STL-based virtual models were pre-printing useful tools when instrumentation on a physical replica was not required.
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Affiliation(s)
- Raul A. Borracci
- Department of Cardiovascular Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | - Luis M. Ferreira
- Department of Cardiovascular Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | | | | | - Michel David
- Department of Cardiovascular Surgery, Deutsches Hospital, Buenos Aires, Argentina
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Mao Z, Zhao L, Huang S, Fan Y, Pui-Wai Lee A. Direct 3D ultrasound fusion for transesophageal echocardiography. Comput Biol Med 2021; 134:104502. [PMID: 34130220 DOI: 10.1016/j.compbiomed.2021.104502] [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: 12/29/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Real-time three-dimensional transesophageal echocardiography (3D TEE) has been increasingly used in clinic for fast 3D analysis of cardiac anatomy and function. However, 3D TEE still suffers from the limited field of view (FoV). It is challenging to adopt conventional multi-view fusion methods to 3D TEE images because feature-based registration methods tend to fail in the ultrasound scenario, and conventional intensity-based methods have poor convergence properties and require an iterative coarse-to-fine strategy. METHODS A novel multi-view registration and fusion method is proposed to enlarge the FoV of 3D TEE images efficiently. A direct method is proposed to solve the registration problem in the Lie algebra space. Fast implementation is realized by searching voxels on three orthogonal planes between two volumes. Besides, a weighted-average 3D fusion method is proposed to fuse the aligned images seamlessly. For a sequence of 3D TEE images, they are fused incrementally. RESULTS Qualitative and quantitative results of in-vivo experiments indicate that the proposed registration algorithm outperforms a state-of-the-art PCA-based registration method in terms of accuracy and efficiency. Image registration and fusion performed on 76 in-vivo 3D TEE volumes from nine patients show apparent enlargement of FoV (enlarged around two times) in the obtained fused images. CONCLUSIONS The proposed methods can fuse 3D TEE images efficiently and accurately so that the whole Region of Interest (ROI) can be seen in a single frame. This research shows good potential to assist clinical diagnosis, preoperative planning, and future intraoperative guidance with 3D TEE.
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Affiliation(s)
- Zhehua Mao
- Centre for Autonomous Systems, Faculty of Engineering and Information Technology, University of Technology, Sydney, Australia.
| | - Liang Zhao
- Centre for Autonomous Systems, Faculty of Engineering and Information Technology, University of Technology, Sydney, Australia
| | - Shoudong Huang
- Centre for Autonomous Systems, Faculty of Engineering and Information Technology, University of Technology, Sydney, Australia
| | - Yiting Fan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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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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Yunker BE, Stupic KF, Wagner JL, Huddle S, Shandas R, Weir RF, Russek SE, Keenan KE. Characterization of 3-Dimensional Printing and Casting Materials for use in Magnetic Resonance Imaging Phantoms at 3 T. JOURNAL OF RESEARCH OF THE NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY 2020; vol:vol125.028. [PMID: 35573857 PMCID: PMC9097953 DOI: 10.6028/jres.125.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 06/14/2023]
Abstract
Imaging phantoms are used to calibrate and validate the performance of magnetic resonance imaging (MRI) systems. Many new materials have been developed for additive manufacturing (three-dimensional [3D] printing) processes that may be useful in the direct printing or casting of dimensionally accurate, anatomically accurate, patient-specific, and/or biomimetic MRI phantoms. The T1, T2, and T2* spin relaxation times of polymer samples were tested to discover materials for use as tissue mimics and structures in MRI phantoms. This study included a cohort of polymer compounds that was tested in cured form. The cohort consisted of 101 standardized polymer samples fabricated from: two-part silicones and polyurethanes used in commercial casting processes; one-part optically cured polyurethanes used in 3D printing; and fused deposition thermoplastics used in 3D printing. The testing was performed at 3 T using inversion recovery, spin echo, and gradient echo sequences for T1, T2, and T2*, respectively. T1, T2, and T2* values were plotted with error bars to allow the reader to assess how well a polymer matches a tissue for a specific application. A correlation was performed between T1, T2, T2* values and material density, elongation, tensile strength, and hardness. Two silicones, SI_XP-643 and SI_P-45, may be usable mimics for reported liver values; one silicone, SI_XP-643, may be a useful mimic for muscle; one silicone, SI_XP-738, may be a useful mimic for white matter; and four silicones, SI_P-15, SI_GI-1000, SI_GI-1040, and SI_GI-1110, may be usable mimics for spinal cord. Elongation correlated to T2 (p = 0.0007), tensile strength correlated to T1 (p = 0.002), T2 (p = 0.0003), and T2* (p = 0.003). The 80 samples not providing measurable signal with T1, T2, T2* relaxation values too short to measure with the standard sequences, may be useful for MRI-invisible fixturing and medical devices at 3 T.
