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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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Yahiro DS, Cruz MDP, Ribeiro BFC, Teixeira LM, de Oliveira MFRM, de Souza ALADAG, Torbey AFM, da Silveira JS, Mesquita CT. Impact of 3D Printing on Cardiac Surgery in Congenital Heart Diseases: A Systematic Review and Meta-Analysis. Arq Bras Cardiol 2024; 121:e20240430. [PMID: 39968976 PMCID: PMC11634304 DOI: 10.36660/abc.20240430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/13/2024] [Accepted: 10/16/2024] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND Congenital heart disease (CHD) poses significant challenges in surgical management due to the complexity of cardiac anatomy. Three-dimensional (3D) printing has emerged as a promising tool in preoperative planning, intraoperative guidance, and medical education for CHD surgeries. OBJECTIVES We aimed to systematically review the literature on the utilization and benefits of 3D printing technology in CHD surgical interventions. METHODS A systematic search was conducted across PubMed and EMBASE for studies published up to February of 2024. We included controlled and uncontrolled studies investigating the surgical role of 3D printing in CHD patients. We conducted a single-arm meta-analysis estimating the proportion of change in treatment planning due to the use of 3D printed-models. Moreover, studies that compared 3D printing to conventional care were included into the meta-analysis. A p-value < 0.05 was considered statistically significant. RESULTS A total of 21 studies met the inclusion criteria, comprising 444 patients undergoing CHD surgeries with 3D printing assistance. Preoperative planning aided by 3D models led to changing surgical decisions in 35 of 75 cases (51.8%; 95% CI 26.6-77.0%, I2=80.68%, p=0.001) and reduced total operative time in 22.25 minutes in favor of the 3D printing group (95%CI 49.95; 5.80 min, I2=0%, p=0.817) but without statistical significance. Albeit in a smaller sample, other endpoints (mechanical ventilation and ICU time) demonstrated some benefit from the technology but without statistical significance. CONCLUSIONS By providing personalized anatomical models, 3D printing may facilitate surgical planning and execution. More studies are needed to investigate the effects of 3D printing on reducing intervention, hospitalization, and mechanical ventilation times.
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Affiliation(s)
- Davi Shunji Yahiro
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
| | - Mariana de Paula Cruz
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
| | | | - Luiza Meireles Teixeira
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
| | | | | | | | | | - Claudio Tinoco Mesquita
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
- Pró-Cardíaco HospitalRio de JaneiroRJBrasilPró-Cardíaco Hospital, Rio de Janeiro, RJ – Brasil
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Isobe S, Katayama Y, Ozawa T, Fujii T. Intracardiac Three-Dimensional Image as Surgical Decision-Making Tool of Congenital Heart Disease. Pediatr Cardiol 2024; 45:351-360. [PMID: 38017199 DOI: 10.1007/s00246-023-03349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
This study aimed to evaluate the anatomical reproducibility of a preoperative intracardiac 3D image (IC image) created using computed tomography, and to investigate its usefulness as a surgical decision-making tool. Between 2012 and 2022, ventricular septal defect (VSD) patients, and double outlet right ventricle (DORV) or transposition of the great arteries (TGA) with pulmonary stenosis (PS) patients who underwent cardiac surgery and had preoperative computed tomography were enrolled. SYNAPSE VINCENT® (Fujifilm) was used to create an IC image which was analyzed retrospectively. In 14 VSD patients, the diagnostic consistency rate in the Soto classification with intraoperative findings was 100% (14/14) for IC image versus 64% (9/14) for transthoracic echocardiography (P = 0.04). The defect size showed a higher correlation coefficient with IC image (0.837, P = 0.001) than with transthoracic echocardiography (0.567, P = 0.034). In 11 DORV/TGA with PS patients, the diagnostic consistency rate in the Lev classification was 100% (9/9) for IC image versus 77% (7/9) for transthoracic echocardiography (P = 0.47). The secondary interventricular foramen (SVF)/left ventricular outflow tract (LVOT) ratio by IC image was significantly smaller in the biventricular-repair group (median 0.71, IQR 0.67-1.06) than in the univentricular-repair group (median 1.79, IQR 1.53-2.42) (P = 0.006). An IC image is useful as a surgical decision-making tool for simple VSDs and complex congenital heart diseases such as DORV or TGA with pulmonary stenosis. The SVF/LVOT ratio determined from the IC image may be a useful indicator for avoiding LVOT obstruction.
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Affiliation(s)
- Sho Isobe
- Division of Cardiovascular Surgery, Department of Surgery, Toho University Omori Medical Center, 6-11 Omori-Nishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Yuzo Katayama
- Division of Cardiovascular Surgery, Department of Surgery, Toho University Omori Medical Center, 6-11 Omori-Nishi Ota-Ku, Tokyo, 143-8541, Japan.
| | - Tsukasa Ozawa
- Division of Cardiovascular Surgery, Department of Surgery, Toho University Omori Medical Center, 6-11 Omori-Nishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Takeshiro Fujii
- Division of Cardiovascular Surgery, Department of Surgery, Toho University Omori Medical Center, 6-11 Omori-Nishi Ota-Ku, Tokyo, 143-8541, Japan
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Ryan JR, Ghosh R, Sturgeon G, Ali A, Arribas E, Braden E, Chadalavada S, Chepelev L, Decker S, Huang YH, Ionita C, Lee J, Liacouras P, Parthasarathy J, Ravi P, Sandelier M, Sommer K, Wake N, Rybicki F, Ballard D. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: pediatric congenital heart disease conditions. 3D Print Med 2024; 10:3. [PMID: 38282094 PMCID: PMC10823658 DOI: 10.1186/s41205-023-00199-3] [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: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The use of medical 3D printing (focusing on anatomical modeling) has continued to grow since the Radiological Society of North America's (RSNA) 3D Printing Special Interest Group (3DPSIG) released its initial guideline and appropriateness rating document in 2018. The 3DPSIG formed a focused writing group to provide updated appropriateness ratings for 3D printing anatomical models across a variety of congenital heart disease. Evidence-based- (where available) and expert-consensus-driven appropriateness ratings are provided for twenty-eight congenital heart lesion categories. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with pediatric congenital heart disease indications. Each study was vetted by the authors and strength of evidence was assessed according to published appropriateness ratings. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for pediatric congenital heart lesions. Recommendations are provided in accordance with strength of evidence of publications corresponding to each cardiac clinical scenario combined with expert opinion from members of the 3DPSIG. CONCLUSIONS This consensus appropriateness ratings document, created by the members of the RSNA 3DPSIG, provides a reference for clinical standards of 3D printing for pediatric congenital heart disease clinical scenarios.
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Affiliation(s)
- Justin R Ryan
- Webster Foundation 3D Innovations Lab, Rady Children's Hospital-San Diego, San Diego, CA, USA.
