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Jenkinson CG, Wood TL. Computational Fluid Dynamics Methodology for Aortic Aneurysm Analysis in Computed Tomography (CT) Datasets. Cureus 2025; 17:e84523. [PMID: 40416907 PMCID: PMC12098751 DOI: 10.7759/cureus.84523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2025] [Indexed: 05/27/2025] Open
Abstract
Aortic aneurysms present significant clinical challenges due to the risk of rupture associated with the abnormal dilation of the aorta. Computational fluid dynamics (CFD) analysis is an emerging, non-invasive method to analyse haemodynamic forces within aneurysmal regions. We present a detailed, reproducible workflow for the CFD analysis of aortic aneurysms based on cardiac-gated computed tomography (CT) data. Using a structured toolchain of open-source software, namely, Horos (Horos Project, Annapolis, MD, USA) for image preparation, Image Tool Kit-SNAP (ITK-SNAP) (University of Pennsylvania, Philadelphia, PA, USA) for segmentation, MeshLab (Istituto di Scienza e Tecnologie dell'Informazione-Consiglio Nazionale delle Ricerche (ISTI-CNR), Pisa, Italy) for mesh refinement, Blender (Blender Foundation, Amsterdam, Netherlands, https://www.blender.org) for boundary patching, OpenFOAM (OpenFOAM Foundation, London, UK) for CFD simulation, ParaView (Kitware, Inc., Clifton Park, NY, USA) for visualisation, and R (R Foundation for Statistical Computing, Vienna, Austria, https://www.R-project.org/) for statistical analysis, the methodology achieves high fidelity in modeling patient-specific flow conditions. Key stages of the workflow address segmentation accuracy, mesh quality, and boundary condition assignment, ensuring that the model captures physiological flow characteristics. This approach provides a valuable and accessible tool for clinicians and researchers, supporting assessments of haemodynamic risk factors in cardiovascular research. Our model aims to provide insights into wall shear stress (WSS), pressure distributions, and flow dynamics that may contribute to aneurysm progression and high-risk features.
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Affiliation(s)
- Charles G Jenkinson
- Faculty of Medicine and Dentistry, Charles Sturt University, Orange, AUS
- Faculty of Medicine, The University of Western Australia, Perth, AUS
- Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, AUS
- Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, AUS
| | - Tristan L Wood
- Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, AUS
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Shiraishi I, Yamagishi M, Hoashi T, Kato Y, Iwai S, Ichikawa H, Nishii T, Yamagishi H, Yasukochi S, Kawada M, Suzuki T, Shinkawa T, Yoshimura N, Inuzuka R, Hirata Y, Hirose K, Ikai A, Sakamoto K, Kotani Y, Kasahara S, Hisada T, Kurosaki K. Evaluation of the Efficacy and Accuracy of Super-Flexible Three-Dimensional Heart Models of Congenital Heart Disease Made via Stereolithography Printing and Vacuum Casting: A Multicenter Clinical Trial. J Cardiovasc Dev Dis 2024; 11:387. [PMID: 39728278 DOI: 10.3390/jcdd11120387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 11/24/2024] [Accepted: 11/25/2024] [Indexed: 12/28/2024] Open
Abstract
Three-dimensional (3D) printing is an advanced technology for accurately understanding anatomy and supporting the successful surgical management of complex congenital heart disease (CHD). We aimed to evaluate whether our super-flexible 3D heart models could facilitate preoperative decision-making and surgical simulation for complex CHD. The super-flexible heart models were fabricated by stereolithography 3D printing of the internal and external contours of the heart from cardiac computed tomography (CT) data, followed by vacuum casting with a polyurethane material similar in elasticity to a child's heart. Nineteen pediatric patients with complex CHD were enrolled (median age, 10 months). The primary endpoint was defined as the percentage of patients rated as "essential" on the surgeons' postoperative 5-point Likert scale. The accuracy of the models was validated by a non-destructive method using industrial CT. The super-flexible heart models allowed detailed anatomical diagnosis and simulated surgery with incisions and sutures. Thirteen patients (68.4%) were classified as "essential" by the primary surgeons after surgery, with a 95% confidence interval of 43.4-87.4%, meeting the primary endpoint. The product error within 90% of the total external and internal surfaces was 0.54 ± 0.21 mm. The super-flexible 3D heart models are accurate, reliable, and useful tools to assist surgeons in decision-making and allow for preoperative simulation in CHD.
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Affiliation(s)
- Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Takaya Hoashi
- Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
- Department of Pediatric Cardiac Surgery, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan
| | - Yoshiaki Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Shigemitsu Iwai
- Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Tatsuya Nishii
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Hiroyuki Yamagishi
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan
| | | | - Masaaki Kawada
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center Tochigi, Shimotsuke 329-0498, Japan
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan
| | - Takeshi Shinkawa
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Naoki Yoshimura
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yasutaka Hirata
- Department of Cardiovascular Surgery, The University of Tokyo, Tokyo 113-8655, Japan
| | - Keiichi Hirose
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka 420-8660, Japan
| | - Akio Ikai
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka 420-8660, Japan
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka 420-8660, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama 700-8558, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama 700-8558, Japan
| | - Toshiaki Hisada
- Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa 227-0871, Japan
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
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Pozza A, Zanella L, Castaldi B, Di Salvo G. How Will Artificial Intelligence Shape the Future of Decision-Making in Congenital Heart Disease? J Clin Med 2024; 13:2996. [PMID: 38792537 PMCID: PMC11122569 DOI: 10.3390/jcm13102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Improvements in medical technology have significantly changed the management of congenital heart disease (CHD), offering novel tools to predict outcomes and personalize follow-up care. By using sophisticated imaging modalities, computational models and machine learning algorithms, clinicians can experiment with unprecedented insights into the complex anatomy and physiology of CHD. These tools enable early identification of high-risk patients, thus allowing timely, tailored interventions and improved outcomes. Additionally, the integration of genetic testing offers valuable prognostic information, helping in risk stratification and treatment optimisation. The birth of telemedicine platforms and remote monitoring devices facilitates customised follow-up care, enhancing patient engagement and reducing healthcare disparities. Taking into consideration challenges and ethical issues, clinicians can make the most of the full potential of artificial intelligence (AI) to further refine prognostic models, personalize care and improve long-term outcomes for patients with CHD. This narrative review aims to provide a comprehensive illustration of how AI has been implemented as a new technological method for enhancing the management of CHD.
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Affiliation(s)
- Alice Pozza
- Paediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy; (A.P.)
| | - Luca Zanella
- Heart Surgery, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Cardiac Surgery Unit, Department of Cardiac-Thoracic-Vascular Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy; (A.P.)
| | - Giovanni Di Salvo
- Paediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy; (A.P.)
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Monaco C, Kronenberger R, Talevi G, Pannone L, Cappello IA, Candelari M, Ramak R, Della Rocca DG, Bori E, Terryn H, Baert K, Laha P, Krasniqi A, Gharaviri A, Bala G, Chierchia GB, La Meir M, Innocenti B, de Asmundis C. Advancing Surgical Arrhythmia Ablation: Novel Insights on 3D Printing Applications and Two Biocompatible Materials. Biomedicines 2024; 12:869. [PMID: 38672223 PMCID: PMC11048352 DOI: 10.3390/biomedicines12040869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
To date, studies assessing the safety profile of 3D printing materials for application in cardiac ablation are sparse. Our aim is to evaluate the safety and feasibility of two biocompatible 3D printing materials, investigating their potential use for intra-procedural guides to navigate surgical cardiac arrhythmia ablation. Herein, we 3D printed various prototypes in varying thicknesses (0.8 mm-3 mm) using a resin (MED625FLX) and a thermoplastic polyurethane elastomer (TPU95A). Geometrical testing was performed to assess the material properties pre- and post-sterilization. Furthermore, we investigated the thermal propagation behavior beneath the 3D printing materials during cryo-energy and radiofrequency ablation using an in vitro wet-lab setup. Moreover, electron microscopy and Raman spectroscopy were performed on biological tissue that had been exposed to the 3D printing materials to assess microparticle release. Post-sterilization assessments revealed that MED625FLX at thicknesses of 1 mm, 2.5 mm, and 3 mm, along with TPU95A at 1 mm and 2.5 mm, maintained geometrical integrity. Thermal analysis revealed that material type, energy source, and their factorial combination with distance from the energy source significantly influenced the temperatures beneath the 3D-printed material. Electron microscopy revealed traces of nitrogen and sulfur underneath the MED625FLX prints (1 mm, 2.5 mm) after cryo-ablation exposure. The other samples were uncontaminated. While Raman spectroscopy did not detect material release, further research is warranted to better understand these findings for application in clinical settings.