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Affiliation(s)
- B. E. Yunker
- Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, CO 80305,
USA
- University of Colorado-Denver/Anschutz, Aurora, CO 80045,
USA
| | - K. F. Stupic
- Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, CO 80305,
USA
| | - J. L. Wagner
- Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, CO 80305,
USA
| | - S. Huddle
- University of Colorado-Denver/Anschutz, Aurora, CO 80045,
USA
| | - R. Shandas
- University of Colorado-Denver/Anschutz, Aurora, CO 80045,
USA
| | - R. F. Weir
- Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, CO 80305,
USA
| | - S. E. Russek
- Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, CO 80305,
USA
| | - K. E. Keenan
- Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, CO 80305,
USA
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Ferrari E, Gallo M, Wang C, Zhang L, Taramasso M, Maisano F, Pirelli L, Berdajs D, von Segesser LK. Three-dimensional printing in adult cardiovascular medicine for surgical and transcatheter procedural planning, teaching and technological innovation. Interact Cardiovasc Thorac Surg 2020; 30:203-214. [PMID: 31633170 DOI: 10.1093/icvts/ivz250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 12/23/2022] Open
Abstract
Three-dimensional (3D)-printing technologies in cardiovascular surgery have provided a new way to tailor surgical and percutaneous treatments. Digital information from standard cardiac imaging is integrated into physical 3D models for an accurate spatial visualization of anatomical details. We reviewed the available literature and analysed the different printing technologies, the required procedural steps for 3D prototyping, the used cardiac imaging, the available materials and the clinical implications. We have highlighted different materials used to replicate aortic and mitral valves, vessels and myocardial properties. 3D printing allows a heuristic approach to investigate complex cardiovascular diseases, and it is a unique patient-specific technology providing enhanced understanding and tactile representation of cardiovascular anatomies for the procedural planning and decision-making process. 3D printing may also be used for medical education and surgical/transcatheter training. Communication between doctors and patients can also benefit from 3D models by improving the patient understanding of pathologies. Furthermore, medical device development and testing can be performed with rapid 3D prototyping. Additionally, widespread application of 3D printing in the cardiovascular field combined with tissue engineering will pave the way to 3D-bioprinted tissues for regenerative medicinal applications and 3D-printed organs.
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Affiliation(s)
- Enrico Ferrari
- Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Michele Gallo
- Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Lei Zhang
- Cardiovascular Surgery, Nanjing Jinling Hospital, Nanjing, China
| | | | - Francesco Maisano
- Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Luigi Pirelli
- Cardiothoracic Surgery, Lenox Hill Heart and Vascular Institute, New York, NY, USA
| | - Denis Berdajs
- Cardiovascular Surgery, Basel University Hospital, Basel, Switzerland
| | - Ludwig Karl von Segesser
- Department of Surgery, Cardiovascular Research Unit, Lausanne University Hospital, Lausanne, Switzerland
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Wang C, Zhang L, Qin T, Xi Z, Sun L, Wu H, Li D. 3D printing in adult cardiovascular surgery and interventions: a systematic review. J Thorac Dis 2020; 12:3227-3237. [PMID: 32642244 PMCID: PMC7330795 DOI: 10.21037/jtd-20-455] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
3D printing in adult cardiac and vascular surgery has been evaluated over the last 10 years, and all of the available literature reports benefits from the use of 3D models. In the present study, we analyzed the current applications of 3D printing for adult cardiovascular disease treated with surgical or catheter-based interventions, including the clinical medical simulation of physiological or pathology conducted with 3D printing in this field. A search of PubMed and MEDLINE databases were supplemented by searching through bibliographies of key articles. Thereafter, data on demographic, clinical scenarios and application, imaging modality, purposes of using with 3D printing, outcomes and follow-up were extracted. A total of 43 articles were deemed eligible and included. 296 patients (mean age: 65.4±14.2 years; male, 58.2%) received 3D printing for cardiac and vascular surgery or conditions [percutaneous left atrial appendage occlusion (LAAO), TAVR, mitral valve disease, aortic valve replacement, coronary artery abnormality, HOCM, aortic aneurysm and aortic dissection, Kommerell's diverticulum, primary cardiac tumor and ventricular aneurysm]. Eight papers reported the utility of 3D printing in the medical simulator and training fields. Most studies were conducted starting in 2014. Twenty-six was case report. The major scenario used with 3D printing technology was LAAO (50.3%) and followed by TAVR (17.6%). CT and echocardiography were two main imaging techniques that were used to generate 3D-printed heart models. All studies showed that 3D-printed models were helpful for preoperative planning, orientation, and medical teaching. The important finding is that 3D printing provides a unique patient-specific method to assess complex anatomy and is helpful for intraoperative orientation, decision-making, creating functional models, and teaching adult cardiac and vascular surgery, including catheter-based heart surgery.