- Department of Neurological Surgery, UC San Diego Health, La Jolla, CA, USA.
| | - Reena Ghosh
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Greg Sturgeon
- Duke Children's Pediatric & Congenital Heart Center, Durham, NC, USA
| | - Arafat Ali
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elsa Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric Braden
- Arkansas Children's Hospital, Little Rock, AR, USA
| | - Seetharam Chadalavada
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Summer Decker
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
- Tampa General Hospital, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Ciprian Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Joonhyuk Lee
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Peter Liacouras
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael Sandelier
- Department of Radiology - Advanced Reality Lab, James A. Haley VA Hospital, Tampa, FL, USA
| | | | - Nicole Wake
- Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene, Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Frank Rybicki
- Department of Radiology, University of Arizona, Phoenix, AZ, USA
| | - David Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
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Sun Z, Silberstein J, Vaccarezza M. Cardiovascular Computed Tomography in the Diagnosis of Cardiovascular Disease: Beyond Lumen Assessment. J Cardiovasc Dev Dis 2024; 11:22. [PMID: 38248892 PMCID: PMC10816599 DOI: 10.3390/jcdd11010022] [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: 11/22/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Cardiovascular CT is being widely used in the diagnosis of cardiovascular disease due to the rapid technological advancements in CT scanning techniques. These advancements include the development of multi-slice CT, from early generation to the latest models, which has the capability of acquiring images with high spatial and temporal resolution. The recent emergence of photon-counting CT has further enhanced CT performance in clinical applications, providing improved spatial and contrast resolution. CT-derived fractional flow reserve is superior to standard CT-based anatomical assessment for the detection of lesion-specific myocardial ischemia. CT-derived 3D-printed patient-specific models are also superior to standard CT, offering advantages in terms of educational value, surgical planning, and the simulation of cardiovascular disease treatment, as well as enhancing doctor-patient communication. Three-dimensional visualization tools including virtual reality, augmented reality, and mixed reality are further advancing the clinical value of cardiovascular CT in cardiovascular disease. With the widespread use of artificial intelligence, machine learning, and deep learning in cardiovascular disease, the diagnostic performance of cardiovascular CT has significantly improved, with promising results being presented in terms of both disease diagnosis and prediction. This review article provides an overview of the applications of cardiovascular CT, covering its performance from the perspective of its diagnostic value based on traditional lumen assessment to the identification of vulnerable lesions for the prediction of disease outcomes with the use of these advanced technologies. The limitations and future prospects of these technologies are also discussed.
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Affiliation(s)
- Zhonghua Sun
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; (J.S.); (M.V.)
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA 6102, Australia
| | - Jenna Silberstein
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; (J.S.); (M.V.)
| | - Mauro Vaccarezza
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; (J.S.); (M.V.)
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA 6102, Australia
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Betancourt MC, Araújo C, Marín S, Buriticá W. The Quantitative Impact of Using 3D Printed Anatomical Models for Surgical Planning Optimization: Literature Review. 3D PRINTING AND ADDITIVE MANUFACTURING 2023; 10:1130-1139. [PMID: 37886412 PMCID: PMC10599434 DOI: 10.1089/3dp.2021.0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
3D printing has entered the medical field as a visualization tool that allows the manufacture of three-dimensional (3D) models that physically represent the anatomy of a patient in need of analysis to improve surgical results. This article analyzes the literature around reported study cases that make use of anatomical models for their surgical processes' planning, focusing on obtaining the quantitative results of each one of them. A search of case studies was carried out in the main medical databases such as PubMed, ScienceDirect, SpringerLink, among others; to obtain the most relevant results of the 56 selected articles, the information of each study was analyzed and categorized. These articles presented figures and data about the benefits that are considered more representative to measure the positive impact of this technology. These benefits are summarized in variables such as the decrease in surgical time, greater accuracy in the diagnosis of pathology, blood loss reduction, and decreasing operating room costs; owed to an improvement in the surgery planning. It was found that in all the cases analyzed there was an improvement in the surgical results related to these variables, which were summarized in macro figures that combine this improvement quantitatively. In the analyzed studies, it was evident that there is great potential in the use of 3D printing for presurgical planning, being as the results of these analyzed interventions were better when using this technology. In addition, it was found that the results obtained initially, before applying the inclusion and exclusion criteria, were mostly of a qualitative nature; expressing the perception of researchers regarding the positive use of this tool in the field and evidencing an opportunity for this research to focus on concrete and technical information to show in numerical terms the effectiveness of this tool, to demonstrate the cost-benefit that it has for the field.
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Peek JJ, Bakhuis W, Sadeghi AH, Veen KM, Roest AAW, Bruining N, van Walsum T, Hazekamp MG, Bogers AJJC. Optimized preoperative planning of double outlet right ventricle patients by 3D printing and virtual reality: a pilot study. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad072. [PMID: 37202357 PMCID: PMC10481772 DOI: 10.1093/icvts/ivad072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/23/2023] [Accepted: 05/17/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES In complex double outlet right ventricle (DORV) patients, the optimal surgical approach may be difficult to assess based on conventional 2-dimensional (2D) ultrasound (US) and computed tomography (CT) imaging. The aim of this study is to assess the added value of 3-dimensional (3D) printed and 3D virtual reality (3D-VR) models of the heart used for surgical planning in DORV patients, supplementary to the gold standard 2D imaging modalities. METHODS Five patients with different DORV subtypes and high-quality CT scans were selected retrospectively. 3D prints and 3D-VR models were created. Twelve congenital cardiac surgeons and paediatric cardiologists, from 3 different hospitals, were shown 2D-CT first, after which they assessed the 3D print and 3D-VR models in random order. After each imaging method, a questionnaire was filled in on the visibility of essential structures and the surgical plan. RESULTS Spatial relationships were generally better visualized using 3D methods (3D printing/3D-VR) than in 2D. The feasibility of ventricular septum defect patch closure could be determined best using 3D-VR reconstructions (3D-VR 92%, 3D print 66% and US/CT 46%, P < 0.01). The percentage of proposed surgical plans corresponding to the performed surgical approach was 66% for plans based on US/CT, 78% for plans based on 3D printing and 80% for plans based on 3D-VR visualization. CONCLUSIONS This study shows that both 3D printing and 3D-VR have additional value for cardiac surgeons and cardiologists over 2D imaging, because of better visualization of spatial relationships. As a result, the proposed surgical plans based on the 3D visualizations matched the actual performed surgery to a greater extent.
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Affiliation(s)
- Jette J Peek
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Wouter Bakhuis
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Amir H Sadeghi
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Nico Bruining
- Department of Clinical Epidemiology and Innovation (KEI), Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Theo van Walsum
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
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Sun Z, Zhao J, Leung E, Flandes-Iparraguirre M, Vernon M, Silberstein J, De-Juan-Pardo EM, Jansen S. Three-Dimensional Bioprinting in Cardiovascular Disease: Current Status and Future Directions. Biomolecules 2023; 13:1180. [PMID: 37627245 PMCID: PMC10452258 DOI: 10.3390/biom13081180] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Three-dimensional (3D) printing plays an important role in cardiovascular disease through the use of personalised models that replicate the normal anatomy and its pathology with high accuracy and reliability. While 3D printed heart and vascular models have been shown to improve medical education, preoperative planning and simulation of cardiac procedures, as well as to enhance communication with patients, 3D bioprinting represents a potential advancement of 3D printing technology by allowing the printing of cellular or biological components, functional tissues and organs that can be used in a variety of applications in cardiovascular disease. Recent advances in bioprinting technology have shown the ability to support vascularisation of large-scale constructs with enhanced biocompatibility and structural stability, thus creating opportunities to replace damaged tissues or organs. In this review, we provide an overview of the use of 3D bioprinting in cardiovascular disease with a focus on technologies and applications in cardiac tissues, vascular constructs and grafts, heart valves and myocardium. Limitations and future research directions are highlighted.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6102, Australia;
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA 6102, Australia
| | - Jack Zhao
- School of Medicine, Faculty of Health Sciences, The University of Western Australia, Perth, WA 6009, Australia; (J.Z.); (E.L.)
| | - Emily Leung
- School of Medicine, Faculty of Health Sciences, The University of Western Australia, Perth, WA 6009, Australia; (J.Z.); (E.L.)
| | - Maria Flandes-Iparraguirre
- Regenerative Medicine Program, Cima Universidad de Navarra, 31008 Pamplona, Spain;
- T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre and UWA Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia; (M.V.); (E.M.D.-J.-P.)
- School of Engineering, The University of Western Australia, Perth, WA 6009, Australia
| | - Michael Vernon
- T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre and UWA Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia; (M.V.); (E.M.D.-J.-P.)
- School of Engineering, The University of Western Australia, Perth, WA 6009, Australia
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre and UWA Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia
| | - Jenna Silberstein
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6102, Australia;
| | - Elena M. De-Juan-Pardo
- T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre and UWA Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia; (M.V.); (E.M.D.-J.-P.)