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Affiliation(s)
- Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Rani Kronenberger
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (R.K.)
| | - Giacomo Talevi
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Ida Anna Cappello
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Mara Candelari
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Edoardo Bori
- BEAMS Department, Bio Electro and Mechanical Systems, École Polytechnique de Bruxelles, Université Libre de Bruxelles, 1050 Brussels, Belgium (B.I.)
| | - Herman Terryn
- Research Group Electrochemical and Surface Engineering (SURF), Department Materials and Chemistry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Kitty Baert
- Research Group Electrochemical and Surface Engineering (SURF), Department Materials and Chemistry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Priya Laha
- Research Group Electrochemical and Surface Engineering (SURF), Department Materials and Chemistry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Ahmet Krasniqi
- In Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Ali Gharaviri
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Mark La Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (R.K.)
| | - Bernardo Innocenti
- BEAMS Department, Bio Electro and Mechanical Systems, École Polytechnique de Bruxelles, Université Libre de Bruxelles, 1050 Brussels, Belgium (B.I.)
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
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Wang H, Liang J, Zhang G, He D, Du B, Ren Z, Dai Z, Lee H, Li D. Application of Three-Dimensional Printing Technology in the Perioperative Management of Cardiac Tumours: A Review and Analysis. Rev Cardiovasc Med 2024; 25:101. [PMID: 39076958 PMCID: PMC11263826 DOI: 10.31083/j.rcm2503101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 07/31/2024] Open
Abstract
Background Multimodal imaging plays a crucial role in evaluating suspected cardiac tumours. In recent years, three-dimensional (3D) printing technology has continued to advance such that image-based 3D-printed models have been incorporated into the auxiliary diagnosis and treatment of cardiac tumour diseases. The purpose of this review is to analyze the existing literature on the application of 3D printing in cardiac tumour surgery to examine the current status of the application of this technology. Methods By searching PubMed, Cochrane, Scopus and Google Scholar, as well as other resource databases, a completed review of the available literature was performed. Effect sizes from published studies were investigated, and results are presented concerning the use of 3D surgical planning in the management of cardiac tumours. Results According to the reviewed literature, our study comes to the point that 3D printing is a valuable technique for planning surgery for cardiac tumours. As shown in the review report, Mucinous and sarcomatous tumours are the most commonly used tumours for 3D printing, magnetic resonance imaging (MRI) and computed tomography (CT) are the most commonly used technologies for preparing 3D printing models, the main printing technology is stereolithography, and the most used 3D modeling software is Mimics. The printing time and cost required for 3D printing are affected by factors such as the size of the type, complexity, the printed material and the 3D printing technology used. The reported research shows that 3D printing can understand the anatomy of complex tumour cases, virtual surgical simulation, as well as facilitate doctor-patient communication and clinical teaching. Conclusions These results show that the development of 3D printing technology has brought more accurate and safe perioperative treatment options for patients with cardiac tumours. Therefore, 3D printing technology is expected to become a routine clinical diagnosis and treatment tool for cardiac tumours.
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Affiliation(s)
- Huan Wang
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 215008 Suzhou, Jiangsu, China
| | - Jixiang Liang
- The State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, 710000 Xi’an, Shaanxi, China
| | - Gen Zhang
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 215008 Suzhou, Jiangsu, China
| | - Dongsheng He
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 215008 Suzhou, Jiangsu, China
| | - Baoluo Du
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 215008 Suzhou, Jiangsu, China
| | - Zhipeng Ren
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 215008 Suzhou, Jiangsu, China
| | - Ziqiang Dai
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 215008 Suzhou, Jiangsu, China
| | - Hsin Lee
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 215008 Suzhou, Jiangsu, China
| | - Dianyuan Li
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 215008 Suzhou, Jiangsu, China
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Stieger-Vanegas SM, Scollan KF. Development of three-dimensional (3D) cardiac models from computed tomography angiography. J Vet Cardiol 2023; 51:195-206. [PMID: 38198977 DOI: 10.1016/j.jvc.2023.11.017] [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: 01/15/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 01/12/2024]
Abstract
Three-dimensional (3D) modeling and printing is an emerging technology in veterinary cardiovascular medicine allowing the fabrication of anatomically correct patient-specific models. These patient-specific models can be used for a wide range of purposes including medical teaching, assessment of cardiac function and movement of valve leaflets, design and assessment of devices created for interventional procedures, and pre-surgical planning [1-3]. Additionally, these 3D models can facilitate communication between the clinical team and the patient's owner. The process of creating 3D models starts with acquiring volumetric imaging data sets of the area of interest. Three-dimensional modeling and printing are reliable when high-quality volumetric imaging data are used to create these models. Currently, only ungated- and electrocardiogram (ECG)-gated computed tomography (CT), cardiac magnetic resonance imaging (CMRI), and 3D echocardiography provide the volumetric data sets needed to create these 3D models. These imaging data sets are imported into a software or open-source freeware platform and then segmented to create a virtual 3D model. This virtual 3D model can be further refined using computer-aided design (CAD) software and then be printed to create a physical 3D model. Cardiovascular 3D modeling and printing is a new medical tool which allows us to expand the way we plan interventional procedures, practice interventional skills, communicate with the medical team and owner, and teach future veterinarians.
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Affiliation(s)
- S M Stieger-Vanegas
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, USA.
| | - K F Scollan
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, USA
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Mohanadas HP, Nair V, Doctor AA, Faudzi AAM, Tucker N, Ismail AF, Ramakrishna S, Saidin S, Jaganathan SK. A Systematic Analysis of Additive Manufacturing Techniques in the Bioengineering of In Vitro Cardiovascular Models. Ann Biomed Eng 2023; 51:2365-2383. [PMID: 37466879 PMCID: PMC10598155 DOI: 10.1007/s10439-023-03322-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
Additive Manufacturing is noted for ease of product customization and short production run cost-effectiveness. As our global population approaches 8 billion, additive manufacturing has a future in maintaining and improving average human life expectancy for the same reasons that it has advantaged general manufacturing. In recent years, additive manufacturing has been applied to tissue engineering, regenerative medicine, and drug delivery. Additive Manufacturing combined with tissue engineering and biocompatibility studies offers future opportunities for various complex cardiovascular implants and surgeries. This paper is a comprehensive overview of current technological advancements in additive manufacturing with potential for cardiovascular application. The current limitations and prospects of the technology for cardiovascular applications are explored and evaluated.
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Affiliation(s)
| | - Vivek Nair
- Computational Fluid Dynamics (CFD) Lab, Mechanical and Aerospace Engineering, University of Texas Arlington, Arlington, TX, 76010, USA
| | | | - Ahmad Athif Mohd Faudzi
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
| | - Nick Tucker
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Ahmad Fauzi Ismail
- School of Chemical and Energy Engineering, Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology Initiative, National University of Singapore, Singapore, Singapore
| | - Syafiqah Saidin
- IJNUTM Cardiovascular Engineering Centre, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Saravana Kumar Jaganathan
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia.
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia.
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK.
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Monitoring the Calibration of In-Office 3D Printers. Dent J (Basel) 2023; 11:dj11010020. [PMID: 36661556 PMCID: PMC9858488 DOI: 10.3390/dj11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
Most desktop 3D printers lack features that allow manual calibration of printer parameters. It is crucial to assess the accuracy of printing to minimize the margin of error and variance between each print. Therefore, this study aimed to develop a method for monitoring the calibration of in-office 3D printers. A calibration coupon was designed to have a tolerance and dimensions that define nominal geometry and allow the measurement of variances occurring in X−Y axes and curvature. Ten printing cycles were run on two stereolithography (SLA) 3D printers with two different resins. Additionally, the coupons were positioned in five positions on the build platform to assess errors caused by differences in positioning. Measurements were made on the X and Y axes. No statistical difference was noted between the coupons being printed in different positions on the build platform and between the two resins at both X and Y axes of measurement (p > 0.05). Desktop 3D printers currently lack a standardized calibration protocol, which provides a closed loop for design and manufacturing of printed parts. The coupon in this study will allow monitoring the calibration of desktop 3D printers to ensure high-quality printing.