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Affiliation(s)
- Changtian Wang
- Department of Cardiovascular Surgery, Jinling Hospital, Nanjing University, School Medicine, Nanjing 210002, China
| | - Lei Zhang
- Department of Cardiovascular Surgery, Jinling Hospital, Nanjing University, School Medicine, Nanjing 210002, China
| | - Tao Qin
- Department of Cardiovascular Surgery, Jinling Hospital, Nanjing University, School Medicine, Nanjing 210002, China
| | - Zhilong Xi
- Department of Cardiovascular Surgery, Jinling Hospital, Nanjing University, School Medicine, Nanjing 210002, China
| | - Lei Sun
- Department of Cardiovascular Surgery, Jinling Hospital, Nanjing University, School Medicine, Nanjing 210002, China
| | - Haiwei Wu
- Department of Cardiovascular Surgery, Jinling Hospital, Nanjing University, School Medicine, Nanjing 210002, China
| | - Demin Li
- Department of Cardiovascular Surgery, Jinling Hospital, Nanjing University, School Medicine, Nanjing 210002, China
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Fan Y, Wong RHL, Lee APW. Three-dimensional printing in structural heart disease and intervention. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:579. [PMID: 31807560 DOI: 10.21037/atm.2019.09.73] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Three-dimensional (3D) printing refers to the process by which physical objects are built by depositing materials in layers based on a specific digital design. It was initially used in manufacture industry. Inspired by the technology, clinicians have recently attempted to integrate 3D printing into medical applications. One of the medical specialties that has recently made such attempt is cardiology, especially in the field of structural heart disease (SHD). SHD refers to a group of non-coronary cardiovascular disorders and related interventions. Obvious examples are aortic stenosis, mitral regurgitation, atrial septal defect, and known or potential left atrial appendage (LAA) clots. In the last decade, cardiologists have witnessed a dramatic increase in the types and complexity of catheter-based interventions for SHD. Current imaging modalities have important limitations in accurate delineation of cardiac anatomies necessary for SHD interventions. Application of 3D printing in SHD interventional planning enables tangible appreciation of cardiac anatomy and allows in vitro interventional device testing. 3D printing is used in diagnostic workup, guidance of treatment strategies, and procedural simulation, facilitating hemodynamic research, enhancing interventional training, and promoting patient-clinician communication. In this review, we attempt to define the concept, technique, and work flow of 3D printing in SHD and its interventions, highlighting the reported clinical benefits and unsolved issues, as well as exploring future developments in this field.
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Affiliation(s)
- Yiting Fan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Randolph H L Wong
- Division of Cardiothoracic Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Jia D, Zhou Q, Song HN, Zhang L, Chen JL, Liu Y, Kong B, He FZ, Wang YJ, Yang YT. The value of the left atrial appendage orifice perimeter of 3D model based on 3D TEE data in the choice of device size of LAmbre™ occluder. Int J Cardiovasc Imaging 2019; 35:1841-1851. [PMID: 31134413 DOI: 10.1007/s10554-019-01627-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/13/2019] [Indexed: 11/28/2022]
Abstract
Preoperative optimal selection of the occluder size is crucial in percutaneous left atrial appendage (LAA) occlusion, and the maximal width of the LAA orifice is the main reference index, however it can not fully meet the practical operation requirements. We retrospectively analyzed three-dimensional (3D) transesophageal echocardiography (TEE) and computed tomography (CT) imaging dataset of the 41 patients who underwent LAA occlusion with LAmbre™ system. The LAA orifice parameters were overall evaluated to determine their role in device size selection. Eight LAA 3D models of the four cases who had been replaced their device during the procedure based on TEE and CT were printed out to verify the optimal parameter decision strategy. There was a significant concordance of the results between 3D TEE and CT in the LAA orifice evaluation. The correlations between the perimeter and maximal width measurements by 3D TEE and the closure disk of the device were stronger than that between the area measurements and the closure disk (r = 0.93, 0.95, 0.86, respectively and p < 0.001 all), and the result was similar to that by CT (r = 0.92, 0.93, 0.84, respectively and p < 0.001 all). The ratios of the maximal width to the minimal width of the four cases were all > 1.4, however the rest 37 cases were all ≤ 1.4. Based on the comprehensive assessment of the LAA orifice perimeter and maximal width of the 3D printed models, the experiments were all succeed just for one try. The LAA orifice perimeter of 3D printed model based on 3D TEE may help in choosing the optimal device size of LAmbre™, especially for the LAA with flater ostial shape.
