A preliminary study for the feasibility and accuracy of three-dimensional printing mitral annulus models based on echocardiographic data

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Objective To evaluate the feasibility of three-dimensional (3D) printing of mitral annulus with transesophageal echocardiographic volume images as the data source, and to assess the accuracy of the 3D printing mitral annulus models based on three dimensional transesophageal echocardiography (3D-TEE) images preliminarily. Methods A retrospective study was performed in 25 patients with mild or slight mitral regurgitation and 10 patients with moderate to severe mitral regurgitation. All the subjects were underwent 3D-TEE. The 3D-TEE volume images of mitral annulus at the end diastole were post-processed by Mimics software to create images of the mitral annulus in standard tessellation language format. The STL file was output to the 3D printer and the 3D printing models of mitral annulus were obtained. The mitral annulus size parameters including the diameter between anterior and posterior, the diameter between anterolaterior and posteromedial, sphericity index and mitral annulus circumference were measured from 3D printing models and 3D-TEE images, respectively. From which the absolute difference of the measurements between 3D printing models and the 3D-TEE images were calculated. Results All of the 3D-TEE images were successfully post-processed, and the corresponding 3D printing models were acquired by high-precision 3D printer. It showed no significant difference in all the mitral annulus size parameters between 3D printing models and 3D-TEE images (all P>0.05). Morever, the size parameters were concordant well between the two methods, all of the data points fell within the limits of agreement. It showed little absolute difference in value of the mitral annulus size parameters between the 3D printing mitral annulus models and the 3D-TEE images. Conclusions It is technically feasible to print 3D models of mitral annulus using 3D-TEE images as the data source. 3D printing mitral annulus models based on transesophageal echocardiographic volume images have high precision. Key words: Echocardiography, transesophageal; 3D printing technology; Mitral annulus; Feasibility; Accuracy