Abstract
Objective:Advanced cardiovascular surgery in structural heart disease require accurate pre-operative evaluation. Most of non-invasive imaging technologies remain limited in two-dimensional and show insufficiency of visualization for procedural planning. The aim of this study was to discuss the value of patient-specific 3-dimensional (3D) printing in treatment of hypertrophic cardiomyopathy (HCM).Methods:Patient-specific 3D-printed models were constructed preoperatively in 12 consecutive HOCM patients which come to Beijing Anzhen Hospital for surgical treatment from October 2016 to March 2017. Image files were extracted from multi-slice computed tomography images, 3D models were constructed by the Mimics 19.0 software and generated by Objet350 Connex3 3D printer. The 3D-printed models were made with soft material that can be surgically performed. The modified Morrow myectomy of the model was performed before the operation. Clinical characters and echocardiographic parameters were recorded.Results:There was no significant difference in tissue volume between the models and specimens. Preoperative and postoperative echocardiography showed the septal thickness was reduced from 18.8±4.5 mm to 12.7±3.3 mm (p<0.001), the left ventricular outflow tract obstruction was adequately relieved (83.0±27.73 mm Hg to 8.7±6.5 mm Hg, p<0.001), and the SAM disappeared completely after the operation. Cardiac function was improved in all patients (New York Heart Association functional class III to class I/II).Conclusions:The proposed optimal 3D-modelled septal myectomy allows intraoperative monitoring of the shape and volume of the myocardium resection to achieve the ‘ideal’ interventricular septum. It eliminates obstruction in the LVOT and SAM, resulting in LV remodeling with an increase in LV end-diastolic volume and diameter at early follow-up.
Highlights
Hypertrophic cardiomyopathy (HCM) is an inheritable cardiovascular disease characterized by unexplained left ventricular hypertrophy, left ventricular outflow tract (LVOT) obstruction, and systolic anterior motion (SAM) of the mitral valve, with a prevalence of approximately 1:500 in the general population.[1]
Twelve consecutive hypertrophic obstructive cardiomyopathy (HOCM) patients who came to Beijing Anzhen Hospital for surgical treatment from October 2016 to March 2017 were included in the study
Septal myectomy was performed in all patients
Summary
Hypertrophic cardiomyopathy (HCM) is an inheritable cardiovascular disease characterized by unexplained left ventricular hypertrophy, left ventricular outflow tract (LVOT) obstruction, and systolic anterior motion (SAM) of the mitral valve, with a prevalence of approximately 1:500 in the general population.[1] Patients with HCM are associated with a variety of symptom that range from dyspnea to syncope. Interventricular septum hypertrophy may focus on basal, midventricular, apical, and mixed types.[2] The representative pathophysiology of HCM is SAM of mitral valve which contribute to the obstruction of LVOT and different degree of mitral valve regurgitation.[3]. Medical treatment is the first-line therapy for symptomatic patients with LVOT obstruction; septal myectomy is the procedure of choice if medical treatment is unsuccessful or intolerable.[4,5] Sometimes, because the anatomy of HCM is complex, septal myectomy remains difficult to learn for young cardiac surgeons. A main challenge of septal myectomy is how to alleviate LVOT gradient completely
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