Implementation of 3D Printing in Medical Care for Preoperative Planning of Complex Ventricular Septal Defect

Abstract

Three-dimensional (3D) modeling and printing in medicine have emerged to encompass every aspect of medical applications. This ranges from education, illustration, and treatment, as well as patient care whether for purposes of diagnosis or treatment and surgical planning. In the past few decades, these novel tools have shown promising utility to help radiologists and the medical team to improve quality of patient care and outcomes via 3D printing application and utilization. This workflow will be illustrated through a ventricular septal defect (VSD) case at which 3D analysis was critical in the assessment and treatment planning of the patient's underlying medical condition.

Keywords: 3D Modeling; 3D Printing; 3D Printing Applications in Cardiac Imaging; 3D Printing in Medicine; Presurgical planning; Ventricular Septal Defect.

Figure 1

An 82-year-old female with history of multiple cardiac comorbidities presented with chest pain after lumbar spine surgery at an outside hospital. FINDINGS: 12-lead electrocardiogram showing sinus rhythm and right bundle branch block, which could be related the patient’s reported history of prior myocardial infarction. TECHNIQUE: 12 lead Electrocardiogram.

Figure 2

An 82-year-old female with history of multiple cardiac comorbidities. FINDINGS: 2D echocardiogram at the level of the aortic valve demonstrates thickening of the aortic valve leaflets indicating aortic stenosis. A blue jet of color flow in the proximal aorta suggesting a superimposed component of aortic regurgitation. TECHNIQUE: 2D Doppler ultrasound echocardiogram at the level of the aortic valve, using 12Hz frequency probe.

Figure 3

An 82-year-old female with history of multiple cardiac comorbidities. FINDINGS: 2D echocardiogram ultrasound at the level of the interventricular septum demonstrates ventricular septal defect and left to right ventricular shunt, indicated by a blue color flow jet. TECHNIQUE: 2D Doppler ultrasound echocardiogram at the level of the interventricular septum using 14Hz frequency probe.

Figure 4

An 82-year-old female with history of multiple cardiac comorbidities. FINDINGS: Arterial phase coronal contrast enhanced computed tomography image of the heart demonstrates a small interventricular defect involving the inferior muscular aspect of the interventricular septum with complex morphology measuring approximately 1.1 cm in diameter. This finding was presumed to be related to the patient’s reported history of prior myocardial infarction. TECHNIQUE: 2D reformatted coronal CT, 430 mAs, 100 kV, 1 mm slice thickness, 60 ml of Isovue-370 contrast intravenous contrast.

Figure 5

An 82-year-old female with history of multiple cardiac comorbidities status post left heart catheterization fluoroscopic procedure. FINDINGS: Left femoral artery catheterization fluoroscopic exam demonstrates multifocal areas of high grade right coronary artery stenosis (yellow arrows) near the origin (Figure 5a). Post-stenting image shows improvement in the sites of focal right coronary artery stenosis (Figure 5b). TECHNIQUE: Fluoroscopic images of the chest at the level of the right coronary artery after the administration of Isovue-370 intravenous iodinated contrast.

Figure 6

An 82-year-old female with history of multiple cardiac comorbidities status post left heart catheterization fluoroscopic procedure. FINDINGS: Left femoral artery catheterization fluoroscopic exam demonstrates successful placement of percutaneous transcatheter aortic valve repair using a 26 mm Sapien aortic valve bioprosthesis (Figures 6a-b). TECHNIQUE: Fluoroscopic images of the chest at the level of the aortic valve after the administration of Isovue-370 intravenous iodinated contrast.

Figure 7

An 82-year-old female with history of multiple cardiac comorbidities status post right coronary artery stenting and percutaneous aortic valve repair procedure. FINDINGS: 12-lead electrocardiogram demonstrates new complete atrioventricular block likely post-procedural in etiology. TECHNIQUE: 12 lead Electrocardiogram.

Figure 8

An 82-year-old female with history of multiple cardiac comorbidities status post right coronary artery stenting and percutaneous aortic valve repair procedure. FINDINGS: right femoral venous catheterization fluoroscopic exam demonstrates successful placement of cardiac pacing triple-lead device using ACCOLADE™ pacemaker (Boston Scientific, model L301). TECHNIQUE: Fluoroscopic images of the chest at the level of the cardiac silhouette.

Figure 9

An 82-year-old female with history of multiple cardiac comorbidities status post cardiac pacing device placement. FINDINGS: 12-lead electrocardiogram demonstrates electronic atrial pacemaker tracer, intraventricular conduction delay, and resolution of the previously seen right bundle branch block. TECHNIQUE: 12 lead Electrocardiogram.

Figure 10

An 82-year-old female with history of multiple cardiac comorbidities status post percutaneous aortic valve repair. FINDINGS: 2D echocardiogram at the level of the aortic valve demonstrates successful placement of transcatheter aortic valve repair using a 26 mm Sapien aortic valve bioprosthesis. Transvalvular peak velocity: 102 cm/s and mean velocity: 67.5 cm/s; left ventricular outflow tract to aortic valve ratio: 0.76, which indicates resolution of the aortic stenosis. TECHNIQUE: 2D echocardiogram at the level of the aortic valve using high frequency ultrasound probe to assess for percutaneous aortic valve prothesis placement.

Figure 11

An 82-year-old female with history of multiple cardiac comorbidities. A 3D heart model designed using software assembly: Mimics Innovation Suite Medical 20.0 and 3-matic 12.0, by Materialise©-FDA cleared medical application, which shows complex anatomy with three ventricular septal defect fenestrations (red labels).

Figure 12

An 82-year-old female with history of multiple cardiac comorbidities. Figure 12a: 3D heart model created using software assembly: Mimics Innovation Suite Medical 20.0 and 3-matic 12.0, by Materialise©-FDA cleared medical application, which shows complex anatomy with three ventricular septal defect fenestrations. Figure 12b: 3D final silicon print of the heart defect created using Form2-SLA Printer, offered by Formlabs employing liquid resin. The ventricular septal defect as shown in the zoomed 3D print image (outlined by a red marker) shows a complex anatomy with three fenestrations, separated by thin membrane, not a single defect as presumed initially. The three fenestrations are of various sizes: 2 mm (the most inferior fenestration), 11 mm (the top left side of the image), and 15 mm (the top right side of the image).