- School of Engineering, The University of Western Australia, Perth, WA 6009, Australia
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia;
| | - Shirley Jansen
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia;
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
- Heart and Vascular Research Institute, Harry Perkins Medical Research Institute, Perth, WA 6009, Australia
- School of Medicine, The University of Western Australia, Perth, WA 6009, Australia
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Pepe A, Crimì F, Vernuccio F, Cabrelle G, Lupi A, Zanon C, Gambato S, Perazzolo A, Quaia E. Medical Radiology: Current Progress. Diagnostics (Basel) 2023; 13:2439. [PMID: 37510183 PMCID: PMC10378672 DOI: 10.3390/diagnostics13142439] [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: 06/12/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Recently, medical radiology has undergone significant improvements in patient management due to advancements in image acquisition by the last generation of machines, data processing, and the integration of artificial intelligence. In this way, cardiovascular imaging is one of the fastest-growing radiological subspecialties. In this study, a compressive review was focused on addressing how and why CT and MR have gained a I class indication in most cardiovascular diseases, and the potential impact of tissue and functional characterization by CT photon counting, quantitative MR mapping, and 4-D flow. Regarding rectal imaging, advances in cancer imaging using diffusion-weighted MRI sequences for identifying residual disease after neoadjuvant chemoradiotherapy and [18F] FDG PET/MRI were provided for high-resolution anatomical and functional data in oncological patients. The results present a large overview of the approach to the imaging of diffuse and focal liver diseases by US elastography, contrast-enhanced US, quantitative MRI, and CT for patient risk stratification. Italy is currently riding the wave of these improvements. The development of large networks will be crucial to create high-quality databases for patient-centered precision medicine using artificial intelligence. Dedicated radiologists with specific training and a close relationship with the referring clinicians will be essential human factors.
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Affiliation(s)
- Alessia Pepe
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Filippo Crimì
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
| | - Giulio Cabrelle
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
| | - Amalia Lupi
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Chiara Zanon
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Sebastiano Gambato
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Anna Perazzolo
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
- Institute of Radiology, Department of Medicine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, University of Udine, 33100 Udine, Italy
| | - Emilio Quaia
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
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Patient-Specific 3D-Printed Models in Pediatric Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020319. [PMID: 36832448 PMCID: PMC9955978 DOI: 10.3390/children10020319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Three-dimensional (3D) printing technology has become increasingly used in the medical field, with reports demonstrating its superior advantages in both educational and clinical value when compared with standard image visualizations or current diagnostic approaches. Patient-specific or personalized 3D printed models serve as a valuable tool in cardiovascular disease because of the difficulty associated with comprehending cardiovascular anatomy and pathology on 2D flat screens. Additionally, the added value of using 3D-printed models is especially apparent in congenital heart disease (CHD), due to its wide spectrum of anomalies and its complexity. This review provides an overview of 3D-printed models in pediatric CHD, with a focus on educational value for medical students or graduates, clinical applications such as pre-operative planning and simulation of congenital heart surgical procedures, and communication between physicians and patients/parents of patients and between colleagues in the diagnosis and treatment of CHD. Limitations and perspectives on future research directions for the application of 3D printing technology into pediatric cardiology practice are highlighted.
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Brüning J, Kramer P, Goubergrits L, Schulz A, Murin P, Solowjowa N, Kuehne T, Berger F, Photiadis J, Weixler VHM. 3D modeling and printing for complex biventricular repair of double outlet right ventricle. Front Cardiovasc Med 2022; 9:1024053. [PMID: 36531701 PMCID: PMC9748612 DOI: 10.3389/fcvm.2022.1024053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/07/2022] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Double outlet right ventricle (DORV) describes a group of congenital heart defects where pulmonary artery and aorta originate completely or predominantly from the right ventricle. The individual anatomy of DORV patients varies widely with multiple subtypes classified. Although the majority of morphologies is suitable for biventricular repair (BVR), complex DORV anatomy can render univentricular palliation (UVP) the only option. Thus, patient-specific decision-making is critical for optimal surgical treatment planning. The evolution of image processing and rapid prototyping techniques facilitate the generation of detailed virtual and physical 3D models of the patient-specific anatomy which can support this important decision process within the Heart Team. MATERILAS AND METHODS The individual cardiovascular anatomy of nine patients with complex DORV, in whom surgical decision-making was not straightforward, was reconstructed from either computed tomography or magnetic resonance imaging data. 3D reconstructions were used to characterize the morphologic details of DORV, such as size and location of the ventricular septal defect (VSD), atrioventricular valve size, ventricular volumes, relationship between the great arteries and their spatial relation to the VSD, outflow tract obstructions, coronary artery anatomy, etc. Additionally, physical models were generated. Virtual and physical models were used in the preoperative assessment to determine surgical treatment strategy, either BVR vs. UVP. RESULTS Median age at operation was 13.2 months (IQR: 9.6-24.0). The DORV transposition subtype was present in six patients, three patients had a DORV-ventricular septal defect subtype. Patient-specific reconstruction was feasible for all patients despite heterogeneous image quality. Complex BVR was feasible in 5/9 patients (55%). Reasons for unsuitability for BVR were AV valve chordae interfering with potential intraventricular baffle creation, ventricular hypoplasia and non-committed VSD morphology. Evaluation in particular of qualitative data from 3D models was considered to support comprehension of complex anatomy. CONCLUSION Image-based 3D reconstruction of patient-specific intracardiac anatomy provides valuable additional information supporting decision-making processes and surgical planning in complex cardiac malformations. Further prospective studies are required to fully appreciate the benefits of 3D technology.
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Affiliation(s)
- Jan Brüning
- Institute for Cardiovascular Computer-Assisted Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Peter Kramer
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Institute for Cardiovascular Computer-Assisted Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
| | - Antonia Schulz
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Peter Murin
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Titus Kuehne
- Institute for Cardiovascular Computer-Assisted Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Felix Berger
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Viktoria Heide-Marie Weixler
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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12
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Ponchant K, Nguyen DA, Prsa M, Beghetti M, Sologashvili T, Vallée JP. Three-dimensional printing and virtual reconstruction in surgical planning of double-outlet right ventricle repair. JTCVS Tech 2022; 17:138-150. [PMID: 36820361 PMCID: PMC9938382 DOI: 10.1016/j.xjtc.2022.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives For more than a decade, 3-dimensional (3D) printing has been identified as an innovative tool for the surgical planning of double-outlet right ventricle (DORV). Nevertheless, lack of evidence concerning its benefits encourages us to identify valuable criteria for future prospective trials. Methods We conducted a retrospective study involving 10 patients with DORV operated between 2015 and 2019 in our center. During a preoperative multidisciplinary heart team meeting, we harvested surgical decisions following a 3-increment step process: (1) multimodal imaging; (2) 3D virtual valvular reconstruction (3DVVR); and (3) 3D-printed heart model (3DPHM). The primary outcome was the proportion of predicted surgical strategy following each of the 3 steps, compared with the institutional retrospective surgical strategy. The secondary outcome was the change of surgical strategy through 3D modalities compared with multimodal imaging. The incremental benefit of the 3DVVR and 3DPHM over multimodal imaging was then assessed. Results The operative strategy was predicted in 5 cases after multimodal imaging, in 9 cases after 3DVVR, and the 10 cases after 3DPHM. Compared with multimodal imaging, 3DVVR modified the strategy for 4 cases. One case was correctly predicted only after 3DPHM inspection. Conclusions 3DVVR and 3DPHM improved multimodal imaging in the surgical planning of patients with DORV. 3DVVR allowed a better appreciation of the relationships between great vessels, valves, and ventricular septal defects. 3DPHM offers a realistic preoperative view at patient scale and enhances the evaluation of outflow tract obstruction. Our retrospective study demonstrates benefits of preoperative 3D modalities and supports future prospective trials to assess their impact on postoperative outcomes.