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Affiliation(s)
- Dan Jia
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Hong-Ning Song
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lan Zhang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jin-Ling Chen
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bin Kong
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fa-Zhi He
- Computer Science and Technology School, Wuhan University, Wuhan, China
| | - Yi-Jia Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuan-Ting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
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Oliveira-Santos MD, Oliveira-Santos E, Gonçalves L, Silva Marques J. Cardiovascular Three-Dimensional Printing in Non-Congenital Percutaneous Interventions. Heart Lung Circ 2019; 28:1525-1534. [PMID: 31176626 DOI: 10.1016/j.hlc.2019.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/01/2019] [Accepted: 04/22/2019] [Indexed: 01/22/2023]
Abstract
Three-dimensional (3D) printing technology is emerging as a potential new tool for the planning of medical interventions. In the last few years, increasing data have accumulated on its ability to guide interventional cardiology procedures, going beyond initial reports in congenital heart disease settings. In fact, there is compelling evidence on the advantages of a 3D-printed guided strategy for left atrial appendage closure, suggesting a high success rate with optimal device selection and lower radiation load. Furthermore, there is emerging experience in aortic root printing, which may improve the success rate and safety of transcatheter aortic valve replacement and may be of particular interest for targeting low-risk populations. Additionally, there are stimulating reports in mitral valve intervention, setting the tone for this new field in cardiovascular percutaneous intervention. In this clinically oriented paper, we will review current 3D printing use in interventional cardiology and we will address future directions, with a focus on procedural planning and medical simulation.
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Affiliation(s)
- Manuel de Oliveira-Santos
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
| | | | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - João Silva Marques
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Morais P, Vilaca JL, Queiros S, De Meester P, Budts W, Tavares JMRS, D'Hooge J. Semiautomatic Estimation of Device Size for Left Atrial Appendage Occlusion in 3-D TEE Images. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:922-929. [PMID: 30869614 DOI: 10.1109/tuffc.2019.2903886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Left atrial appendage (LAA) occlusion is used to reduce the risk of thromboembolism in patients with nonvalvular atrial fibrillation by obstructing the LAA through a percutaneously delivered device. Nonetheless, correct device sizing is complex, requiring the manual estimation of different measurements in preprocedural/periprocedural images, which is tedious and time-consuming and with high interobserver and intraobserver variability. In this paper, a semiautomatic solution to estimate the required relevant clinical measurements is described. This solution starts with the 3-D segmentation of the LAA in 3-D transesophageal echocardiographic images, using a constant blind-ended model initialized through a manually defined spline. Then, the segmented LAA surface is aligned with a set of templates, i.e., 3-D surfaces plus relevant measurement planes (manually defined by one observer), transferring the latter to the unknown situation. Specifically, the alignment is performed in three consecutive steps, namely: 1) rigid alignment using the LAA clipping plane position; 2) orientation compensation using the circumflex artery location; and 3) anatomical refinement through a weighted iterative closest point algorithm. The novel solution was evaluated in a clinical database with 20 volumetric TEE images. Two experiments were set up to assess: 1) the sensitivity of the model's parameters and 2) the accuracy of the proposed solution for the estimation of the clinical measurements. Measurement levels manually identified by two observers were used as ground truth. The proposed solution obtained results comparable to the interobserver variability, presenting narrower limits of agreement for all measurements. Moreover, this solution proved to be fast, taking nearly 40 s (manual analysis took 3 min) to estimate the relevant measurements while being robust to the variation of the model's parameters. Overall, the proposed solution showed its potential for fast and robust estimation of the clinical measurements for occluding device selection, proving its added value for clinical practice.
