Structural and congenital heart disease interventions: the role of three-dimensional printing.

L M Meier,J Qua Hiansen,M Meineri,E M Horlick

doi:10.1007/s12471-016-0942-3

Abstract

Advances in catheter-based interventions in structural and congenital heart disease have mandated an increased demand for three-dimensional (3D) visualisation of complex cardiac anatomy. Despite progress in 3D imaging modalities, the pre- and periprocedural visualisation of spatial anatomy is relegated to two-dimensional flat screen representations. 3D printing is an evolving technology based on the concept of additive manufacturing, where computerised digital surface renders are converted into physical models. Printed models replicate complex structures in tangible forms that cardiovascular physicians and surgeons can use for education, preprocedural planning and device testing. In this review we discuss the different steps of the 3D printing process, which include image acquisition, segmentation, printing methods and materials. We also examine the expanded applications of 3D printing in the catheter-based treatment of adult patients with structural and congenital heart disease while highlighting the current limitations of this technology in terms of segmentation, model accuracy and dynamic capabilities. Furthermore, we provide information on the resources needed to establish a hospital-based 3D printing laboratory.Electronic supplementary materialThe online version of this article (doi: 10.1007/s12471-016-0942-3) contains supplementary material, which is available to authorized users.

Highlights

Structural heart disease intervention has been a rapidly growing field in interventional cardiology, involving a broadening variety of catheter-based treatment options for acquired and congenital heart defects
Transcatheter interventions have become the standard of care for several structural and functional abnormalities of heart valves, cardiac chambers and proximal vessels [1]
Hybrid 3D printed heart models of congenitally corrected transposition of the great arteries (TGA) [8] and dextroTGA after a Mustard operation [27] have been produced for illustrating the volume and morphologies of the chambers and proximal vessels

Summary

Introduction

Structural heart disease intervention has been a rapidly growing field in interventional cardiology, involving a broadening variety of catheter-based treatment options for acquired and congenital heart defects. The ability to generate a tangible 3D model of complex cardiac anatomy has made this a promising tool for education, preprocedural planning, and device testing in structural and congenital heart disease interventions (Fig. 1; [4,5,6]). Special software is required to process the source imaging datasets to generate a model via segmentation and export it as a stereolithographic (STL) file to be printed (Fig. 1). Available software (Mimics, Belgium) combines semi-automatic segmentation and manual editing in a single product and allows segmentation from all imaging modalities Freeware, such as ITK-SNAP or 3D Slicer [10, 11], is available but is less user friendly and currently limited to CT and MRI data. High resolution (16 microns), multi-durometer printing, multi-coloured printing, large build volume Very large build volumes can produce mechanically functional prints out of ceramics and metals, excellent surface quality and precision

Limitations

Limitations and challenges

Conclusion