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Key Words
- 3D modality in surgical planning
- 3D printed heart model
- 3D printing
- 3D virtual valvular reconstruction
- 3D, 3-dimensional
- 3DPHM, 3D-printed heart model
- 3DVVR, 3D virtual valvular annulus reconstruction
- CTA, computed tomography angiogram
- DORV, double-outlet right ventricle
- LV, left ventricle
- PA, pulmonary artery
- PV, pulmonary valve
- TGA, transposition of the great arteries
- TTE, transthoracic echocardiography
- VSD, ventricular septal defect
- double-outlet right ventricle
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Affiliation(s)
- Kevin Ponchant
- Cardiovascular Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland,Address for reprints: Kevin Ponchant, Cardiovascular Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Duy-Anh Nguyen
- Pediatric Cardiology Unit, Children's University Hospital, Geneva, Switzerland
| | - Milan Prsa
- Division of Pediatric Cardiology, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Geneva University Hospitals/Lausanne University Hospital, Geneva/Lausanne, Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Children's University Hospital, Geneva, Switzerland,Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Geneva University Hospitals/Lausanne University Hospital, Geneva/Lausanne, Switzerland
| | - Tornike Sologashvili
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Geneva University Hospitals/Lausanne University Hospital, Geneva/Lausanne, Switzerland,Division of Cardiac Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Vallée
- Cardiovascular Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Liang J, Lu B, Zhao X, Wang J, Zhao D, Zhang G, Zhu B, Ma Q, Pan G, Li D. Feasibility analyses of virtual models and 3D printing for surgical simulation of the double-outlet right ventricle. Med Biol Eng Comput 2022; 60:3029-3040. [DOI: 10.1007/s11517-022-02660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
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Sun Z, Wee C. 3D Printed Models in Cardiovascular Disease: An Exciting Future to Deliver Personalized Medicine. MICROMACHINES 2022; 13:1575. [PMID: 36295929 PMCID: PMC9610217 DOI: 10.3390/mi13101575] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
3D printing has shown great promise in medical applications with increased reports in the literature. Patient-specific 3D printed heart and vascular models replicate normal anatomy and pathology with high accuracy and demonstrate superior advantages over the standard image visualizations for improving understanding of complex cardiovascular structures, providing guidance for surgical planning and simulation of interventional procedures, as well as enhancing doctor-to-patient communication. 3D printed models can also be used to optimize CT scanning protocols for radiation dose reduction. This review article provides an overview of the current status of using 3D printing technology in cardiovascular disease. Limitations and barriers to applying 3D printing in clinical practice are emphasized while future directions are highlighted.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth 6845, Australia
| | - Cleo Wee
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth 6845, Australia
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15
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Bernhard B, Illi J, Gloeckler M, Pilgrim T, Praz F, Windecker S, Haeberlin A, Gräni C. Imaging-Based, Patient-Specific Three-Dimensional Printing to Plan, Train, and Guide Cardiovascular Interventions: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022; 31:1203-1218. [PMID: 35680498 DOI: 10.1016/j.hlc.2022.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To tailor cardiovascular interventions, the use of three-dimensional (3D), patient-specific phantoms (3DPSP) encompasses patient education, training, simulation, procedure planning, and outcome-prediction. AIM This systematic review and meta-analysis aims to investigate the current and future perspective of 3D printing for cardiovascular interventions. METHODS We systematically screened articles on Medline and EMBASE reporting the prospective use of 3DPSP in cardiovascular interventions by using combined search terms. Studies that compared intervention time depending on 3DPSP utilisation were included into a meta-analysis. RESULTS We identified 107 studies that prospectively investigated a total of 814 3DPSP in cardiovascular interventions. Most common settings were congenital heart disease (CHD) (38 articles, 6 comparative studies), left atrial appendage (LAA) occlusion (11 articles, 5 comparative, 1 randomised controlled trial [RCT]), and aortic disease (10 articles). All authors described 3DPSP as helpful in assessing complex anatomic conditions, whereas poor tissue mimicry and the non-consideration of physiological properties were cited as limitations. Compared to controls, meta-analysis of six studies showed a significant reduction of intervention time in LAA occlusion (n=3 studies), and surgery due to CHD (n=3) if 3DPSPs were used (Cohen's d=0.54; 95% confidence interval, 0.13 to 0.95; p=0.001), however heterogeneity across studies should be taken into account. CONCLUSIONS 3DPSP are helpful to plan, train, and guide interventions in patients with complex cardiovascular anatomy. Benefits for patients include reduced intervention time with the potential for lower radiation exposure and shorter mechanical ventilation times. More evidence and RCTs including clinical endpoints are needed to warrant adoption of 3DPSP into routine clinical practice.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joël Illi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Swiss MedTech Center, Switzerland Innovation Park Biel/Bienne AG, Switzerland
| | - Martin Gloeckler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland.
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Qiu H, Wen S, Ji E, Chen T, Liu X, Li X, Teng Y, Zhang Y, Liufu R, Zhang J, Xu X, Chen J, Huang M, Cen J, Zhuang J. A Novel 3D Visualized Operative Procedure in the Single-Stage Complete Repair With Unifocalization of Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries. Front Cardiovasc Med 2022; 9:836200. [PMID: 35548444 PMCID: PMC9081567 DOI: 10.3389/fcvm.2022.836200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) is a relatively rare, complex, and heterogeneous congenital heart disease. As one of the effective treatments, the midline unifocalization strategy still remains complicated and challenging due to the diverse forms of MAPCAs and pulmonary arteries. The purpose of this study is to summarize our experience of a novel three-dimensional (3D) visualized operative procedure in the single-stage complete repair with unifocalization and to clarify the benefits it may bring to us. Methods We described our experience of the 3D visualized operative procedure such as 3D printing, virtual reality (VR), and mixed reality (MR) technology in patients with PA/VSD/MAPCAs who underwent a single-stage complete repair with unifocalization. The data from the patients who underwent this procedure (3D group) and those who underwent the conventional procedure (conventional group) were compared. Results The conventional and 3D groups included 11 patients from September 2011 to December 2017 and 9 from January 2018 to March 2021, respectively. The baseline characteristics such as age, body weight, preoperative saturation, the anatomy of the pulmonary arteries and MAPCAs, the Nakata index, and TNPAI had no statistical significance. All 9 patients in the 3D group were operated only through a median sternotomy, while 8 cases (72.7%) in the conventional group needed another posterolateral thoracotomy (p = 0.001). In the 3D group, the CPB time was shorter (93.2 ± 63.8 vs. 145.1 ± 68.4 min, p = 0.099), and the median pre-CPB time per MAPCAs was significantly shorter [25.7 (14.0, 46.3) vs. 65 (41.3, 75.0) min, p = 0.031]. There was no early death in the 3D group, while there were 3 in the conventional group (0 vs. 27.3%, p = 0.218). Conclusion The novel 3D visualized operative procedure may help improve the performance of the single-stage complete repair with the midline unifocalization of PA/VSD/MAPCAs and help shorten the dissecting time of the MAPCAs. It may promote the routine and successful application of this strategy in more centers.
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Affiliation(s)
- Hailong Qiu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Erchao Ji
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tianyu Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaobing Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohua Li
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yun Teng
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Zhang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rong Liufu
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiawei Zhang
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaowei Xu
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Meiping Huang
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Meiping Huang
| | - Jianzheng Cen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Jianzheng Cen
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Jian Zhuang
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Frei M, Reymond P, Wacker J, van Steenberghe M, Beghetti M, Sologashvili T, Vallée JP. Three-dimensional printed moulds to obtain silicone hearts with congenital defects for paediatric heart-surgeon training. Eur J Cardiothorac Surg 2022; 65:ezae079. [PMID: 38445719 PMCID: PMC10942813 DOI: 10.1093/ejcts/ezae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/12/2024] [Accepted: 03/04/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES Many types of congenital heart disease are amenable to surgical repair or palliation. The procedures are often challenging and require specific surgical training, with limited real-life exposure and often costly simulation options. Our objective was to create realistic and affordable 3D simulation models of the heart and vessels to improve training. METHODS We created moulded vessel models using several materials, to identify the material that best replicated human vascular tissue. This material was then used to make more vessels to train residents in cannulation procedures. Magnetic resonance imaging views of a 23-month-old patient with double-outlet right ventricle were segmented using free open-source software. Re-usable moulds produced by 3D printing served to create a silicone model of the heart, with the same material as the vessels, which was used by a heart surgeon to simulate a Rastelli procedure. RESULTS The best material was a soft elastic silicone (Shore A hardness 8). Training on the vessel models decreased the residents' procedural time and improved their grades on a performance rating scale. The surgeon evaluated the moulded heart model as realistic and was able to perform the Rastelli procedure on it. Even if the valves were poorly represented, it was found to be useful for preintervention training. CONCLUSIONS By using free segmentation software, a relatively low-cost silicone and a technique based on re-usable moulds, the cost of obtaining heart models suitable for training in congenital heart defect surgery can be substantially decreased.