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Fan Y, Yang F, Cheung GSH, Chan AKY, Wang DD, Lam YY, Chow MCK, Leong MCW, Kam KKH, So KCY, Tse G, Qiao Z, He B, Kwok KW, Lee APW. Device Sizing Guided by Echocardiography-Based Three-Dimensional Printing Is Associated with Superior Outcome after Percutaneous Left Atrial Appendage Occlusion. J Am Soc Echocardiogr 2019; 32:708-719.e1. [PMID: 30948144 DOI: 10.1016/j.echo.2019.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Left atrial appendage (LAA) occlusion is an alternative to anticoagulation for stroke prevention in patients with atrial fibrillation. Accurate device sizing is crucial for optimal outcome. Patient-specific LAA models can be created using three-dimensional (3D) printing from 3D transesophageal echocardiographic (TEE) images, allowing in vitro model testing for device selection. The aims of this study were to assess the association of model-based device selection with procedural safety and efficacy and to determine if preprocedural model testing leads to superior outcomes. METHODS In 72 patients who underwent imaging-guided LAA occlusion, 3D models of the LAA were created from 3D TEE data sets retrospectively (retrospective cohort). The optimal device determined by in vitro model testing was compared with the actual device used. Associations of model-match and model-mismatch device sizing with outcomes were analyzed. In another 32 patients, device selection was prospectively guided by 3D models in adjunct to imaging (prospective cohort). The impact of model-based sizing on outcomes was assessed by comparing the two cohorts. RESULTS Patients in the retrospective cohort with model-mismatch sizing had longer procedure times, more implantation failures, more devices used per procedure, more procedural complications, more peridevice leak, more device thrombus, and higher cumulative incidence rates of ischemic stroke and cardiovascular or unexplained death (P < .05 for all) over 3.0 ± 2.3 years after LAA occlusion. Compared with the retrospective imaging-guided cohort, the prospective model-guided patients achieved higher implantation success and shorter procedural times (P < .05) without complications. Clinical device compression (r = 0.92) and protrusion (r = 0.95) agreed highly with model testing (P < .0001). Predictors for sizing mismatch were nonwindsock morphology (odds ratio, 4.7) and prominent LAA trabeculations (odds ratio, 7.1). CONCLUSIONS In patients undergoing LAA occlusion, device size selection in agreement with 3D-printed model-based sizing is associated with improved safety and efficacy. Preprocedural device sizing with 3D models in adjunct to imaging guidance may lead to superior outcomes.
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Affiliation(s)
- Yiting Fan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fan Yang
- Division of Cardiology, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Gary Shing-Him Cheung
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anna Kin-Yin Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dee Dee Wang
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - Yat-Yin Lam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marco Chun-Kit Chow
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | | | - Kevin Ka-Ho Kam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kent Chak-Yu So
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gary Tse
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhiqing Qiao
- Division of Cardiology, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ben He
- Division of Cardiology, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Pantelic M, Pantelic M, Pietila T, Rollet M, Myers E, Song T, O’Neill WW, Wang DD. Using 3D-Printed Models to Advance Clinical Care. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2019.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Witowski J, Wake N, Grochowska A, Sun Z, Budzyński A, Major P, Popiela TJ, Pędziwiatr M. Investigating accuracy of 3D printed liver models with computed tomography. Quant Imaging Med Surg 2019; 9:43-52. [PMID: 30788245 DOI: 10.21037/qims.2018.09.16] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The aim of this study was to evaluate the accuracy of three-dimensional (3D) printed liver models developed by a cost-effective approach for establishing validity of using these models in a clinical setting. Methods Fifteen patients undergoing laparoscopic liver resection in a single surgical department were included. Patient-specific, 1-1 scale 3D printed liver models including the liver, tumor, and vasculature were created from contrast-enhanced computed tomography (CT) images using a cost-effective approach. The 3D models were subsequently CT scanned, 3D image post-processing was performed, and these 3D computer models (MCT) were compared to the original 3D models created from the original patient images (PCT). 3D computer models of each type were co-registered using a point set registration method. 3D volume measurements of the liver and lesions were calculated and compared for each set. In addition, Hausdorff distances were calculated and surface quality was compared by generated heatmaps. Results The median liver volume in MCT was 1,281.84 [interquartile range (IQR) =296.86] cm3, and 1,448.03 (IQR =413.23) cm3 in PCT. Analysis of differences between surfaces showed that the median value of mean Hausdorff distances for liver parenchyma was 1.92 mm. Bland-Altman plots revealed no significant bias in liver volume and diameters of hepatic veins and tumor location. Median errors of all measured vessel diameters were smaller than CT slice height. There was a slight trend towards undersizing anatomical structures, although those errors are most likely due to source imaging. Conclusions We have confirmed the accuracy of 3D printed liver models created by using the low-cost method. 3D models are useful tools for pre-operative planning and intra-operative guidance. Future research in this field should continue to move towards clinical trials for assessment of the impact of these models on pre-surgical planning decisions and perioperative outcomes.