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Candelari M, Cappello IA, Pannone L, Monaco C, Talevi G, Bori E, Ramak R, La Meir M, Gharaviri A, Chierchia GB, Innocenti B, de Asmundis C. A 3D-printed surgical guide for ischemic scar targeting and ablation. Front Cardiovasc Med 2022; 9:1029816. [PMID: 36465435 PMCID: PMC9715585 DOI: 10.3389/fcvm.2022.1029816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/31/2022] [Indexed: 09/19/2023] Open
Abstract
Background 3D printing technology development in medical fields allows to create 3D models to assist preoperative planning and support surgical procedures. Cardiac ischemic scar is clinically associated with malignant arrhythmias. Catheter ablation is aimed at eliminating the arrhythmogenic tissue until the sinus rhythm is restored. The scope of this work is to describe the workflow for a 3D surgical guide able to define the ischemic scar and target catheter ablation. Materials and methods For the patient-specific 3D surgical guide and 3D heart phantom model realization, both CT scan and cardiac MRI images were processed; this was necessary to extract anatomical structures and pathological information, respectively. Medical images were uploaded and processed in 3D Slicer. For the surgical guide modeling, images from CT scan and MRI were loaded in Meshmixer and merged. For the heart phantom realization, only the CT segmentation was loaded in Meshmixer. The surgical guide was printed in MED625FLX with Polyjet technology. The heart phantom was printed in polylactide with FDM technology. Results 3D-printed surgical model was in agreement with prespecified imputed measurements. The phantom fitting test showed high accuracy of the 3D surgical tool compared with the patient-specific reproduced heart. Anatomical references in the surgical guide ensured good stability. Ablation catheter fitting test showed high suitability of the guide for different ablation tools. Conclusion A 3D-printed guide for ventricular tachycardia ablation is feasible and accurate in terms of measurements, stability, and geometrical structure. Concerning clinical use, further clinical investigations are eagerly awaited.
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Affiliation(s)
- Mara Candelari
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
| | - Ida Anna Cappello
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
| | - Giacomo Talevi
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
| | - Ali Gharaviri
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel–Vrije Universiteit Brussel, Brussels, Belgium
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10
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Bertolini M, Rossoni M, Colombo G. Operative Workflow from CT to 3D Printing of the Heart: Opportunities and Challenges. Bioengineering (Basel) 2021; 8:bioengineering8100130. [PMID: 34677203 PMCID: PMC8533410 DOI: 10.3390/bioengineering8100130] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 01/25/2023] Open
Abstract
Medical images do not provide a natural visualization of 3D anatomical structures, while 3D digital models are able to solve this problem. Interesting applications based on these models can be found in the cardiovascular field. The generation of a good-quality anatomical model of the heart is one of the most complex tasks in this context. Its 3D representation has the potential to provide detailed spatial information concerning the heart’s structure, also offering the opportunity for further investigations if combined with additive manufacturing. When investigated, the adaption of printed models turned out to be beneficial in complex surgical procedure planning, for training, education and medical communication. In this paper, we will illustrate the difficulties that may be encountered in the workflow from a stack of Computed Tomography (CT) to the hand-held printed heart model. An important goal will consist in the realization of a heart model that can take into account real wall thickness variability. Stereolithography printing technology will be exploited with a commercial rigid resin. A flexible material will be tested too, but results will not be so satisfactory. As a preliminary validation of this kind of approach, print accuracy will be evaluated by directly comparing 3D scanner acquisitions to the original Standard Tessellation Language (STL) files.
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11
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Cernica D, Benedek I, Polexa S, Tolescu C, Benedek T. 3D Printing-A Cutting Edge Technology for Treating Post-Infarction Patients. Life (Basel) 2021; 11:910. [PMID: 34575059 PMCID: PMC8468787 DOI: 10.3390/life11090910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 02/06/2023] Open
Abstract
The increasing complexity of cardiovascular interventions requires advanced peri-procedural imaging and tailored treatment. Three-dimensional printing technology represents one of the most significant advances in the field of cardiac imaging, interventional cardiology or cardiovascular surgery. Patient-specific models may provide substantial information on intervention planning in complex cardiovascular diseases, and volumetric medical imaging from CT or MRI can be translated into patient-specific 3D models using advanced post-processing applications. 3D printing and additive manufacturing have a great variety of clinical applications targeting anatomy, implants and devices, assisting optimal interventional treatment and post-interventional evaluation. Although the 3D printing technology still lacks scientific evidence, its benefits have been shown in structural heart diseases as well as for treatment of complex arrhythmias and corrective surgery interventions. Recent development has enabled transformation of conventional 3D printing into complex 3D functional living tissues contributing to regenerative medicine through engineered bionic materials such hydrogels, cell suspensions or matrix components. This review aims to present the most recent clinical applications of 3D printing in cardiovascular medicine, highlighting also the potential for future development of this revolutionary technology in the medical field.
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Affiliation(s)
- Daniel Cernica
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
| | - Imre Benedek
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
| | - Stefania Polexa
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
| | - Cosmin Tolescu
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
| | - Theodora Benedek
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
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12
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The Importance of Pre-Operative Imaging and 3-D Printing in Transcatheter Tricuspid Valve-in-Valve Replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:161-165. [DOI: 10.1016/j.carrev.2020.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/18/2022]
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13
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Tan H, Huang E, Deng X, Ouyang S. Application of 3D printing technology combined with PBL teaching model in teaching clinical nursing in congenital heart surgery: A case-control study. Medicine (Baltimore) 2021; 100:e25918. [PMID: 34011060 PMCID: PMC8137022 DOI: 10.1097/md.0000000000025918] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/19/2021] [Indexed: 01/05/2023] Open
Abstract
We aimed to explore the application of three-dimensional (3D) printing technology with problem-based learning (PBL) teaching model in clinical nursing education of congenital heart surgery, and to further improve the teaching quality of clinical nursing in congenital heart surgery. In this study, a total of 132 trainees of clinical nursing in congenital heart surgery from a grade-A tertiary hospital in 2019 were selected and randomly divided into 3D printing group or traditional group. The 3D printing group was taught with 3D printed heart models combined with PBL teaching technique, while the traditional group used conventional teaching aids combined with PBL technique for teaching. After the teaching process, the 2 groups of nursing students were assessed and surveyed separately to evaluate the results. Compared to the traditional group, the theoretical scores, clinical nursing thinking ability, self-evaluation for comprehensive ability, and teaching satisfaction from the questionnaires filled by the 3D printing group were all higher than the traditional group. The difference was found to be statistically significant (P < .05). Our study has shown the 3D printing technology combined with the PBL teaching technique in the clinical nursing teaching of congenital heart surgery achieved good results.
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Affiliation(s)
- Hui Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Erjia Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Xicheng Deng
- Heart Center, Hunan Children's Hospital, Changsha, China
| | - Shayuan Ouyang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
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14
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Knockdown of Long Noncoding RNA SNHG14 Protects H9c2 Cells Against Hypoxia-induced Injury by Modulating miR-25-3p/KLF4 Axis in Vitro. J Cardiovasc Pharmacol 2021; 77:334-342. [PMID: 33278191 DOI: 10.1097/fjc.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cyanotic congenital heart disease (CCHD) is the main cause of death in infants worldwide. Long noncoding RNAs (lncRNAs) have been pointed to exert crucial roles in development of CHD. The current research is designed to illuminate the impact and potential mechanism of lncRNA SNHG14 in CCHD in vitro. The embryonic rat ventricular myocardial cells (H9c2 cells) were exposed to hypoxia to establish the model of CCHD in vitro. Quantitative real-time polymerase chain reaction was conducted to examine relative expressions of SNHG14, miR-25-3p, and KLF4. Cell viability was determined by the MTT assay. Lactate dehydrogenase (LDH) was measured by an LDH assay kit. Apoptosis-related proteins (Bax and Bcl-2) and KLF4 were detected by Western Blot. The targets of SNHG14 and miR-25-3p were verified by the dual-luciferase reporter assay. SNHG14 and KLF4 were upregulated, whereas miR-25-3p was downregulated in hypoxia-induced H9c2 cells and cardiac tissues of patients with CCHD compared with their controls. Knockdown of SNHG14 or overexpression of miR-25-3p facilitated cell viability, while depressing cell apoptosis and release of LDH in hypoxia-induced H9c2 cells. MiR-25-3p was a target of SNHG14 and inversely modulated by SNHG14. MiR-25-3p could directly target KLF4 and negatively regulate expression of KLF4. Repression of miR-25-3p or overexpression of KLF4 reversed the suppression impacts of sh-SNHG14 on cell apoptosis and release of LDH as well as the promotion impact of sh-SNHG14 on cell viability in hypoxia-induced H9c2 cells. Sh-SNHG14 protected H9c2 cells against hypoxia-induced injury by modulating miR-25-3p/KLF4 axis in vitro.
