Application of Echocardiographic Three-Dimensional Printed Left Atrial Appendage Model to Guide Transcatheter Left Atrial Appendage Occlusion

Abstract

This study aimed to determine the feasibility of three dimensional (3D) printed left atrial appendage (LAA) models based on 3D transesophageal echocardiography (3D TEE) data and its application value in the interventional LAA closure. Eighteen patients who had interventional LAA occlusion underwent pre-procedure TEE and cardiac CT. TEE 3D full volume raw data of the LAA were acquired and post-processed to create a 3D model file. Two modes of the LAA model (cardiac chamber model, cardiac wall model) were printed out by 3D printer. The LAA morphologic classification was assessed by 3D printed chamber model and the LAA dimension measurement was performed on 3D printed wall model. Additionally, preoperative rehearsal was performed on the 3D printed cardiac wall models in the cases with complex LAA structure. In all the patients, 3D TEE full volume data of the LAA were successfully reprocessed and printed out as 3D LAA chamber models and 3D LAA wall models. The consistency of LAA morphologic classification judgment based on 3D printed models and cardiac CT was 0.918 (P<0.01).The LAA ostium dimension measured on 3D printed model was greater than 2D TEE (P<0.01) and smaller than X-ray (P=0.02), and the LAA depth was greater than 2D TEE (P<0.01) whereas was not significantly different with X-ray (P=0.54).Based on 3D model morphology, there were 3 complex LAA which were recommended a particular occlusion plan after pre-procedure rehearsal on 3D model. The occlusion success rate was 100%. Echocardiographic 3D printing technique is feasible and have promising value in supporting planning the transcatheter LAA occlusion.