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. 2022 Apr 14;39(2):Doc23.
doi: 10.3205/zma001544. eCollection 2022.

3D-printed heart models for hands-on training in pediatric cardiology - the future of modern learning and teaching?

Barbara S Brunner  1 , Alisa Thierij  1 , Andre Jakob  1 , Anja Tengler  1 , Maximilian Grab  2 , Nikolaus Thierfelder  2 , Christian J Leuner  3 , Nikolaus A Haas  1 , Carina Hopfner  1
Affiliations

3D-printed heart models for hands-on training in pediatric cardiology - the future of modern learning and teaching?

Barbara S Brunner et al. GMS J Med Educ. .

Abstract
in English, German

Background: This project aims to develop a new concept in training pediatric cardiologists to meet the requirements of interventional cardiac catheterizations today in terms of complexity and importance. This newly developed hands-on training program is supposed to enable the acquisition of certain skills which are necessary when investigating and treating patients in a catheter laboratory.

Methods: Based on anonymous CT-scans of pediatric patients' digital 3D heart models with or without cardiac defects were developed and printed three-dimensionally in a flexible material visible under X-ray. Hands-on training courses were offered using models of a healthy heart and the most common congenital heart defects (CHD). An evaluation was performed by quantifying fluoroscopy times (FL-time) and a questionnaire.

Results: The acceptance of theoretical and practical contents within the hands-on training was very positive. It was demonstrated that it is possible to master various steps of a diagnostic procedure and an intervention as well as to practice and repeat them independently which significantly reduced FL-time. The participants stated that the hands-on training led to more confidence in interventions on real patients.

Conclusion: With the development of a training module using 3D-printed heart models, basic and advanced training in the field of diagnostic cardiac examinations as well as interventional therapies of CHD is possible. The learning effect for both, practical skills and theoretical understanding, was significant which underlines the importance of integrating such hands-on trainings on 3D heart models in education and practical training.

Zielsetzung: Ziel dieses Projektes ist die Entwicklung eines neuen Aus- und Weiterbildungskonzepts in der Kinderkardiologie, um der zunehmenden Komplexität und dem Stellenwert interventioneller Eingriffe mittels Herzkatheter (HK) gerecht zu werden. Das neu entwickelte Hands-on Training soll den Erwerb entsprechender Fertigkeiten für die Durchführung der HK-Untersuchung an Patient*innen ermöglichen.

Methodik: Basierend auf anonymisierten CT-Bildern von pädiatrischen Patient*innen wurden digitale 3D-Herzmodelle entwickelt und in einem flexiblen, unter Röntgenstrahlung sichtbaren Material dreidimensional ausgedruckt. Es fanden Hands-on Trainingskurse statt, bei denen Modelle eines gesunden Herzens sowie der häufigsten angeborenen Herzfehler (AHF) zum Einsatz kamen. Eine Evaluation erfolgte anhand der Quantifizierung von Durchleuchtungszeiten (DL-Zeit) und eines Fragebogens.

Ergebnisse: Die Akzeptanz der theoretischen und praktischen Inhalte des Hands-on Trainings war sehr gut. Es hat sich gezeigt, dass sowohl das Erlernen diverser Schritte als auch selbstständiges Üben und Wiederholen und eine damit verbundene signifikante Verkürzung der benötigten DL-Zeit möglich sind. Die Teilnehmenden gaben an, dass das Hands-on Training zu mehr Sicherheit bei der Intervention an Patient*innen führen würde.

Schlussfolgerung: Mit der Entwicklung eines Trainingsmoduls unter dem Einsatz 3D-gedruckter Herzmodelle sind Aus- und Weiterbildung im Bereich diagnostischer HK-Untersuchungen sowie interventioneller Therapien von AHF möglich. Der signifikante Lerneffekt sowohl für die praktischen Fähigkeiten als auch für das theoretische Verständnis spricht für die Integration des Simulationstrainings an 3D-Herzmodellen in Aus- und Weiterbildung.