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Affiliation(s)
- Mélanie Frei
- Radiology Clinics, Diagnostic Department, Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Department of Cardiac Surgery, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Philippe Reymond
- Charles Hahn Hemodynamic Propulsion Laboratory, Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Julie Wacker
- Department of Women, Children and Adolescents, Paediatric Specialties Service, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Mathieu van Steenberghe
- Charles Hahn Hemodynamic Propulsion Laboratory, Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Maurice Beghetti
- Department of Women, Children and Adolescents, Paediatric Specialties Service, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Tornike Sologashvili
- Department of Cardiac Surgery, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Jean-Paul Vallée
- Radiology Clinics, Diagnostic Department, Geneva University Hospital and University of Geneva, Geneva, Switzerland
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Krasemann T, Branstetter J. Virtual Reality Treatment Planning for Congenital Heart Disease. JACC Case Rep 2021; 3:1584-1585. [PMID: 34729505 PMCID: PMC8543154 DOI: 10.1016/j.jaccas.2021.08.023] [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: 11/26/2022]
Affiliation(s)
- Thomas Krasemann
- Department of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Joshua Branstetter
- Department of Pharmacy, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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Feasibility and accuracy of printed models of complex cardiac defects in small infants from cardiac computed tomography. Pediatr Radiol 2021; 51:1983-1990. [PMID: 34129069 DOI: 10.1007/s00247-021-05110-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/04/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Three-dimensional (3-D) printed models are increasingly used to enhance understanding of complex anatomy in congenital heart disease. OBJECTIVE To assess feasibility and accuracy of 3-D printed models obtained from cardiac CT scans in young children with complex congenital heart diseases. MATERIALS AND METHODS We included children with conotruncal heart anomalies who were younger than 2 years and had a cardiac CT scan in the course of their follow-up. We used cardiac CT scan datasets to generate 3-D models. To assess the models' accuracy, we compared four diameters for each child between the CT images and the printed models, including the largest diameters (Dmax) of ventricular septal defects and aortic annulus and their minimal diameters (Dmin). RESULTS We obtained images from 14 children with a mean age of 5.5 months (range 1-24 months) and a mean weight of 6.7 kg (range 3.4-14.5 kg). We generated 3-D models for all children. Mean measurement difference between CT images and 3-D models was 0.13 mm for Dmin and 0.12 mm for Dmax for ventricular septal defect diameters, and it was 0.16 mm for Dmin and -0.13 mm for Dmax for aortic annulus diameter, indicating a non-clinically significant difference. CONCLUSION Three-dimensional printed models could be feasibly generated from cardiac CT scans in a small pediatric population with complex congenital heart diseases. This technique is highly accurate and reliably reflects the same structural dimensions when compared to CT source images.
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Yıldız O, Köse B, Tanıdır IC, Pekkan K, Güzeltaş A, Haydin S. Single-center experience with routine clinical use of 3D technologies in surgical planning for pediatric patients with complex congenital heart disease. ACTA ACUST UNITED AC 2021; 27:488-496. [PMID: 34313233 DOI: 10.5152/dir.2021.20163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE This study was planned to assess the application of three-dimensional (3D) cardiac modeling in preoperative evaluation for complex congenital heart surgeries. METHODS From July 2015 to September 2019, 18 children diagnosed with complex congenital heart diseases (CHDs) were enrolled in this study (double outlet right ventricle in nine patients, complex types of transposition of the great arteries in six patients, congenitally corrected transposition of the great arteries in two patients, and univentricular heart in one patient). The patients' age ranged from 7 months to 19 years (median age, 14 months). Before the operation, 3D patient-specific cardiac models were created based on computed tomography (CT) data. Using each patient's data, a virtual computer model (3D mesh) and stereolithographic (SLA) file that would be printed as a 3D model were generated. These 3D cardiac models were used to gather additional data about cardiac anatomy for presurgical decision-making. RESULTS All 18 patients successfully underwent surgeries, and there were no mortalities. The 3D patient-specific cardiac models led to a change from the initial surgical plans in 6 of 18 cases (33%), and biventricular repair was considered feasible. Moreover, the models helped to modify the planned biventricular repair in five cases, for left ventricular outflow tract obstruction removal and ventricular septal defect enlargement. 3D cardiac models enable pediatric cardiologists to better understand the spatial relationships between the ventricular septal defect and great vessels, and they help surgeons identify risk structures more clearly for detailed planning of surgery. There was a strong correlation between the models of the patients and the anatomy encountered during the operation. CONCLUSION 3D cardiac models accurately reveal the patient's anatomy in detail and are therefore beneficial for planning surgery in patients with complex intracardiac anatomy.
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Affiliation(s)
- Okan Yıldız
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Banu Köse
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | | | - Kerem Pekkan
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Alper Güzeltaş
- Department of Biomedical Engineering, Koç University, Istanbul, Turkey
| | - Sertaç Haydin
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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21
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Andersen ND, Sturgeon GM, Barker PCA, Turek JW. Commentary: Inspection of 3-dimensional rendered hearts will become the standard of care before complex congenital heart surgery. JTCVS Tech 2021; 7:204-205. [PMID: 34318247 PMCID: PMC8311859 DOI: 10.1016/j.xjtc.2021.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 10/28/2022] Open
Affiliation(s)
- Nicholas D Andersen
- Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC
| | - Gregory M Sturgeon
- Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC
| | - Piers C A Barker
- Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC
| | - Joseph W Turek
- Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC
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22
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Tack P, Willems R, Annemans L. An early health technology assessment of 3D anatomic models in pediatric congenital heart surgery: potential cost-effectiveness and decision uncertainty. Expert Rev Pharmacoecon Outcomes Res 2021; 21:1107-1115. [PMID: 33475446 DOI: 10.1080/14737167.2021.1879645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Three-dimensional anatomic models have been used for surgical planning and simulation in pediatric congenital heart surgery. This research is the first to evaluate the potential cost-effectiveness of 3D anatomic models with the intent to guide surgeons and decision makers on its use.Method: A decision tree and subsequent Markov model with a 15-year time horizon was constructed and analyzed for nine cardiovascular surgeries. Epidemiological, clinical, and economic data were derived from databases. Literature and experts were consulted to close data gaps. Scenario, one-way, threshold, and probabilistic sensitivity analysis captured methodological and parameter uncertainty.Results: Incremental costs of using anatomical models ranged from -366€ (95% credibility interval: -2595€; 1049€) in the Norwood operation to 1485€ (95% CI: 1206€; 1792€) in atrial septal defect repair. Incremental health-benefits ranged from negligible in atrial septal defect repair to 0.54 Quality Adjusted Life Years (95% CI: 0.06; 1.43) in truncus arteriosus repair. Variability in the results was mainly caused by a temporary postoperative quality-adjusted life years gain.Conclusion: For complex operations, the implementation of anatomic models is likely to be cost-effective on a 15 year time horizon. For the right indication, these models thus provide a clinical advantage at an acceptable cost.
