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. 2023 Nov;18(11):2111-2116.
doi: 10.1007/s11548-023-02870-w. Epub 2023 Mar 30.

MRI-based training model for left atrial appendage closure

Dagmar Bertsche  1 , Mona Pfisterer  1 , Tillman Dahme  1 , Leonhard-Moritz Schneider  1 , Patrick Metze  1 , Ina Vernikouskaya  1 , Volker Rasche  2
Affiliations

MRI-based training model for left atrial appendage closure

Dagmar Bertsche et al. Int J Comput Assist Radiol Surg. 2023 Nov.

Abstract

Purpose: Percutaneous closure of the left atrial appendage (LAA) reduces the risk of embolic stroke in patients with atrial fibrillation. Thereby, the optimal transseptal puncture (TSP) site differs due to the highly variable anatomical shape of the LAA, which is rarely considered in existing training models. Based on non-contrast-enhanced magnetic resonance imaging (MRI) volumes, we propose a training model for LAA closure with interchangeable and patient-specific LAA enabling LAA-specific identification of the TSP site best suited.

Methods: Based on patient-specific MRI data, silicone models of the LAAs were produced using a 3D-printed cast model. In addition, an MRI-derived 3D-printed base model was set up, including the right and left atrium with predefined passages in the septum, mimicking multiple TSP sites. The various silicone models and a tube mimicking venous access were connected to the base model. Empirical use of the model allowed the demonstration of its usability.

Results: Patient-specific silicone models of the LAA could be generated from all LAA patient MRI datasets. The influence of various combinations regarding TSP sites and LAA shapes could be demonstrated as well as the technical functionality of the occluder system. Via the attached tube mimicking the venous access, the correct handling of the deployment catheter even in case of not optimal puncture site could be practiced.

Conclusion: The proposed contrast-agent and radiation-free MRI-based training model for percutaneous LAA closure enables the pre-interventional assessment of the influence of the TSP site on the access of patient-specific LAA shapes. A straightforward replication of this work is measured by using clinically available imaging protocols and a widespread 3D printer technique to build the model.

Keywords: LAA closure; Training model; Transseptal puncture.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
a Segmentation (yellow) of the left atrium (LA), left atrial appendage (LAA), and right atrium (RA) based on the underlaying MRI image volume (transversal, coronal, and sagittal plane) with the resulting base model (red). b TSP sites in the base model with vena cava superior (VCS), vena cava inferior (VCI), RA, and LAA as landmarks, c base model (red) in 3D space with the underlaying segmentation (yellow)
Fig. 2
Fig. 2
Base model with advanced sheath (Watchman TrueSeal™ double curve, Boston Scientific Corporation, Marlborough, MA, USA) through vena cava inferior, TSP and LAA cutout
Fig. 3
Fig. 3
a Selection of different silicone models. b Clinically implanted occluder (WatchmanFLX, Boston Scientific, Marlborough, MA, USA) deployed into the respective silicone model
Fig. 4
Fig. 4
Examples of a optimal (sheath delivery to the LAA along the LAA’s neck axis) and b non-optimal (sheath delivery not along the LAA’s neck axis) transseptal puncture site in combination with specific LAA shape
See this image and copyright information in PMC

References

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