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Affiliation(s)
- Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU School of Medicine, New York, NY, USA
| | - Anna Grochowska
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Australia
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | | | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
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Morais P, Queiros S, Meester PD, Budts W, Vilaca JL, Tavares JMRS, D'Hooge J. Fast Segmentation of the Left Atrial Appendage in 3-D Transesophageal Echocardiographic Images. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:2332-2342. [PMID: 30281444 DOI: 10.1109/tuffc.2018.2872816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Left atrial appendage (LAA) has been generally described as "our most lethal attachment," being considered the major source of thromboembolism in patients with nonvalvular atrial fibrillation. Currently, LAA occlusion can be offered as a treatment for these patients, obstructing the LAA through a percutaneously delivered device. Nevertheless, correct device sizing is not straightforward, requiring manual analysis of peri-procedural images. This approach is suboptimal, time demanding, and highly variable between experts, which can result in lengthy procedures and excess manipulations. In this paper, a semiautomatic LAA segmentation technique for 3-D transesophageal echocardiography (TEE) images is presented. Specifically, the proposed technique relies on a novel segmentation pipeline where a curvilinear blind-ended model is optimized through a double stage strategy: 1) fast contour evolution using global terms and 2) contour refinement based on regional energies. To reduce its computational cost, and thus make it more attractive to real interventions, the B-spline explicit active surface framework was used. This novel method was evaluated in a clinical database of 20 patients. Manual analysis performed by two observers was used as ground truth. The 3-D segmentation results corroborated the accuracy, robustness to the variation of the parameters, and computationally attractiveness of the proposed method, taking approximately 14 s to segment the LAA with an average accuracy of ~0.9 mm. Moreover, a performance comparable to the interobserver variability was found. Finally, the advantages of the segmented model were evaluated, while semiautomatically extracting the clinical measurements for device selection, showing a similar accuracy but with a higher reproducibility when compared to the current practice. Overall, the proposed segmentation method shows potential for an improved planning of LAA occlusion, demonstrating its added value for normal clinical practice.
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Conti M, Marconi S, Muscogiuri G, Guglielmo M, Baggiano A, Italiano G, Mancini ME, Auricchio F, Andreini D, Rabbat MG, Guaricci AI, Fassini G, Gasperetti A, Costa F, Tondo C, Maltagliati A, Pepi M, Pontone G. Left atrial appendage closure guided by 3D computed tomography printing technology: A case control study. J Cardiovasc Comput Tomogr 2018; 13:336-339. [PMID: 30389341 DOI: 10.1016/j.jcct.2018.10.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/26/2018] [Accepted: 10/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We sought to evaluate the additional value of left atrial appendage (LAA) 3D printing derived from computed tomography (CCT) in determining the size for LAA occlusion (LAAO) devices as compared to standard measurement by using occurrence of LAA leak as endpoint. METHODS We evaluated 6 patients with LAA leak (cases) and 14 matched patients without LAA leak (controls) after LAAO. For each group, a patient-specific 3D printed model of LAA was manufactured using CT pre-operative images. The size recommended by the 3D printed model was compared with the size of the implanted device. RESULTS Compared to the 3D printed model, 55% of the devices were underestimated, the two sizing approaches agreed in 35% of the patients, while the 3D printed model overestimated the size in 10% of patients. The prevalence of LAA leak was significantly higher in the subset of patients with underestimation of prosthesis implanted with the standard approach as compared to the other patients (p = 0.019). CONCLUSION 3D printing of the LAA may provide additional value to standard practice for LAAO device prosthesis sizing with the potential impact to reduce LAA leak.
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Affiliation(s)
- Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Stefania Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Giuseppe Muscogiuri
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Rome, Italy
| | | | | | | | | | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA; Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Andrea Igoren Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital, Policlinico of Bari, Italy
| | | | | | | | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Manufacturing Better Outcomes in Cardiovascular Intervention: 3D Printing in Clinical Practice Today. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:95. [DOI: 10.1007/s11936-018-0692-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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30
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Singam NSV, Gopinathannair R, Stidam JM, Solankhi NK, Bessen M, Stoddard MF. A curious case of an absent left atrial appendage. Echocardiography 2018; 35:1882-1884. [PMID: 30338562 DOI: 10.1111/echo.14151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/09/2018] [Accepted: 09/12/2018] [Indexed: 12/01/2022] Open
Abstract
The left atrial appendage (LAA) in the setting of non-valvular atrial fibrillation (NVAF) is the predominant location for intracardiac thrombus formation. An absent LAA is a very rare congenital cardiac anomaly. We present a case of a 79-year-old female with NVAF, high CHADS2VASC2 score, and high bleeding risk who presented for elective Watchman™ left atrial appendage closure device implant. A pre-procedural transesophageal echocardiography showed an absent LAA. This finding was confirmed with cardiac computed tomography and a left atrial angiogram. The patient was discharged on medical therapy with close outpatient follow-up.