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15
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Bouma BJ, Sieswerda GT, Post MC, Ebels T, van Kimmenade R, de Winter RJ, Mulder BJ. New developments in adult congenital heart disease. Neth Heart J 2020; 28:44-49. [PMID: 32780331 PMCID: PMC7419394 DOI: 10.1007/s12471-020-01455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Congenital heart disease (CHD) affects 0.8% of live births and over the past decades technical improvements and large-scale repair has led to increased survival into adulthood of over 95% of the new-born. A new group of patients, those who survived their congenital heart defect, has emerged but late complications including heart failure, pulmonary hypertension (PH), arrhythmias, aneurysms and endocarditis appeared numerous, with a huge impact on mortality and morbidity. However, innovations over the past years have changed the landscape of adult CHD dramatically. In the diagnostic process important improvements have been made in the use of MRI, biomarkers, e‑health concepts and 3D visualisation of anatomy. Care is now concentrated in specialised centres, with a continuous emphasis on education and the introduction of weekly multidisciplinary consultations on diagnosis and intervention. Surgery and percutaneous intervention have been refined and new concepts applied, further reducing the burden of the congenital malformations. Research has matured from case series to global networks. Currently, adults with CHD are still facing high risks of early mortality and morbidity. By global collaboration and continuous education and development and innovation of our diagnostic and therapeutic arsenal, we will improve the perspectives of these young patients.
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Affiliation(s)
- B J Bouma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - G T Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Post
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - T Ebels
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R van Kimmenade
- Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - R J de Winter
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - B J Mulder
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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16
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Karakas AB, Govsa F, Ozer MA, Eraslan C. 3D Brain Imaging in Vascular Segmentation of Cerebral Venous Sinuses. J Digit Imaging 2020; 32:314-321. [PMID: 30242780 DOI: 10.1007/s10278-018-0125-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The three-dimensional (3D) visualization of dural venous sinuses (DVS) networks is desired by surgical trainers to create a clear mental picture of the neuroanatomical orientation of the complex cerebral anatomy. Our purpose is to document those identified during routine 3D venography created through 3D models using two-dimensional axial images for teaching and learning neuroanatomy. Anatomical data were segmented and extracted from imaging of the DVS of healthy people. The digital data of the extracted anatomical surfaces was then edited and smoothed, resulting in a set of digital 3D models of the superior sagittal, inferior sagittal, transverse, and sigmoid, rectus sinuses, and internal jugular veins. A combination of 3D printing technology and casting processes led to the creation of realistic neuroanatomical models that include high-fidelity reproductions of the neuroanatomical features of DVS. The life-size DVS training models were provided good detail and representation of the spatial distances. Geometrical details between the neighboring of DVS could be easily manipulated and explored from different angles. A graspable, patient-specific, 3D-printed model of DVS geometry could provide an improved understanding of the complex brain anatomy. These models have various benefits such as the ability to adjust properties, to convert two-dimension images of the patient into three-dimension images, to have different color options, and to be economical. Neuroanatomy experts can model such as the reliability and validity of the designed models, enhance patient satisfaction with improved clinical examination, and demonstrate clinical interventions by simulation; thus, they teach neuroanatomy training with effective teaching styles.
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Affiliation(s)
- Asli Beril Karakas
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Govsa
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey.
- Department of Anatomy, Faculty of Medicine, Ege University, TR-35100, Izmir, Turkey.
| | - Mehmet Asım Ozer
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Cenk Eraslan
- Department of Radiology Faculty of Medicine, Ege University, Izmir, Turkey
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Meineri M, Qua-Hiansen J, Garijo JM, Ansari B, Ruggeri GM, Ender J, Mashari A. Evaluation of a Patient-Specific, Low-Cost, 3-Dimensional-Printed Transesophageal Echocardiography Human Heart Phantom. J Cardiothorac Vasc Anesth 2020; 35:208-215. [PMID: 32732098 DOI: 10.1053/j.jvca.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Currently available 3-dimensional (3D) modeling and printing techniques allow for the creation of patient-specific models based on 3D medical imaging data. The authors hypothesized that a low-cost, patient-specific, cardiac computed tomography-based phantom, created using desktop 3D printing and casting, would have comparable image quality, accuracy, and usability to an existing commercially available echocardiographic phantom. DESIGN Blinded comparative study. SETTING Simulation laboratory at a single academic institution. PARTICIPANTS Voluntary cardiac anesthesiologists at a single academic institution. INTERVENTIONS Stage 1 of the study consisted of an online questionnaire in which a set of basic transesophageal echocardiography (TEE) views obtained from the 3D printed phantom and commercial phantom were presented to participants, who had to identify the views and evaluate their fidelity to clinical images on a Likert scale. In stage 2, participants performed an unblinded basic TEE examination on both phantoms. MEASUREMENTS AND MAIN RESULTS The time needed to acquire each basic view was recorded. Overall usability of the phantoms was assessed through a questionnaire. The participants could recognize most of the views. Fidelity ratings for both phantoms were similar (p < 0.05), with the exception of a midesophageal 2-chamber view that was observed better on the 3D printed phantom. The time required to obtain the views was shorter for the 3D printed phantom, although not statistically significant for most views. The overall user experience was better for the 3D phantom for all categories examined (p < 0.05). CONCLUSIONS The study suggested that a 3D-printed TEE phantom is comparable with the commercially available one with good usability.
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Affiliation(s)
- Massimiliano Meineri
- Department of Anesthesiology and Intensive Care, Herzzentrum Leipzig, Leipzig, Germany.
| | - Joshua Qua-Hiansen
- Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jacobo Moreno Garijo
- Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Ansari
- Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Giulia Maria Ruggeri
- Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Joerg Ender
- Department of Anesthesiology and Intensive Care, Herzzentrum Leipzig, Leipzig, Germany
| | - Azad Mashari
- Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
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18
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Wilk R, Likus W, Hudecki A, Syguła M, Różycka-Nechoritis A, Nechoritis K. What would you like to print? Students' opinions on the use of 3D printing technology in medicine. PLoS One 2020; 15:e0230851. [PMID: 32240212 PMCID: PMC7117709 DOI: 10.1371/journal.pone.0230851] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/10/2020] [Indexed: 02/08/2023] Open
Abstract
Background Recent advances in 3D printing technology, and biomaterials are revolutionizing medicine. The beneficiaries of this technology are primarily patients, but also students of medical faculties. Taking into account that not all students have full, direct access to the latest advances in additive technologies, we surveyed their opinion on 3D printing and education in this area. The research aimed to determine what knowledge about the use of 3D printing technology in medicine, do students of medical faculties have. Methods The research was carried out in the form of a questionnaire among 430 students of the Medical University of Silesia in Katowice (Poland) representing various fields of medicine and health sciences. The questions included in the survey analyzed the knowledge of the respondents for 3D printing technology and the opportunities it creates in medicine. Results The results indicate that students do have knowledge about 3D printing obtained mainly from the internet. They would be happy to deepen their knowledge at specialized courses in this field. Students appreciated the value of 3D printing in order to obtain accurate anatomical models, helpful in learning. However, they do not consider the possibility of complete abandonment of human cadavers in the anatomy classes. Their knowledge includes basic information about current applications of 3D printing in medicine, but not in all areas. However, they have no ethical doubts regarding the use of 3D printing in any form. The vast majority of students deemed it necessary to incorporate information regarding 3D printing technology into the curriculum of different medical majors. Conclusion This research is the first of its kind, which allows for probing students' knowledge about the additive technologies in medicine. Medical education should be extended to include issues related to the use of 3D printing for medical applications.
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Affiliation(s)
- Renata Wilk
- Department of Anatomy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Wirginia Likus
- Department of Anatomy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
- * E-mail: ,
| | - Andrzej Hudecki
- Łukasiewicz Research Network–Institute of Non-Ferrous Metals, Gliwice, Poland
| | - Marita Syguła
- Department of Anatomy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Konstantinos Nechoritis
- Department of Anatomy, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Giugno L, Faccini A, Carminati M. Percutaneous Pulmonary Valve Implantation. Korean Circ J 2020; 50:302-316. [PMID: 32157831 DOI: 10.4070/kcj.2019.0291.pmid:32157831;pmcid:pmc7067602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/22/2019] [Indexed: 05/23/2023] Open
Abstract
Percutaneous pulmonary valve implantation (PPVI) is recognized as a feasible and low risk alternative to surgery to treat dysfunctional right ventricular outflow tract (RVOT) in usually pluri-operated patients. Evolving technology allowed to develop different kind of prosthesis and to go from an initial treatment exclusively of stenotic conduit to an actual approach extended also to wide native RVOT. The Melody transcatheter pulmonary valve (TPV) and the Edwards Sapien valve are nowadays the most commonly implanted prostheses. However, other devices have been developed to treat large RVOT (i.e., the Venus p-valve, the Medtronic Harmony TPV, the Alterra Adaptive Prestent, and the Pulsta valve). Indications for PPVI are the same as for surgical interventions on pulmonary valve, with limits related to the maximum diameter of the available percutaneous prosthesis. Therefore, an accurate preoperative evaluation is of paramount importance to select patients who could benefit from this procedure. The overall periprocedural mortality incidence is around 1.4%, while freedom from RVOT reintervention ranges from 100% at 4 months to 70% at 70 months, according to the different published studies.