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Affiliation(s)
- Philip Tack
- Department of Innovation, Entrepreneurship and Service Management, Ghent University, Ghent, Belgium
| | - Ruben Willems
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
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23
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Lee S, Squelch A, Sun Z. Quantitative Assessment of 3D Printed Model Accuracy in Delineating Congenital Heart Disease. Biomolecules 2021; 11:biom11020270. [PMID: 33673159 PMCID: PMC7917618 DOI: 10.3390/biom11020270] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Three-dimensional (3D) printing is promising in medical applications, especially presurgical planning and the simulation of congenital heart disease (CHD). Thus, it is clinically important to generate highly accurate 3D-printed models in replicating cardiac anatomy and defects. The present study aimed to investigate the accuracy of the 3D-printed CHD model by comparing them with computed tomography (CT) images and standard tessellation language (STL) files. Methods: Three models were printed, comprising different CHD pathologies, including the tetralogy of Fallot (ToF), ventricular septal defect (VSD) and double-outlet right-ventricle (DORV). The ten anatomical locations were measured in each comparison. Pearson’s correlation coefficient, Bland–Altman analysis and intra-class correlation coefficient (ICC) determined the model accuracy. Results: All measurements with three printed models showed a strong correlation (r = 0.99) and excellent reliability (ICC = 0.97) when compared to original CT images, CT images of the 3D-printed models, STL files and 3D-printed CHD models. Conclusion: This study demonstrated the high accuracy of 3D-printed heart models with excellent correlation and reliability when compared to multiple source data. Further investigation into 3D printing in CHD should focus on the clinical value and the benefits to patients.
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Affiliation(s)
- Shenyuan Lee
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, GPO Box, U1987, Perth, WA 6845, Australia;
| | - Andrew Squelch
- Discipline of Exploration Geophysics, Western Australian School of Mines, Minerals, Energy and Chemical Engineering, Curtin University, Perth, WA 6845, Australia;
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, GPO Box, U1987, Perth, WA 6845, Australia;
- Correspondence: ; Tel.: +61-8-9266-7509; Fax: +61-8-9266-2377
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24
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Gehrsitz P, Rompel O, Schöber M, Cesnjevar R, Purbojo A, Uder M, Dittrich S, Alkassar M. Cinematic Rendering in Mixed-Reality Holograms: A New 3D Preoperative Planning Tool in Pediatric Heart Surgery. Front Cardiovasc Med 2021; 8:633611. [PMID: 33634174 PMCID: PMC7900175 DOI: 10.3389/fcvm.2021.633611] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Cinematic rendering (CR) is based on a new algorithm that creates a photo-realistic three-dimensional (3D) picture from cross-sectional images. Previous studies have shown its positive impact on preoperative planning. To date, CR presentation has only been possible on 2D screens which limited natural 3D perception. To depict CR-hearts spatially, we used mixed-reality technology and mapped corresponding hearts as holograms in 3D space. Our aim was to assess the benefits of CR-holograms in the preoperative planning of cardiac surgery. Including 3D prints allowed a direct comparison of two spatially resolved display methods. Twenty-six patients were recruited between February and September 2019. CT or MRI was used to visualize the patient's heart preoperatively. The surgeon was shown the anatomy in cross-sections on a 2D screen, followed by spatial representations as a 3D print and as a high-resolution hologram. The holographic representation was carried out using mixed-reality glasses (HoloLens®). To create the 3D prints, corresponding structures were segmented to create STL files which were printed out of resin. In 22 questions, divided in 5 categories (3D-imaging effect, representation of pathology, structure resolution, cost/benefit ratio, influence on surgery), the surgeons compared each spatial representation with the 2D method, using a five-level Likert scale. The surgical preparation time was assessed by comparing retrospectively matched patient pairs, using a paired t-test. CR-holograms surpassed 2D-monitor imaging in all categories. CR-holograms were superior to 3D prints in all categories (mean Likert scale 4.4 ± 1.0 vs. 3.7 ± 1.3, P < 0.05). Compared to 3D prints it especially improved the depth perception (4.7 ± 0.7 vs. 3.7 ± 1.2) and the representation of the pathology (4.4 ± 0.9 vs. 3.6 ± 1.2). 3D imaging reduced the intraoperative preparation time (n = 24, 59 ± 23 min vs. 73 ± 43 min, P < 0.05). In conclusion, the combination of an extremely photo-realistic presentation via cinematic rendering and the spatial presentation in 3D space via mixed-reality technology allows a previously unattained level of comprehension of anatomy and pathology in preoperative planning.
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Affiliation(s)
- Pia Gehrsitz
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Oliver Rompel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Martin Schöber
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Muhannad Alkassar
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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25
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Corno AF, Durairaj S, Skinner GJ. Narrative review of assessing the surgical options for double outlet right ventricle. Transl Pediatr 2021; 10:165-176. [PMID: 33633949 PMCID: PMC7882294 DOI: 10.21037/tp-20-227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The individualized surgical approach in individuals with both arterial trunks arising from the morphologically right ventricle is dictated by the extreme morphological variability encountered in this setting, with each patient being unique. An individualized surgical approach has been designed to take account of the morphological variations, identifying the anatomy with the preoperative three-dimensional CT scan reconstruction. The key features have been considered the distance between tricuspid and pulmonary valves, the size and location of the interventricular communication, and the relationship between the outflow tracts. The surgical approach is tailored, whenever feasible, to create a connection between left ventricle and aorta, but primarily to achieve biventricular repair. Account has been taken of all available surgical options already reported in the literature, identifying the most suitable to provide the best outcomes for each unique morphology. To date, meaningful comparison between different reported surgical series has been difficult because of the marked variation of individual intracardiac morphology, and the lack of reports of specific surgical approaches for well-categorized groups of patients. Our approach, being tailored to the individual cardiac morphology, can be offered to any patient with this ventriculo-arterial connection. Given the difficulties of diagnosis, and the multiple therapeutic indications, very close collaboration between cardiologists and surgeons is indispensable for further progress in the understanding and management of this complex congenital cardiac lesion.
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Affiliation(s)
- Antonio F Corno
- Houston Children's Heart Institute, Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, TX, USA
| | - Saravanan Durairaj
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, UK
| | - Gregory J Skinner
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, UK
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26
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Wang H, Song H, Yang Y, Cao Q, Hu Y, Chen J, Guo J, Wang Y, Jia D, Cao S, Zhou Q. Three-dimensional printing for cardiovascular diseases: from anatomical modeling to dynamic functionality. Biomed Eng Online 2020; 19:76. [PMID: 33028306 PMCID: PMC7542711 DOI: 10.1186/s12938-020-00822-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
Three-dimensional (3D) printing is widely used in medicine. Most research remains focused on forming rigid anatomical models, but moving from static models to dynamic functionality could greatly aid preoperative surgical planning. This work reviews literature on dynamic 3D heart models made of flexible materials for use with a mock circulatory system. Such models allow simulation of surgical procedures under mock physiological conditions, and are; therefore, potentially very useful to clinical practice. For example, anatomical models of mitral regurgitation could provide a better display of lesion area, while dynamic 3D models could further simulate in vitro hemodynamics. Dynamic 3D models could also be used in setting standards for certain parameters for function evaluation, such as flow reserve fraction in coronary heart disease. As a bridge between medical image and clinical aid, 3D printing is now gradually changing the traditional pattern of diagnosis and treatment.
