Abstract
Congenital heart diseases causing significant hemodynamic and functional consequences require surgical repair. Understanding of the precise surgical anatomy is often challenging and can be inadequate or wrong. Modern high resolution imaging techniques and 3D printing technology allow 3D printing of the replicas of the patient’s heart for precise understanding of the complex anatomy, hands-on simulation of surgical and interventional procedures, and morphology teaching of the medical professionals and patients. CT or MR images obtained with ECG-gating and breath-holding or respiration navigation are best suited for 3D printing. 3D echocardiograms are not ideal but can be used for printing limited areas of interest such as cardiac valves and ventricular septum. Although the print materials still require optimization for representation of cardiovascular tissues and valves, the surgeons find the models suitable for practicing closure of the septal defects, application of the baffles within the ventricles, reconstructing the aortic arch, and arterial switch procedure. Hands-on surgical training (HOST) on models may soon become a mandatory component of congenital heart disease surgery program. 3D printing will expand its utilization with further improvement of the use of echocardiographic data and image fusion algorithm across multiple imaging modalities and development of new printing materials. Bioprinting of implants such as stents, patches and artificial valves and tissue engineering of a part of or whole heart using the patient’s own cells will open the door to a new era of personalized medicine.
Highlights
Congenital heart diseases are the most common significant birth defects with a live birth prevalence of 7.5 per 1000 [1]
Understanding of the surgical anatomy from the provided images requires a complicated process of mental reconstruction and can be often inadequate or wrong
Virtual demonstration of the 3D structures on a 2D computer screen facilitates understanding of the complex anatomy. 3D printing takes a closer step toward the reality by providing the physical replicas out of the digital data processed for the virtual models
Summary
Congenital heart diseases are the most common significant birth defects with a live birth prevalence of 7.5 per 1000 [1]. Modern imaging technologies including ultrasound, computed tomography (CT) and magnetic resonance (MR) provide accurate information regarding the anatomy and hemodynamic consequences of congenital heart disease. ECG-gated CT angiograms provide a spatial resolution of 0.3–0.7 mm and are the most commonly used images among currently applicable imaging modalities in 3D printing of cardiovascular structures. ECG-gated and respirationnavigated 3D FLASH (fast low angle shot) angiography using blood-pool contrast agent (Gadofoveset: ABLAVAR®, Lantheus Medical Imaging, Inc. MA, USA) provides excellent images with homogeneous distribution of contrast medium and no significant artifact from turbulent flow [35]. Postprocessing of image data The postprocessing procedure includes: 1) segmentation, 2) conversion of the DICOM (Digital Imaging and Communication in Medicine) file to the STL (Stereolithography or Standard Tessellation Language) or other file fomat for 3D printing, and 3) computer aided design (CAD) (Fig. 1).
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