3-dimensional printing for the diagnosis of left ventricular outflow tract obstruction after mitral valve replacement

Abstract

The objective of this study was to evaluate the use of the generation of 3D models and 3D prints of complex cases for physicians at the example of an intricate left ventricular outflow tract obstruction (LVOTO). LVOTO is a known complication of mitral valve surgery. A 38-year-old female patient with increasing dyspnoea after mitral valve replacement was referred to our centre. Echocardiography showed a strut of the bioprosthetic heart valve protruding into the left ventricular outflow tract. However, the diagnosis of a LVOTO was difficult based on echocardiography alone. Therefore, we fabricated a physical model of the left ventricular outflow tract, the mitral valve, the aortic valve and the left ventricle. With this physical model in hand, we were able to visualize the LVOTO and to discuss potential therapeutic options. Moreover, we were able to plan the subsequent redo surgery in detail using the model. This case shows the benefit of 3D printing technologies for surgeons and patients, not only for analysis, but also during the decision-making and pre-operative planning process.

Keywords: LVOTO 3D printing rapid; Prototyping mitral valve surgery.

Figure 1:

Echocardiography, computed tomography and illustrationof the patient’s left ventricular outflow tract obstruction pre-operational: it can be observed that one strut (5) of the bioprosthesis (4) is protruding into the left ventricular outflow tract (2), hindering the blood flow from the left ventricle (1) into the aorta (3). In the corresponding postoperational images, we can clearly see an unobstructed left ventricular outflow tract. The minimal diameter of the pre- and postoperational left ventricular outflow tract is highlighted in yellow. CT: computed tomography; TTE: transthoracic echocardiography.