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Affiliation(s)
- Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hongning Song
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yugang Hu
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jinling Chen
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Juan Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yijia Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dan Jia
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Sheng Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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27
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Cen J, Liufu R, Wen S, Qiu H, Liu X, Chen X, Yuan H, Huang M, Zhuang J. Three-Dimensional Printing, Virtual Reality and Mixed Reality for Pulmonary Atresia: Early Surgical Outcomes Evaluation. Heart Lung Circ 2020; 30:296-302. [PMID: 32863113 DOI: 10.1016/j.hlc.2020.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/07/2020] [Accepted: 03/28/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Single-stage unifocalisation for pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCA) requires a high degree of three-dimensional (3D) anatomical imagination. A previous study has reported the application of a 3D-printed heart model with virtual reality (VR) or mixed reality (MR). However, few studies have evaluated the surgical outcomes of the 3D model with VR or MR in PA/VSD patients. METHODS Three-dimensional (3D) heart models of five selected PA/VSD patients were derived from traditional imageology of their hearts. Using VR glasses, the 3D models were also visualised in the operating room. Both the 3D-printed heart models and preoperative evaluation by VR were used in the five selected patients for surgical simulation and better anatomical understanding. Mixed reality holograms were used as perioperative assistive tools. Surgical outcomes were assessed, including in-hospital and early follow-up clinical data. RESULTS The use of these three new technologies had favourable feedback from the surgeons on intraoperative judgment. There were no in-hospital or early deaths. No reintervention was required until the last follow-up. Three (3) patients developed postoperative complications: one had right bundle branch block and ST-segment change, one had chest drainage >7 days (>40 mL/day) and one had pneumonia. CONCLUSION The preoperative application of a 3D-printed heart model with VR or MR helped in aligning the surgical field. These technologies improved the understanding of complicated cardiac anatomy and achieved acceptable surgical outcomes as guiding surgical planning.
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Affiliation(s)
- Jianzheng Cen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rong Liufu
- Cardiovascular Intensive Care Unit, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hailong Qiu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaobin Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaokun Chen
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haiyun Yuan
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Meiping Huang
- Radiology Department, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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28
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Arce K, Morris JM, Alexander AE, Ettinger KS. Developing a Point-of-Care Manufacturing Program for Craniomaxillofacial Surgery. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:165-179. [PMID: 32741513 DOI: 10.1016/j.cxom.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kevin Arce
- Division of Oral and Maxillofacial Surgery, Section of Head and Neck Oncologic Surgery and Reconstruction, Department of Surgery, Mayo Clinic and Mayo College of Medicine, 200 First St. SW, Mail Code: RO_MA_12_03E-OS, Rochester, MN 55905, USA.
| | - Jonathan M Morris
- Division of Neuroradiology, Medical Director of Anatomic Modeling Lab, Department of Radiology, Mayo Clinic and Mayo College of Medicine, 200 First St. SW, Mail Code: RO_MA_02_48WRAD, Rochester, MN 55905, USA
| | - Amy E Alexander
- Anatomic Modeling Lab, Department of Radiology, Mayo Clinic, 200 First St. SW, Mail Code: RO_JO_06_201RAD, Rochester, MN 55905, USA
| | - Kyle S Ettinger
- Division of Oral and Maxillofacial Surgery, Section of Head and Neck Oncologic Surgery and Reconstruction, Department of Surgery, Mayo Clinic and Mayo College of Medicine, 200 First St. SW, Mail Code: RO_MA_12_03E-OS, Rochester, MN 55905, USA
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29
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Oliveira MABD, Santos CAD, Brandi AC, Botelho PHH, Braile DM. Three-Dimensional Printing: is it useful for Cardiac Surgery? Braz J Cardiovasc Surg 2020; 35:549-554. [PMID: 32864936 PMCID: PMC7454638 DOI: 10.21470/1678-9741-2019-0475] [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: 11/20/2022] Open
Abstract
Introduction The medical use of three-dimensional (3-D) images has been a topic in the literature since 1988, but 95% of papers on 3-D printing were published in the last six years. The increase in publications is the result of advances in 3-D printing methods, as well as of the increasing availability of these machines in different hospitals. This paper sought to review the literature on 3-D printing and to discuss thoughtful ideas regarding benefits and challenges to its incorporation into cardiothoracic surgeons’ routines. Methods A comprehensive and systematic search of the literature was performed in PubMed and included material published as of March 2020. Results Using this search strategy, 9,253 publications on 3-D printing and 497 on “heart” 3-D printing were retrieved. Conclusion 3-D printed models are already helping surgeons to plan their surgeries, helping patients and their families to understand complex anatomy, helping fellows and residents to practice surgery, even for rare cases, and helping nurses and other health care staff to better understand some conditions, such as heart diseases.
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Affiliation(s)
- Marcos Aurélio Barboza de Oliveira
- Department of Cardiac Surgery, Hospital Santo Antônio and Femina Cuiabá, Sinop, Mato Grosso, Brazil.,Department of Cardiovascular Surgery, Universidade Federal do Mato Grosso, Sinop, Mato Grosso, Brazil
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30
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Hermsen JL, Roldan-Alzate A, Anagnostopoulos PV. Three-dimensional printing in congenital heart disease. J Thorac Dis 2020; 12:1194-1203. [PMID: 32274200 PMCID: PMC7138972 DOI: 10.21037/jtd.2019.10.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Three-dimensional printing (3Dp) has a broad array of medical applications and has been applied extensively in congenital heart disease given the variety and complexity of lesions encountered. 3Dps are unique when compared to other imaging modalities in that they are theoretically equally interpretable by radiologists, cardiologists and surgeons. The literature regarding 3Dp in congenital heart disease is recent and burgeoning. This review, categorized by application, should provide the reader with a comprehensive, albeit not complete, overview of 3Dp in congenital heart disease during the last decade.
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Affiliation(s)
- Joshua L Hermsen
- University of Wisconsin-Madison and American Family Children's Hospital, Madison, WI, USA
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31
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Abdullah I. Commentary: Is 3-dimensional printing the panacea for preoperative surgical planning of complex congenital heart disease? JTCVS Tech 2020; 2:143-144. [PMID: 34317783 PMCID: PMC8298852 DOI: 10.1016/j.xjtc.2020.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ibrahim Abdullah
- Department of Pediatric Cardiac Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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32
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Lau IWW, Sun Z. Dimensional Accuracy and Clinical Value of 3D Printed Models in Congenital Heart Disease: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8091483. [PMID: 31540421 PMCID: PMC6780783 DOI: 10.3390/jcm8091483] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 12/24/2022] Open
Abstract
The aim of this paper is to summarize and evaluate results from existing studies on accuracy and clinical value of three-dimensional printed heart models (3DPHM) for determining whether 3D printing can significantly improve on how the congenital heart disease (CHD) is managed in current clinical practice. Proquest, Google Scholar, Scopus, PubMed, and Medline were searched for relevant studies until April 2019. Two independent reviewers performed manual data extraction and assessed the risk of bias of the studies using the tools published on National Institutes of Health (NIH) website. The following data were extracted from the studies: author, year of publication, study design, imaging modality, segmentation software, utility of 3DPHM, CHD types, and dimensional accuracy. R software was used for the meta-analysis. Twenty-four articles met the inclusion criteria and were included in the systematic review. However, only 7 studies met the statistical requirements and were eligible for meta-analysis. Cochran's Q test demonstrated significant variation among the studies for both of the meta-analyses of accuracy of 3DPHM and the utility of 3DPHM in medical education. Analysis of all included studies reported the mean deviation between the 3DPHM and the medical images is not significant, implying that 3DPHM are highly accurate. As for the utility of the 3DPHM, it is reported in all relevant studies that the 3DPHM improve the learning experience and satisfaction among the users, and play a critical role in facilitating surgical planning of complex CHD cases. 3DPHM have the potential to enhance communication in medical practice, however their clinical value remains debatable. More studies are required to yield a more meaningful meta-analysis.
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Affiliation(s)
- Ivan Wen Wen Lau
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth 6845, Western Australia, Australia.
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth 6845, Western Australia, Australia.