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Affiliation(s)
- Luca Giugno
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessia Faccini
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
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20
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Gardin C, Ferroni L, Latremouille C, Chachques JC, Mitrečić D, Zavan B. Recent Applications of Three Dimensional Printing in Cardiovascular Medicine. Cells 2020; 9:E742. [PMID: 32192232 PMCID: PMC7140676 DOI: 10.3390/cells9030742] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/20/2022] Open
Abstract
Three dimensional (3D) printing, which consists in the conversion of digital images into a 3D physical model, is a promising and versatile field that, over the last decade, has experienced a rapid development in medicine. Cardiovascular medicine, in particular, is one of the fastest growing area for medical 3D printing. In this review, we firstly describe the major steps and the most common technologies used in the 3D printing process, then we present current applications of 3D printing with relevance to the cardiovascular field. The technology is more frequently used for the creation of anatomical 3D models useful for teaching, training, and procedural planning of complex surgical cases, as well as for facilitating communication with patients and their families. However, the most attractive and novel application of 3D printing in the last years is bioprinting, which holds the great potential to solve the ever-increasing crisis of organ shortage. In this review, we then present some of the 3D bioprinting strategies used for fabricating fully functional cardiovascular tissues, including myocardium, heart tissue patches, and heart valves. The implications of 3D bioprinting in drug discovery, development, and delivery systems are also briefly discussed, in terms of in vitro cardiovascular drug toxicity. Finally, we describe some applications of 3D printing in the development and testing of cardiovascular medical devices, and the current regulatory frameworks that apply to manufacturing and commercialization of 3D printed products.
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Affiliation(s)
- Chiara Gardin
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola (RA), Italy; (C.G.); (L.F.)
- Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Letizia Ferroni
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola (RA), Italy; (C.G.); (L.F.)
- Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Christian Latremouille
- Department of Cardiac Surgery Pompidou Hospital, Laboratory of Biosurgical Research, Carpentier Foundation, University Paris Descartes, 75105 Paris, France; (C.L.); (J.C.C.)
| | - Juan Carlos Chachques
- Department of Cardiac Surgery Pompidou Hospital, Laboratory of Biosurgical Research, Carpentier Foundation, University Paris Descartes, 75105 Paris, France; (C.L.); (J.C.C.)
| | - Dinko Mitrečić
- Laboratory for Stem Cells, Croatian Institute for Brain Research, School of Medicine University of Zagreb, Šalata 12, 10 000 Zagreb, Croatia;
| | - Barbara Zavan
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola (RA), Italy; (C.G.); (L.F.)
- Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 70, 44121 Ferrara, Italy
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21
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Pumacayo-Cárdenas S, Arias-Vela G, Quea-Pinto E. Impresión 3D de rara patología congénita de aorta y vasos supraaórticos. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Advances in fetal echocardiography: myocardial deformation analysis, cardiac MRI and three-dimensional printing. Curr Opin Cardiol 2020; 34:35-40. [PMID: 30444761 DOI: 10.1097/hco.0000000000000584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Advances in ultrasound technology have led to new ways of evaluating cardiac function and structure, including myocardial deformation imaging (strain and strain rate), cardiac MRI and three-dimensional (3D) printing. As ultrasound technology has improved, it has become possible to use these modalities to evaluate the fetal heart. This article will review some of the more recent developments in applying these techniques to the evaluation of fetal cardiac structure and function. RECENT FINDINGS Myocardial deformation analyses have led to the establishment of normative values for strain and strain rate in the fetal heart and have also been used to evaluate fetal heart function in both fetal disease states and maternal disease states. Technological advances in MRI technology, 3D imaging and 3D printing have opened up new methods of evaluating fetal structural heart disease. SUMMARY A deeper understanding of the subtleties of myocardial dysfunction in various fetal and maternal disease states may elucidate the pathophysiology involved and lead to new treatment and/or counseling paradigms that may ultimately affect outcome. Similarly, the ability to image the fetal heart in new ways, including fetal MRI and 3D printing, could potentially change fetal counseling techniques and prenatal planning.
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Giugno L, Faccini A, Carminati M. Percutaneous Pulmonary Valve Implantation. Korean Circ J 2020; 50:302-316. [PMID: 32157831 PMCID: PMC7067602 DOI: 10.4070/kcj.2019.0291] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/22/2019] [Indexed: 01/09/2023] Open
Abstract
Percutaneous pulmonary valve implantation (PPVI) is recognized as a feasible and low risk alternative to surgery to treat dysfunctional right ventricular outflow tract (RVOT) in usually pluri-operated patients. Evolving technology allowed to develop different kind of prosthesis and to go from an initial treatment exclusively of stenotic conduit to an actual approach extended also to wide native RVOT. The Melody transcatheter pulmonary valve (TPV) and the Edwards Sapien valve are nowadays the most commonly implanted prostheses. However, other devices have been developed to treat large RVOT (i.e., the Venus p-valve, the Medtronic Harmony TPV, the Alterra Adaptive Prestent, and the Pulsta valve). Indications for PPVI are the same as for surgical interventions on pulmonary valve, with limits related to the maximum diameter of the available percutaneous prosthesis. Therefore, an accurate preoperative evaluation is of paramount importance to select patients who could benefit from this procedure. The overall periprocedural mortality incidence is around 1.4%, while freedom from RVOT reintervention ranges from 100% at 4 months to 70% at 70 months, according to the different published studies.
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Affiliation(s)
- Luca Giugno
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessia Faccini
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
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Dhavalikar P, Lan Z, Kar R, Salhadar K, Gaharwar AK, Cosgriff-Hernandez E. Biomedical Applications of Additive Manufacturing. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00040-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Lv Y, Liu Z, Huang J, Yu J, Dong Y, Wang J. LncRNA nuclear-enriched abundant transcript 1 regulates hypoxia-evoked apoptosis and autophagy via mediation of microRNA-181b. Mol Cell Biochem 2019; 464:193-203. [PMID: 31853799 DOI: 10.1007/s11010-019-03660-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/16/2019] [Indexed: 12/22/2022]
Abstract
Nuclear-enriched abundant transcript 1 (NEAT1), a vital long noncoding RNA (lncRNA), exhibits the functions in disparate cancers. Nevertheless, the influences of NEAT1 in congenital heart disease (CHD) remain unreported. The research delves into whether NEAT1 affects H9c2 cells apoptosis and autophagy under the hypoxia condition. Overexpressed NEAT1 vector was transfected into H9c2 cells; then, functions of NEAT1 in cell viability, apoptosis, autophagy, PI3K/AKT/mTOR and JAK1/STAT3 pathways were detected in H9c2 cells under hypoxia condition. Expression of NEAT1 and miR-181b in hypoxia and blood samples from CHD was evaluated. After miR-181b inhibitor transfection, functions of miR-181b repression in the above-mentioned cell behavior and PI3K/AKT/mTOR and JAK1/STAT3 pathways were reassessed. Overexpressed NEAT1 clearly allayed hypoxia-triggered H9c2 cells apoptosis and autophagy. The decreased NEAT1 and miR-181b were showcased in hypoxia and blood samples from CHD; meanwhile, elevated miR-181b evoked by overexpressed NEAT1 was observed in hypoxia-managed H9c2 cells. More importantly, miR-181b inhibition obviously overturned the influences of NEAT1 in hypoxia-affected H9c2 cells apoptosis and autophagy. Besides, overexpressed NEAT1 facilitated PI3K/AKT/mTOR and JAK1/STAT3 activations via enhancing miR-181b. The research exposed that NEAT1 eased hypoxia-triggered H9c2 cells apoptosis and autophagy by expediting PI3K/AKT/mTOR and JAK1/STAT3 pathways via elevating miR-181b.
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Affiliation(s)
- Ying Lv
- Department of Cardiovascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Zhaoming Liu
- Department of Pediatric Surgery, Shijiazhuang Maternity & Child Healthcare Hospital, No. 9 Jianguo Road, Shijiazhuang, 050051, Hebei, China
| | - Jiancheng Huang
- Department of Cardiovascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Jie Yu
- Department of Cardiovascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Yanbo Dong
- Department of Cardiovascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Jun Wang
- Department of Cardiovascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, China.
