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. 2020 Dec;6(2):72-76.
doi: 10.4244/AIJ-D-19-00013. Epub 2020 Dec 2.

Evaluation of a portable assembly catheter simulator using a 3D-printed heart model for percutaneous transvenous mitral commissurotomy in developing countries: Catheter simulator for PTMC

Xiaoyang Song  1 , Naritatsu Saito  1 , Yoshimas Nagata  2 , Afzalur Rahman  3 , Martin M Murage  4 , Farhana Ahmed  3 , Mohammad Arifur Rahman  3 , Tariq Ahmed Chowdhury  3 , Bernard Muriuki Gitura  4 , Christine Awuor Yuko-Jowi  4 , Peter Muriithi Nyamu  4 , Takeshi Kimura  1 , Kanji Inoue  2
Affiliations

Evaluation of a portable assembly catheter simulator using a 3D-printed heart model for percutaneous transvenous mitral commissurotomy in developing countries: Catheter simulator for PTMC

Xiaoyang Song et al. AsiaIntervention. 2020 Dec.

Abstract

Aims: We developed a catheter simulator for percutaneous transvenous mitral commissurotomy (PTMC) based on the data from a patient with mitral valve stenosis. The simulator has the following characteristics: 1) the simulator is portable and easy to assemble and disassemble, 2) the cardiac portion is created using a 3D-printer, based on patient computed tomography data, 3) the simulator uses a foot-operated water pump to create pulsatile flow, and 4) the fossa ovalis in the atrial septum of the heart model is made of a thin polyurethane membrane and is interchangeable. We aimed to assess the effectiveness of this novel simulator for training in PTMC using the Inoue balloon in developing countries.

Methods and results: We used this simulator for training in the National Institute of Cardiovascular Diseases in Bangladesh (13 physicians), and in Kenyatta National Hospital in Kenya (11 physicians). The effectiveness of training was evaluated by questionnaire and the procedure time in simulation. The questionnaire obtained from the trainees showed that the model scored 4.7±0.5 for realism, utility of pulsatile flow scored 4.7±0.5, simulator utility scored 4.9±0.3, and the effect of training on PTMC performance scored 4.9±0.5. The procedure time in simulation was shortened from 30.0±12.6 min (first time), to 23.4±11.9 min (second time) and to 20.4 ± 11.1 min (third time) (p<0.01).

Conclusions: The novel portable assembly catheter simulator using a 3D-printed heart model for PTMC received positive comments and improved the skills of trainees.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Percutaneous transvenous mitral commissurotomy simulator using a 3D-printed heart model. A) Design of the heart model (frontal view). The right and left ventricles are omitted to better visualise the catheter movement. B) The cardiac portion is created using a 3D-printer based on patient computed tomography data. The fossa ovalis in the atrial septum is made of an interchangeable thin polyurethane membrane. C) Overall view of the simulator. D) Simulator packed away in its water tank.
Figure 2.
Figure 2.
The translucent cap of the suction tube covering the mitral annulus. The suction tube is connected to a foot pump creating pulsatile flow that sucks the Inoue balloon catheter into the translucent cap.
Figure 3.
Figure 3.
Questionnaire for assessing efficacy of catheter simulator training.
Figure 4.
Figure 4.
Change in simulation procedure time during training. The blue marker indicates the procedure time of each participant in National Institute of Cardiovascular Disease in Bangladesh, and the red marker indicates the procedure time of each participant in Kenyatta National Hospital in Kenya. Note that the procedure time in simulation was not recorded in three trainees in KNH.
Figure 5.
Figure 5.
Simulation training and observation and education in an actual percutaneous transvenous mitral commissurotomy (PTMC). A) Simulation training in National Institute of Cardiovascular Disease (NICVD; B) Actual PTMC in NICVD; C) Simulation training in Kenyatta National Hospital (KNH); D) Actual PTMC in KNH.
See this image and copyright information in PMC

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