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33
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Personalized Three-Dimensional Printed Models in Congenital Heart Disease. J Clin Med 2019; 8:jcm8040522. [PMID: 30995803 PMCID: PMC6517984 DOI: 10.3390/jcm8040522] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022] Open
Abstract
Patient-specific three-dimensional (3D) printed models have been increasingly used in cardiology and cardiac surgery, in particular, showing great value in the domain of congenital heart disease (CHD). CHD is characterized by complex cardiac anomalies with disease variations between individuals; thus, it is difficult to obtain comprehensive spatial conceptualization of the cardiac structures based on the current imaging visualizations. 3D printed models derived from patient's cardiac imaging data overcome this limitation by creating personalized 3D heart models, which not only improve spatial visualization, but also assist preoperative planning and simulation of cardiac procedures, serve as a useful tool in medical education and training, and improve doctor-patient communication. This review article provides an overall view of the clinical applications and usefulness of 3D printed models in CHD. Current limitations and future research directions of 3D printed heart models are highlighted.
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34
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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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Sydney Gladman A, Garcia-Leiner M, F. Sauer-Budge A. Emerging polymeric materials in additive manufacturing for use in biomedical applications. AIMS BIOENGINEERING 2019. [DOI: 10.3934/bioeng.2019.1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Shearn AIU, Yeong M, Richard M, Ordoñez MV, Pinchbeck H, Milano EG, Hayes A, Caputo M, Biglino G. Use of 3D Models in the Surgical Decision-Making Process in a Case of Double-Outlet Right Ventricle With Multiple Ventricular Septal Defects. Front Pediatr 2019; 7:330. [PMID: 31482075 PMCID: PMC6710409 DOI: 10.3389/fped.2019.00330] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/23/2019] [Indexed: 02/04/2023] Open
Abstract
3D printing has recently become an affordable means of producing bespoke models and parts. This has now been extended to models produced from medical imaging, such as computed tomography (CT). Here we report the production of a selection of 3D models to compliment the available imaging data for a 12-month-old child with double-outlet right ventricle and two ventricular septal defects. The models were produced to assist with case management and surgical planning. We used both stereolithography and polyjet techniques to produce white rigid and flexible color models, respectively. The models were discussed both at the joint multidisciplinary meeting and between surgeon and cardiologist. From the blood pool model the clinicians were able to determine that the position of the coronary arteries meant an arterial switch operation was unlikely to be feasible. The soft myocardium model allowed the clinicians to assess the VSD anatomy and relationship with the aorta. The models, therefore, were of benefit in the development of the surgical plan. It was felt that the clinical situation was stable enough that an immediate intervention was not required, but the timing of any intervention would be dictated by decreasing oxygen saturation. Subsequently, the oxygen saturation of the patient did decrease and the decision was made to intervene. A further model was created to demonstrate the tricuspid apparatus. An arterial switch was ultimately performed without the LeCompte maneuver, the muscular VSD enlarged and baffled into the neo aortic root and the perimembranous VSD closed. At 1 month follow up SO2 was 100%, there was no breathlessness and no echocardiogram changes.
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Affiliation(s)
- Andrew I U Shearn
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael Yeong
- University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | | | - Maria Victoria Ordoñez
- Bristol Medical School, University of Bristol, Bristol, United Kingdom.,University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | | | - Elena G Milano
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Alison Hayes
- University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, United Kingdom.,University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Batteux C, Haidar MA, Bonnet D. 3D-Printed Models for Surgical Planning in Complex Congenital Heart Diseases: A Systematic Review. Front Pediatr 2019; 7:23. [PMID: 30805324 PMCID: PMC6378296 DOI: 10.3389/fped.2019.00023] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/21/2019] [Indexed: 01/29/2023] Open
Abstract
Background: 3D technology support is an emerging technology in the field of congenital heart diseases (CHD). The goals of 3D printings or models is mainly a better analysis of complex anatomies to optimize the surgical repair or intervention planning. Method: We performed a systematic review to evaluate the accuracy and reliability of CHD modelization and 3D printing, as well as the proof of concept of the benefit of 3D printing in planning interventions. Results: Correlation studies showed good results with anatomical measurements. This technique can therefore be considered reliable with the limit of the operator's subjectivity in modelizing the defect. In cases series, the benefits of the 3D technology have been shown for describing the vessels anatomy and guiding the surgical approach. For intra-cardiac complex anatomy, 3D models have been shown helpful for the planification of intracardiac repair. However, there is still lack of evidence based approach for the usefulness of 3D models in CHD in changing outcomes after surgery or interventional procedures due to the difficulty to design a prospective study with comprehensive and clinically meaningful end-points. Conclusion: 3D technology can be used to improve the understanding of anatomy of complex CHD and to guide surgical strategy. However, there is a need to design clinical studies to identify the place of this approach in the current clinical practice.
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Affiliation(s)
- Clément Batteux
- Department of Congenital and Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Moussa A Haidar
- Department of Congenital and Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Damien Bonnet
- Department of Congenital and Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Townsend K, Pietila T. 3D printing and modeling of congenital heart defects: A technical review. Birth Defects Res 2018; 110:1091-1097. [PMID: 30063112 DOI: 10.1002/bdr2.1342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 11/07/2022]
Abstract
Use of 3D printing technology is expanding in healthcare. One of the common applications is the creation of anatomical models of congenital heart defects (CHD) from medical image data. These patient-specific models are being used for multiple purposes including visualization of anatomy, simulation of surgical procedures, patient education, and facilitating communication between clinical staff. The process for creating CHD models begins with acquiring volumetric image data that is segmented using medical image processing software. A virtual 3D model is calculated based on the segmented data which can be further refined using computer-aided design software. Last, the virtual model is transferred to a 3D printer for production. By obtaining detailed knowledge on the process for creating patient-specific CHD anatomical models, institutions can implement the technology in an efficient and cost-effective manner.
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Binsalamah ZM, Greenleaf CE, Heinle JS. Type A interrupted aortic arch and type III aortopulmonary window with anomalous origin of the right pulmonary artery from the aorta. J Card Surg 2018; 33:344-347. [PMID: 29749109 DOI: 10.1111/jocs.13717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Interruption of the aortic arch, aortopulmonary window, and anomalous origin of the right pulmonary artery from the ascending aorta are very rare congenital anomalies. It is even rarer to have all three anomalies in the same setting. We present a case of a newborn who was diagnosed with these lesions and describe the primary repair of these anomalies.
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Affiliation(s)
- Ziyad M Binsalamah
- Congenital Heart Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Christopher E Greenleaf
- Congenital Heart Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Congenital Heart Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
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Liu RH, Fraser CD, Zhou X, Cameron DE, Vricella LA, Hibino N. Pseudoaneurysm formation after valve sparing root replacement in children with Loeys-Dietz syndrome. J Card Surg 2018; 33:339-343. [DOI: 10.1111/jocs.13709] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rui H. Liu
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Charles D. Fraser
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Xun Zhou
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Duke E. Cameron
- Division of Cardiac Surgery; The Massachusetts General Hospital; Boston Massachusetts
| | - Luca A. Vricella
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Narutoshi Hibino
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore Maryland
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Bakas AM, Vardas PN, Farrell AG, Rodefeld MD. Congenital aortic paravalvular tunnel masquerading as a recurrent ventricular septal defect. J Card Surg 2018; 33:289-291. [PMID: 29638016 DOI: 10.1111/jocs.13573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 4-year-old female underwent surgical repair of an unusual variation of an aorto-left ventricular tunnel (ALVT). Serial echocardiograms had demonstrated previous spontaneous closure of a perimembranous ventricular septal defect (VSD). The patient presented with concern for residual VSD which was later demonstrated to be an eccentric jet through an ALVT. This case emphasizes early and accurate diagnosis for ALVTs and how they can be misdiagnosed as VSDs.
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Affiliation(s)
- Anna M Bakas
- Divisions of Cardiothoracic Surgery, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Panos N Vardas
- Divisions of Cardiothoracic Surgery, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anne G Farrell
- Divisions of Cardiology, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark D Rodefeld
- Divisions of Cardiothoracic Surgery, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana
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42
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Lazar HL. Three-dimensional printing in cardiac surgery: Enhanced imagery results in enhanced outcomes. J Card Surg 2018; 33:28. [PMID: 29409168 DOI: 10.1111/jocs.13514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, The Boston University School of Medicine, Boston, Massachusetts
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