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Bartel T, Müller S. 3-Dimensional Printing in Personalized Interventional Cardiology and Cardiac Surgery. JACC Case Rep 2019; 1:538-539. [PMID: 34316873 PMCID: PMC8288587 DOI: 10.1016/j.jaccas.2019.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas Bartel
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Dubai, United Arab Emirates
| | - Silvana Müller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
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27
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Han F, Co-Vu J, Lopez-Colon D, Forder J, Bleiweis M, Reyes K, DeGroff C, Chandran A. Impact of 3D Printouts in Optimizing Surgical Results for Complex Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2019; 10:533-538. [PMID: 31496399 DOI: 10.1177/2150135119852316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Planning corrective and palliative surgery for patients who have complex congenital heart disease often relies on the assessment of cardiac anatomy using two-dimensional noninvasive cardiac imaging modalities (echocardiography, cardiac magnetic resonance imaging, and computed tomography scan). Advances in cardiac noninvasive imaging now include the use of three-dimensional (3D) reconstruction tools that produce 3D images and 3D printouts. There is scant evidence available in the literature as to what effect the availability of 3D printouts of complex congenital heart defects has on surgical outcomes. Surgical outcomes of study subjects with a 3D cardiac printout available and their paired control subject without a 3D cardiac printout available were compared. We found a trend toward shorter surgical times in the study group who had the benefit of 3D models, but no statistical significance was found for bypass time, cross-clamp time, total time, length of stay, or respiratory support. These preliminary results support the proposal that 3D modeling be made readily available to congenital cardiac surgery teams, for use in patients with the most complex congenital heart disease.
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Affiliation(s)
- Frank Han
- Department of Pediatric Cardiology, Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Jennifer Co-Vu
- Department of Pediatric Cardiology, Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Dalia Lopez-Colon
- Department of Pediatric Cardiology, Congenital Heart Center, University of Florida, Gainesville, FL, USA.,Department of Chemistry, Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - John Forder
- Department of Radiology, Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Mark Bleiweis
- Department of Pediatric Congenital Heart Surgery, Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Karl Reyes
- Department of Pediatric Congenital Heart Surgery, Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Curt DeGroff
- Department of Pediatric Cardiology, Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Arun Chandran
- Department of Pediatric Cardiology, Congenital Heart Center, University of Florida, Gainesville, FL, USA
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Burkhardt BEU, Brown NK, Carberry JE, Velasco Forte MN, Byrne N, Greil G, Hussain T, Tandon A. Creating three dimensional models of the right ventricular outflow tract: influence of contrast, sequence, operator, and threshold. Int J Cardiovasc Imaging 2019; 35:2067-2076. [PMID: 31203535 DOI: 10.1007/s10554-019-01646-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Abstract
The use of 3D printed models of the right ventricular outflow tract (RVOT) for surgical and interventional planning is growing and often requires image segmentation of cardiac magnetic resonance (CMR) images. Segmentation results may vary based on contrast, image sequence, signal threshold chosen by the operator, and manual post-processing. The purpose of this study was to determine potential biases and post-processing errors in image segmentation to enable informed decisions. Models of the RVOT and pulmonary arteries from twelve patients who had contrast enhanced CMR angiography with gadopentetate dimeglumine (GPD), gadofosveset trisodium (GFT), and a post-GFT inversion-recovery (IR) whole heart sequence were segmented, trimmed, and aligned by three operators. Geometric agreement and minimal RVOT diameters were compared between sequences and operators. To determine the contribution of threshold, interoperator variability was compared between models created by the same two operators using the same versus different thresholds. Geometric agreement by Dice between objects was high (intraoperator: 0.89-0.95; interoperator: 0.95-0.97), without differences between sequences. Minimal RVOT diameters differed on average by - 1.9 to - 1.3 mm (intraoperator) and by 0.4 to 1.4 mm (interoperator). The contribution of threshold to interoperator geometric agreement was not significant (same threshold: 0.96 ± 0.06, different threshold: 0.93 ± 0.05; p = 0.181), but minimal RVOT diameters were more variable with different versus constant thresholds (- 9.12% vs. 2.42%; p < 0.05). Thresholding does not significantly change interoperator variability for geometric agreement, but does for minimal RVOT diameter. Minimal RVOT diameters showed clinically relevant variation within and between operators.
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Affiliation(s)
- Barbara E U Burkhardt
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland.
| | - Nicholas K Brown
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jaclyn E Carberry
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | - Nicholas Byrne
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Gerald Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Animesh Tandon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Bramlet M, Olivieri L, Farooqi K, Ripley B, Coakley M. Impact of Three-Dimensional Printing on the Study and Treatment of Congenital Heart Disease. Circ Res 2019; 120:904-907. [PMID: 28302738 DOI: 10.1161/circresaha.116.310546] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew Bramlet
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.).
| | - Laura Olivieri
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
| | - Kanwal Farooqi
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
| | - Beth Ripley
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
| | - Meghan Coakley
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
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Garner KH, Singla DK. 3D modeling: a future of cardiovascular medicine. Can J Physiol Pharmacol 2019; 97:277-286. [DOI: 10.1139/cjpp-2018-0472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiovascular disease resulting from atypical cardiac structures continues to be a leading health concern despite advancements in diagnostic imaging and surgical techniques. However, the ability to visualize spatial relationships using current technologies remains a challenge. Therefore, 3D modeling has gained significant interest to understand complex and atypical cardiovascular disorders. Moreover, 3D modeling can be personalized and patient-specific. 3D models have been demonstrated to aid surgical planning and simulation, enhance communication among surgeons and patients, optimize medical device design, and can be used as a potential teaching tool in medical schools. In this review, we discuss the key components needed to generate cardiac 3D models. We highlight prevalent structural conditions that have utilized 3D modeling in pre-operative planning. Furthermore, we discuss the current limitations of routine use of 3D models in the clinic as well as future directions for utilization of this technology in the cardiovascular field.
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Affiliation(s)
- Kaley H. Garner
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Dinender K. Singla
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
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31
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Shan L, Kadhum AAH, Al-Furjan MSH, Weng W, Gong Y, Cheng K, Zhou M, Dong L, Chen G, Takriff MS, Sulong AB. In Situ Controlled Surface Microstructure of 3D Printed Ti Alloy to Promote Its Osteointegration. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E815. [PMID: 30857349 PMCID: PMC6427748 DOI: 10.3390/ma12050815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 12/21/2022]
Abstract
It is well known that three-dimensional (3D) printing is an emerging technology used to produce customized implants and surface characteristics of implants, strongly deciding their osseointegration ability. In this study, Ti alloy microspheres were printed under selected rational printing parameters in order to tailor the surface micro-characteristics of the printed implants during additive manufacturing by an in situ, controlled way. The laser path and hatching space were responsible for the appearance of the stripy structure (S), while the bulbous structure (B) and bulbous⁻stripy composite surface (BS) were determined by contour scanning. A nano-sized structure could be superposed by hydrothermal treatment. The cytocompatibility was evaluated by culturing Mouse calvaria-derived preosteoblastic cells (MC3T3-E1). The results showed that three typical microstructured surfaces, S, B, and BS, could be achieved by varying the 3D printing parameters. Moreover, the osteogenic differentiation potential of the S, B, and BS surfaces could be significantly enhanced, and the addition of nano-sized structures could be further improved. The BS surface with nano-sized structure demonstrated the optimum osteogenic differentiation potential. The present research demonstrated an in situ, controlled way to tailor and optimize the surface structures in micro-size during the 3D printing process for an implant with higher osseointegration ability.
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Affiliation(s)
- Lijun Shan
- Department of Chemical & Process Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia, Bangi, Selangor 43600, Malaysia.
| | - Abdul Amir H Kadhum
- Department of Chemical & Process Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia, Bangi, Selangor 43600, Malaysia.
| | - M S H Al-Furjan
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou 310018, China.
- School of Materials Science and Engineering, State Key Laboratory of Silicon Materials, Zhejiang University, Hangzhou 310027, China.
| | - Wenjian Weng
- School of Materials Science and Engineering, State Key Laboratory of Silicon Materials, Zhejiang University, Hangzhou 310027, China.
| | - Youping Gong
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou 310018, China.
| | - Kui Cheng
- School of Materials Science and Engineering, State Key Laboratory of Silicon Materials, Zhejiang University, Hangzhou 310027, China.
| | - Maoying Zhou
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou 310018, China.
| | - Lingqing Dong
- School of Materials Science and Engineering, State Key Laboratory of Silicon Materials, Zhejiang University, Hangzhou 310027, China.
| | - Guojin Chen
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou 310018, China.
| | - Mohd S Takriff
- Research Center for Sustainable Process Technology (CESPRO), Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi, Selangor 43600, Malaysia.
| | - Abu Bakar Sulong
- Department of Mechanical and Materials Engineering, Universiti Kebangsaan Malaysia, Selangor 43600, Malaysia.