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Affiliation(s)
| | | | | | | | | | - Marcus F Stoddard
- Division of Cardiology, University of Louisville, Louisville, Kentucky
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31
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Applications of low-cost 3D printing in left atrial appendage closure using epicardial approaches - initial clinical experience. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:135-140. [PMID: 30069196 PMCID: PMC6066675 DOI: 10.5114/kitp.2018.76481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022]
Abstract
Introduction Left atrial appendage occlusion procedure (LAAO) became an alternative method for stroke prevention in atrial fibrillation (AF) patients with contraindication or intolerance for oral anticoagulation therapy. However, LAA anatomy is complex with several different types of LAA morphology. Therefore matching the correct size of a delivery device to LAA morphology is difficult. In such circumstances, the 3D-printed model of LAA closure may be useful for preoperative planning which increases the efficacy of LAAO procedure. Material and methods We report as a first 2 cases of LAA occlusion procedure using 2 different systems: thoracoscopic AtriClip and the LARIAT device in which a 3D printed LAA model was used in preoperative planning. Results In the first patient, preoperative measurements of 3D LAA model were performed using a dedicated selection guide for AtriClip device were comparable with the intraoperative examination. Left atrial appendage was closed epicardial using 40 mm size AtriClip. In second patients, LAA closure was performed completely percutaneously using LARIAT device. For better visualization of LAA shape on fluoroscopy and TEE examination, intraoperatively sterilized 3D LAA model was used during the procedure. In both cases, intraoperative TEE examination confirmed complete LAA closure with no leak. Conclusions Left atrial appendage 3D model is a useful tool in preoperative planning of a left atrial appendage occlusion using epicardial approaches with thoracoscopic or percutaneous access using LARIAT device. The quality of low-cost 3D printed LAA model is sufficient in planning minimally invasive procedure.
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Hachulla AL, Noble S, Guglielmi G, Agulleiro D, Müller H, Vallée JP. 3D-printed heart model to guide LAA closure: useful in clinical practice? Eur Radiol 2018; 29:251-258. [PMID: 29948082 DOI: 10.1007/s00330-018-5569-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/19/2018] [Accepted: 05/28/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Correct device sizing for left atrial appendage (LAA) closure remains challenging due to complex LAA shapes. The aim of our study was to investigative the utility of personalized 3D-printed models (P3DPM) of the LAA to guide device size selection. METHODS Fifteen patients (75.4 ±8.5years) scheduled for LAA closure using an Amulet device underwent cardiac computed tomography (CT). The LAA was segmented by semiautomatic algorithms using Vitrea® software. A 1.5-mm LAA thick shell was exported in stereolithography format and printed using TangoPlus flexible material. Different Amulet device sizes on the P3DPM were tested. New P3DPM-CT with the device was acquired in order to appreciate the proximal disc sealing the LAA ostium and the compression of the distal lobe within the LAA. We predicted the device size with P3DPM and compared this with the device sizes predicted by transesophageal echocardiography (TEE) and CT as well as the device size implanted in patients. RESULTS The device size predicted by 3D-TEE and CT corresponded to the implanted device size in 8/15 (53%) and 10/15 (67%), respectively. The predicted device size from the P3DPM was accurate in all patients, obtaining perfect contact with the LAA wall, without device instability or excessive compression. P3DPM-CT with the deployed device showed device deformation and positioning of the disk in relation to the pulmonary veins, allowing us to determine the best device size in all 15 cases. CONCLUSION P3DPM allowed us to simulate the LAA closure procedure and thus helped to identify the best Amulet size and position within the LAA. KEY POINTS • A 3D-printed heart model allows to simulate the LAA closure procedure. • A 3D-printed heart model allowed to identify the optimal Amulet size and position. • 3D-printed heart models may contribute to reduce the Amulet implantation learning curve.
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Affiliation(s)
- Anne-Lise Hachulla
- Division of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1291, Geneva, Switzerland.