Keywords: 3D-printed models; congenital heart defects; diagnostic and interventional cardiac catheterizations; medical education,; pediatric cardiology; simulation training.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. 3D-printed heart models in different sizes
The image shows 3D models of the heart in different sizes, i.e., of an adult, a teenager, and an infant. The heart models for the hands-on training were printed in an additive manufacturing process on a 3D-printer (Agilista 3200W, Keyence Corp.) using a flexible silicon rubber.
Figure 2
Figure 2. Baby doll with 3D-printed heart model inside the chest
A) The doll is positioned on the catherization table like a real patient. B) The 3D-printed heart model of a healthy heart inside the doll can be seen under anterior-posterior fluoroscopy.
Figure 3
Figure 3. Demonstration of the correct handling of the guide wire
A) It was demonstrated how the guide wire is inserted into the catheter and moved forward using one hand. B) It was demonstrated how the long wire can be folded into loops when outside of the catheter to ensure sterile handling.
Figure 4
Figure 4. Influence of the projection levels on the anatomic representation during fluoroscopy of a 3D-printed left heart with physiological anatomy in two planes (Aorta = aortic arch, LV = left ventricle, LA = left atrium)
A) Representation of a 3D-printed heart model in anterior-posterior fluoroscopy. B) Representation of a 3D-printed heart model in lateral fluoroscopy.
Figure 5
Figure 5. Fluoroscopic documentation of a balloon dilatation of a valvular stenosis within the 3D-printed heart model
A) Balloon dilatation of a valvular aortic stenosis. The inflated balloon is positioned at the level of the aortic valve. The long guide wire is inserted via the descending aorta with its tip lying in the left ventricle. B) Balloon dilatation of a valvular pulmonary stenosis. The inflated balloon is positioned at the level of the pulmonary valve. The long guide wire is inserted via the vena cava inferior through the right atrium into the right ventricle with its tip lying in the right pulmonary artery. (Aorta = aortic arch, AS = aortic stenosis, PS = pulmonary stenosis, LV = left ventricle, LA = left atrium, RV = right ventricle, RA = right atrium).
Figure 6
Figure 6. Development of the median distribution of fluoroscopy times of all participants (n=11) in three training rounds
The median fluoroscopy time could be reduced from 218 seconds in the beginning to 104 seconds at the end of the third training round. Attention needs to be paid to the fact that the 1st and 2nd round were performed on the model of a healthy heart whereas the same steps were performed on a model with valvular pulmonary stenosis in the 3rd round. Thus, the last round contained an additional difficulty because the wire and catheter had to be steered past the obstacle of the pulmonary valve stenosis. Nevertheless, a significant difference, i.e., decrease of fluoroscopy time, among these three rounds could be shown. (Sign test: *p<0,05, ***p<0,001).
Figure 7
Figure 7. Responses of all participants (n=19) divided into approval and rejection regarding the suitability of 3D-printed heart models to learn the steps of a catheter intervention
Altogether the data showed a broad acceptance regarding the suitability of learning the steps of cardiac catheterization using 3D-printed heart models. All participants (n=19) agreed that changing a catheter can be trained on the models. Only few participants felt that the heart models were less suitable to learn how to insert a sheath and wire and to dilate a stenosis (n=18).
Figure 8
Figure 8. Responses of all participants (n=19) divided into approval and rejection regarding the suitability for certain learning contents
All participants (n=19) agreed that it is possible to practice and repeat independently as well as to learn the handling of catheterization devices. Only few participants felt that the training on 3D-printed heart models was less suited for understanding the anatomy of the heart and the procedure of catheter interventions. The were no rejections.
Figure 9
Figure 9. Assessment of possible benefits of the 3D hands-on training
The responses were divided by level of experience (inexperienced (n=14, one abstention), moderately experienced (n=2), experienced (n=3)). For the assessment of possible benefits of the 3D hands-on training the participants’ level of experience was considered. Regardless of the level of experience all participants wished to have more possibilities to use this new method of training. All participants also agreed that the practice on 3D-printed heart models could lead to more confidence when intervening on patients.
See this image and copyright information in PMC

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