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Bateman MG, Durfee WK, Iles TL, Martin CM, Liao K, Erdman AG, Iaizzo PA. Cardiac patient-specific three-dimensional models as surgical planning tools. Surgery 2019; 167:259-263. [PMID: 30792012 DOI: 10.1016/j.surg.2018.11.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Three-dimensional printing is an additive manufacturing method that builds objects from digitally generated computational models. Core technologies behind three-dimensional printing are evolving rapidly with major advances in materials, resolution, and speed that enable greater realism and higher accuracy. These improvements have led to novel applications of these processes in the medical field. METHODS The process of going from a medical image data set (computed tomography, magnetic resonance imaging, ultrasound) to a physical three-dimensional print includes several steps that are described. Medical images originate from Digital Imaging and Communications in Medicine files or data sets, the current standard for storing and transmitting medical images. Via Digital Imaging and Communications in Medicine manipulation software packages, a segmentation process, and manual intervention by an expert user, three-dimensional digital and printed models can be constructed in great detail. RESULTS Cardiovascular medicine is one of the fastest growing applications for medical three-dimensional printing. The technology is more frequently being used for patient and clinician education, preprocedural planning, and medical device design and prototyping. We report on three case studies, describing how our three-dimensional printing has contributed to the care of cardiac patients at the University of Minnesota. CONCLUSION Medical applications of computational three-dimensional modeling and printing are already extensive and growing rapidly and are routinely used for visualizing complex anatomies from patient imaging files to plan surgeries and create surgical simulators. Studies are needed to determine whether three-dimensional printed models are cost effective and can consistently improve clinical outcomes before they become part of routine clinical practice.
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Affiliation(s)
- Michael G Bateman
- Department of Surgery, University of Minnesota, Minneapolis, MN; Visible Heart Laboratories, University of Minnesota, Minneapolis, MN
| | - William K Durfee
- Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN
| | - Tinen L Iles
- Department of Surgery, University of Minnesota, Minneapolis, MN; Visible Heart Laboratories, University of Minnesota, Minneapolis, MN
| | - Cindy M Martin
- Department of Cardiology, University of Minnesota, Minneapolis, MN
| | - Kenneth Liao
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Arthur G Erdman
- Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN
| | - Paul A Iaizzo
- Department of Surgery, University of Minnesota, Minneapolis, MN; Visible Heart Laboratories, University of Minnesota, Minneapolis, MN; Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN.
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Tuncay V, van Ooijen PMA. 3D printing for heart valve disease: a systematic review. Eur Radiol Exp 2019; 3:9. [PMID: 30771098 PMCID: PMC6377684 DOI: 10.1186/s41747-018-0083-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/27/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Current developments showed a fast-increasing implementation and use of three-dimensional (3D) printing in medical applications. Our aim was to review the literature regarding the application of 3D printing to cardiac valve disease. METHODS A PubMed search for publications in English with the terms "3D printing" AND "cardiac valve", performed in January 2018, resulted in 64 items. After the analysis of the abstract and text, 27 remained related to the topic. From the references of these 27 papers, 7 papers were added resulting in a total of 34 papers. Of these, 5 were review papers, thus reducing the papers taken into consideration to 29. RESULTS The 29 papers showed that about a decade ago, the interest in 3D printing for this application area was emerging, but only in the past 2 to 3 years it really gained interest. Computed tomography is the most common imaging modality taken into consideration (62%), followed by ultrasound (28%), computer-generated models (computer-aided design) (7%), and magnetic resonance imaging (3%). Acrylonitrile butadiene styrene (4/14, 29%) and TangoPlus FullCure 930 (5/14, 36%) are the most used printing materials. Stereolithography (40%) and fused deposition modeling (30%) are the preferred printing techniques, while PolyJet (25%) and laser sintering (4%) are used in a minority of cases. The reported time ranges from 30 min to 3 days. The most reported application area is preoperative planning (63%), followed by training (19%), device testing (11%), and retrospective procedure evaluation (7%). CONCLUSIONS In most cases, CT datasets are used and models are printed for preoperative planning.
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Affiliation(s)
- Volkan Tuncay
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
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34
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Haleem A, Javaid M, Saxena A. Additive manufacturing applications in cardiology: A review. Egypt Heart J 2018; 70:433-441. [PMID: 30591768 PMCID: PMC6303383 DOI: 10.1016/j.ehj.2018.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Additive manufacturing (AM) has emerged as a serious planning, strategy, and education tool in cardiovascular medicine. This review describes and illustrates the application, development and associated limitation of additive manufacturing in the field of cardiology by studying research papers on AM in medicine/cardiology. METHODS Relevant research papers till August 2018 were identified through Scopus and examined for strength, benefits, limitation, contribution and future potential of AM. With the help of the existing literature & bibliometric analysis, different applications of AM in cardiology are investigated. RESULTS AM creates an accurate three-dimensional anatomical model to explain, understand and prepare for complex medical procedures. A prior study of patient's 3D heart model can help doctors understand the anatomy of the individual patient, which may also be used create training modules for institutions and surgeons for medical training. CONCLUSION AM has the potential to be of immense help to the cardiologists and cardiac surgeons for intervention and surgical planning, monitoring and analysis. Additive manufacturing creates a 3D model of the heart of a specific patient in lesser time and cost. This technology is used to create and analyse 3D model before starting actual surgery on the patient. It can improve the treatment outcomes for patients, besides saving their lives. Paper summarised additive manufacturing applications particularly in the area of cardiology, especially manufacturing of a patient-specific artificial heart or its component. Model printed by this technology reduces risk, improves the quality of diagnosis and preoperative planning and also enhanced team communication. In cardiology, patient data of heart varies from patient to patient, so AM technologies efficiently produce 3D models, through converting the predesigned virtual model into a tangible object. Companies explore additive manufacturing for commercial medical applications.
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Affiliation(s)
- Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Mohd Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Anil Saxena
- Cardiac Pacing & Electrophysiology, Fortis Escorts, New Delhi, India
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Riggs KW, Dsouza G, Broderick JT, Moore RA, Morales DLS. 3D-printed models optimize preoperative planning for pediatric cardiac tumor debulking. Transl Pediatr 2018; 7:196-202. [PMID: 30159245 PMCID: PMC6087832 DOI: 10.21037/tp.2018.06.01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study reports the first known application of 3-dimensional (3D) printing of cardiac tumors to preoperatively plan debulking in infants. 3D-printed cardiac tumor models were used to identify the spacial relationship between the tumors and coronary arteries as well as understand the depth and infiltration of the tumors. METHODS Physical 3D cardiac tumor models of two children were obtained using medical imaging, image 3D rendering and modeling, and 3D printing. The hearts were 3D-printed in an opaque material while the tumors were made transparent to allow optimal visualization of the cardiovascular anatomy within the tumor. The surgical team used these models to plan exposure of the tumor, as well as, the extent of debulking. RESULTS Patient 1 had a cardiac tumor arising from the anterior surface of the right ventricle causing significant right ventricular outflow tract obstruction and involving the right and left coronary artery courses. Patient 2 had a cardiac tumor arising from the left ventricle and extending beyond the left atrium compressing the airway preventing extubation, and surrounding the left coronary artery system. In both patients, 3D-printed models were used to maximize debulking and avoid injury to the coronaries. CONCLUSIONS 3D-printed cardiac tumor and anatomic models were effectively used to preoperatively plan two pediatric tumor debulkings. Both patients had tumors that were integrally involved with the coronary arteries. The 3D models helped devise a safe surgical strategy for maximal tumor debulking while protecting the coronary circulation.
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Affiliation(s)
- Kyle W Riggs
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gavin Dsouza
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John T Broderick
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ryan A Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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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: 0.4] [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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Abstract
PURPOSE OF REVIEW To define the magnitude of problems faced by patients with adult congenital heart disease (ACHD) and to identify unmet needs for this population. RECENT FINDINGS The ACHD population is estimated to include more than 1 million people in the United States and continues to grow at a steady rate. Owing to the decline in early mortality in this group, modern medicine is now faced by the long-term complications associated with congenital heart disease such as chronic heart failure, increased endocarditis risk, elevated burden of arrhythmias, pulmonary hypertension, valvular dysfunction, and pregnancy. SUMMARY Increasing access to ACHD care, evolution of imaging techniques and transcatheter technology and continued efforts at quality improvement will be key to successfully facing the challenges that are a product of the astounding success of pediatric cardiac surgery.
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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: 3.7] [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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Anwar S, Singh GK, Miller J, Sharma M, Manning P, Billadello JJ, Eghtesady P, Woodard PK. 3D Printing is a Transformative Technology in Congenital Heart Disease. JACC Basic Transl Sci 2018; 3:294-312. [PMID: 30062215 PMCID: PMC6059001 DOI: 10.1016/j.jacbts.2017.10.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 12/26/2022]
Abstract
Survival in congenital heart disease has steadily improved since 1938, when Dr. Robert Gross successfully ligated for the first time a patent ductus arteriosus in a 7-year-old child. To continue the gains made over the past 80 years, transformative changes with broad impact are needed in management of congenital heart disease. Three-dimensional printing is an emerging technology that is fundamentally affecting patient care, research, trainee education, and interactions among medical teams, patients, and caregivers. This paper first reviews key clinical cases where the technology has affected patient care. It then discusses 3-dimensional printing in trainee education. Thereafter, the role of this technology in communication with multidisciplinary teams, patients, and caregivers is described. Finally, the paper reviews translational technologies on the horizon that promise to take this nascent field even further.