| | - Stéphane Noble
- Department of Cardiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Gabriel Guglielmi
- Division of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1291, Geneva, Switzerland
| | - Daniel Agulleiro
- Computer Science Center, Faculty of Science, Carouge, Switzerland
| | - Hajo Müller
- Department of Cardiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Paul Vallée
- Division of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1291, Geneva, Switzerland
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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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Obasare E, Mainigi SK, Morris DL, Slipczuk L, Goykhman I, Friend E, Ziccardi MR, Pressman GS. CT based 3D printing is superior to transesophageal echocardiography for pre-procedure planning in left atrial appendage device closure. Int J Cardiovasc Imaging 2017; 34:821-831. [PMID: 29222738 DOI: 10.1007/s10554-017-1289-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/06/2017] [Indexed: 01/04/2023]
Abstract
Accurate assessment of the left atrial appendage (LAA) is important for pre-procedure planning when utilizing device closure for stroke reduction. Sizing is traditionally done with transesophageal echocardiography (TEE) but this is not always precise. Three-dimensional (3D) printing of the LAA may be more accurate. 24 patients underwent Watchman device (WD) implantation (71 ± 11 years, 42% female). All had complete 2-dimensional TEE. Fourteen also had cardiac computed tomography (CCT) with 3D printing to produce a latex model of the LAA for pre-procedure planning. Device implantation was unsuccessful in 2 cases (one with and one without a 3D model). The model correlated perfectly with implanted device size (R2 = 1; p < 0.001), while TEE-predicted size showed inferior correlation (R2 = 0.34; 95% CI 0.23-0.98, p = 0.03). Fisher's exact test showed the model better predicted final WD size than TEE (100 vs. 60%, p = 0.02). Use of the model was associated with reduced procedure time (70 ± 20 vs. 107 ± 53 min, p = 0.03), anesthesia time (134 ± 31 vs. 182 ± 61 min, p = 0.03), and fluoroscopy time (11 ± 4 vs. 20 ± 13 min, p = 0.02). Absence of peri-device leak was also more likely when the model was used (92 vs. 56%, p = 0.04). There were trends towards reduced trans-septal puncture to catheter removal time (50 ± 20 vs. 73 ± 36 min, p = 0.07), number of device deployments (1.3 ± 0.5 vs. 2.0 ± 1.2, p = 0.08), and number of devices used (1.3 ± 0.5 vs. 1.9 ± 0.9, p = 0.07). Patient specific models of the LAA improve precision in closure device sizing. Use of the printed model allowed rapid and intuitive location of the best landing zone for the device.
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Affiliation(s)
- Edinrin Obasare
- Einstein Heart and Vascular Institute, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA. .,Einstein Medical Center, 5501 Old York Road, Room 3232 Levy Building, Philadelphia, PA, 19141, USA.
| | - Sumeet K Mainigi
- Einstein Heart and Vascular Institute, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - D Lynn Morris
- Einstein Heart and Vascular Institute, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Leandro Slipczuk
- Einstein Heart and Vascular Institute, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Igor Goykhman
- Department of Radiology, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Evan Friend
- Einstein Heart and Vascular Institute, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Mary Rodriguez Ziccardi
- Department of Internal Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Gregg S Pressman
- Einstein Heart and Vascular Institute, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
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Hell M, Achenbach S, Yoo I, Franke J, Blachutzik F, Roether J, Graf V, Raaz-Schrauder D, Marwan M, Schlundt C. 3D printing for sizing left atrial appendage closure device: head-to-head comparison with computed tomography and transoesophageal echocardiography. EUROINTERVENTION 2017; 13:1234-1241. [DOI: 10.4244/eij-d-17-00359] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Berte B, Jost CA, Maurer D, Fäh-Gunz A, Pillois X, Naegeli B, Pfyffer M, Sütsch G, Scharf C. Long-term follow-up after left atrial appendage occlusion with comparison of transesophageal echocardiography versus computed tomography to guide medical therapy and data about postclosure cardioversion. J Cardiovasc Electrophysiol 2017; 28:1140-1150. [DOI: 10.1111/jce.13289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/18/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Benjamin Berte
- Cardiovascular Center; Klinik Im Park; Zürich Switzerland
| | | | - Dominik Maurer
- Cardiovascular Center; Klinik Im Park; Zürich Switzerland
| | - Anja Fäh-Gunz
- Cardiovascular Center; Klinik Im Park; Zürich Switzerland
| | | | | | - Monica Pfyffer
- Cardiovascular Center; Klinik Im Park; Zürich Switzerland
| | - Gabor Sütsch
- Herzzentrum; Hirslanden Clinic; Zürich Switzerland
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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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Luo H. Three-Dimensional Printing for Cardiology: To Be, or Not To Be? Cardiology 2017; 137:62-63. [PMID: 28118638 DOI: 10.1159/000455067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/13/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Hongxing Luo
- Zhengzhou University People's Hospital, Zhengzhou, China
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Liu P, Li X, Zhang Y. Three-Dimensional Printing for Cardiology: A Useful Tool for Cardiac Intervention. Cardiology 2017; 137:64-65. [DOI: 10.1159/000455251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 11/19/2022]
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Athanassopoulos GD. 3D Printing for Left Atrial Appendage (LAA) Modeling Based on Transesophageal Echocardiography: A Step Forward in Closure with LAA Devices. Cardiology 2016; 135:249-254. [PMID: 27537688 DOI: 10.1159/000448024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022]
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