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Key Words
- 3D printing
- 3D, three-dimensional
- ACHD, adults with congenital heart disease
- APC, aortopulmonary collaterals
- ASD, atrial septal defect
- CHD, congenital heart disease
- CT, computed tomography
- DORV, double outlet right ventricle
- MAPCAs, multiple aortopulmonary collaterals
- MRI, magnetic resonance imaging
- OR, operating room
- VSD, ventricular septal defect
- cardiac imaging
- cardiothoracic surgery
- congenital heart disease
- simulation
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Affiliation(s)
- Shafkat Anwar
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Gautam K. Singh
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jacob Miller
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Monica Sharma
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Peter Manning
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph J. Billadello
- Division of Cardiovascular Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Pirooz Eghtesady
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Pamela K. Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Miller JR, Lancaster TS, Callahan C, Abarbanell AM, Eghtesady P. An overview of mechanical circulatory support in single-ventricle patients. Transl Pediatr 2018; 7:151-161. [PMID: 29770296 PMCID: PMC5938256 DOI: 10.21037/tp.2018.03.03] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The population of people with a single-ventricle is continually increasing due to improvements across the spectrum of medical care. Unfortunately, a proportion of these patients will develop heart failure. Often, for these patients, mechanical circulatory support (MCS) represents the only available treatment option. While single-ventricle patients currently represent a small proportion of the total number of patients who receive MCS, as the single-ventricle patient population increases, this number will increase as well. Outcomes for these complex single-ventricle patients who require MCS has begun to be evaluated. When considering the entire population, survival to hospital discharge is 30-50%, though this must be considered with the significant heterogeneity of the single-ventricle patient population. Patients with a single-ventricle have unique anatomy, mechanisms of failure, indications for MCS and the type of support utilized. This has made the interpretation and the generalizability of the limited available data difficult. It is likely that some subsets will have a significantly worse prognosis and others a better one. Unfortunately, with these limited data, indications of a favorable or poor outcome have not yet been elucidated. Though currently, a database has been constructed to address this issue. While the outcomes for these complex patients is unclear, at least in some situations, they are poor. However, significant advances may provide improvements going forward, including new devices, computer simulations and 3D printed models. The most important factor, however, will be the increased experience gained by the heart failure team to improve patient selection, timing, device and configuration selection and operative approach.
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Affiliation(s)
- Jacob R Miller
- Division of Cardiothoracic Surgery, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy S Lancaster
- Division of Cardiothoracic Surgery, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO, USA
| | - Connor Callahan
- Department of Surgery, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO, USA
| | - Aaron M Abarbanell
- Section of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital/Washington University School of Medicine, St. Louis, MO, USA
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital/Washington University School of Medicine, St. Louis, MO, USA
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What topics caught your attention in 2017? Neth Heart J 2018; 26:175-176. [PMID: 29488169 PMCID: PMC5876175 DOI: 10.1007/s12471-018-1093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Recent Advances and Trends in Pediatric Cardiac Imaging. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:9. [DOI: 10.1007/s11936-018-0599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hadeed K, Acar P, Dulac Y, Cuttone F, Alacoque X, Karsenty C. Cardiac 3D printing for better understanding of congenital heart disease. Arch Cardiovasc Dis 2017; 111:1-4. [PMID: 29158165 DOI: 10.1016/j.acvd.2017.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Khaled Hadeed
- Pediatric and congenital cardiology, children hospital, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - Philippe Acar
- Pediatric and congenital cardiology, children hospital, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
| | - Yves Dulac
- Pediatric and congenital cardiology, children hospital, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - Fabio Cuttone
- Pediatric and congenital cardiology, children hospital, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - Xavier Alacoque
- Pediatric and congenital cardiology, children hospital, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - Clément Karsenty
- Pediatric and congenital cardiology, children hospital, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
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Zhu Y, Liu J, Wang L, Guan X, Luo Y, Geng J, Geng Q, Lin Y, Zhang L, Li X, Lu Y. Preliminary study of the application of transthoracic echocardiography-guided three-dimensional printing for the assessment of structural heart disease. Echocardiography 2017; 34:1903-1908. [PMID: 29067708 DOI: 10.1111/echo.13715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and diagnostic value of a preoperative transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) for the assessment of structural heart disease (SHD). METHODS Fourty-four patients underwent cardiac surgery at Tianjin Chest Hospital. The patients were preoperatively assessed using TTE-guided 3DPM, which was compared to conventional three-dimensional transthoracic echocardiography (3DTTE) along with direct intraoperative findings, which were considered the "gold standard." Twelve patients had SHD, including four with mitral prolapse, two with partial endocardial cushion defects, two with secondary atrial septal defects, two with rheumatic mitral stenosis, one with tetralogy of Fallot, and one with a ventricular septal defect (VSD). Thirty-two patients who did not have SHDs were designated as the negative control group. RESULTS The sensitivity and specificity of the TTE-guided 3DPM were greater than or equal to those of the 3DTTE. The P-value of the McNemar test of 3DTTE was >.05, which indicates that the difference was not statistically significant (Kappa = 0.745, P < .001). The P-value of the McNemar test of TTE-guided 3DPM was >.05, which indicates that the difference was not statistically significant (Kappa = 0.955, P < .001). A comparison of 3DTTE and TTE-guided 3DPM resulted in a P-value >.05, which indicates that the difference was not statistically significant (Kappa = 0.879, P < .001). TTE-guided 3DPM displayed the 3D structure of SHDs and cardiac lesions clearly and was consistent with the intra-operative findings. CONCLUSION Transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) provides essential information for preoperative evaluation and decision making for patients with SHDs.
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Affiliation(s)
- Yanbo Zhu
- Graduate School of Tianjin Medical University, Tianjin, China.,Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Jianshi Liu
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Lianqun Wang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Xin Guan
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Yongjuan Luo
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Jie Geng
- Cardiac Intensive Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Qingguo Geng
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Yunjia Lin
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Lixia Zhang
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Xixue Li
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
| | - Yaping Lu
- Department of Ultrasound, Tianjin Chest Hospital, Tianjin, China
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Abudayyeh I, Gordon B, Ansari MM, Jutzy K, Stoletniy L, Hilliard A. A practical guide to cardiovascular 3D printing in clinical practice: Overview and examples. J Interv Cardiol 2017; 31:375-383. [PMID: 28948646 DOI: 10.1111/joic.12446] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 12/23/2022] Open
Abstract
The advent of more advanced 3D image processing, reconstruction, and a variety of three-dimensional (3D) printing technologies using different materials has made rapid and fairly affordable anatomically accurate models much more achievable. These models show great promise in facilitating procedural and surgical planning for complex congenital and structural heart disease. Refinements in 3D printing technology lend itself to advanced applications in the fields of bio-printing, hemodynamic modeling, and implantable devices. As a novel technology with a large variability in software, processing tools and printing techniques, there is not a standardized method by which a clinician can go from an imaging data-set to a complete model. Furthermore, anatomy of interest and how the model is used can determine the most appropriate technology. In this over-view we discuss, from the standpoint of a clinical professional, image acquisition, processing, and segmentation by which a printable file is created. We then review the various printing technologies, advantages and disadvantages when printing the completed model file, and describe clinical scenarios where 3D printing can be utilized to address therapeutic challenges.
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Affiliation(s)
- Islam Abudayyeh
- Division of Cardiology, Interventional Cardiology, Loma Linda University Health, Loma Linda, California
| | - Brent Gordon
- Division of Pediatric Cardiology, Loma Linda University Health, Loma Linda, California
| | - Mohammad M Ansari
- Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Jutzy
- Division of Cardiology, Interventional Cardiology, Loma Linda University Health, Loma Linda, California
| | - Liset Stoletniy
- Division of Cardiology, Loma Linda University Health, Loma Linda, California
| | - Anthony Hilliard
- Division of Cardiology, Interventional Cardiology, Loma Linda University Health, Loma Linda, California
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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: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Voskuil M, Sievert H, Arslan F. Guidance of interventions in structural heart disease; three-dimensional techniques are here to stay. Neth Heart J 2017; 25:63-64. [PMID: 28097519 PMCID: PMC5260629 DOI: 10.1007/s12471-016-0945-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- M Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - F Arslan
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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