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. 2025 May;42(5):e70184.
doi: 10.1111/echo.70184.

Development of an Innovative Pipeline With Fusion, Digital Planning, and Three-Dimensional Printing to Improve Mitral Valve Interventional Care

Jelle P Man  1   2 , Berto J Bouma  1 , Folkert Asselbergs  1   3   4 , Steven A J Chamuleau  1 , Mark J Schuuring  5   6
Affiliations

Development of an Innovative Pipeline With Fusion, Digital Planning, and Three-Dimensional Printing to Improve Mitral Valve Interventional Care

Jelle P Man et al. Echocardiography. 2025 May.

Abstract

Aim: Transesophageal echocardiography (TEE) is the modality of choice for mitral valve (MV) interventional planning. However, computed tomography (CT) has been proposed as a standard screening tool for MV interventions to assess the risk of injury to the left circumflex artery. We aimed to develop a pipeline to fuse CT and MV modalities and create three-dimensional (3D) printable models of the MV apparatus to enhance interventional planning and assessed its usability among clinicians.

Methods and results: The design, production, and assessment of the 3D-printed personalized models were based on TEE enriched with data from CT. The digital pipeline consisted of fusion with a mutual information algorithm using 3D Slicer (Slicer) and Elastix toolboxes. Flexible 3D printing was performed using Agilus 30 Clear. The pipeline was feasible for achieving semiautomatic fusion of anatomical structures related to MV interventional planning. Visualization of fused synergistic information for 3D planning could be provided in three distinct cases of MV regurgitation (secondary MR with tenting, flail leaflet, and prolapse). The 3D printing resulted in a flexibility in line with actual tissue allowing for tactile modification. An average System Usability Score of 71 indicates a moderately good usability among imaging cardiologists, intervention cardiologists, and cardiac surgeons.

Conclusion: The presented pipeline with digital planning and personalized 3D printing has reached the technology readiness level for application in mitral valve interventions, and prospective clinical trials with endpoints of surgical effectiveness. Comprehensive and efficient interactions between clinicians and technical staff are essential to establish well-designed patient-specific interventions.

Keywords: 3D printing; fusion workflow; image registration; mitral valve; mitral valve repair; rapid prototyping.

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Conflict of interest statement

Prof. Dr. F. W. Asselbergs received grant funding from the European Union Horizon scheme (AI4HF 101080430 and DataTools4Heart 101057849). Dr. M. J. Schuuring received an independent research grant from AstraZeneca to the research institute and is supported by Stichting Hartcentrum Twente. The remaining authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
The CT slices display the location of the left trigone, posterior–anterior midpoint, and right trigone of the mitral valve.
FIGURE 2
FIGURE 2
Fusion overlay after the semiautomatic algorithm. A TEE segmentation of the mitral valve is transparently visualized as an overlay over CT slices.
See this image and copyright information in PMC

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References

    1. d'Arcy J. L., Coffey S., Loudon M. A., et al., “Large‐Scale Community Echocardiographic Screening Reveals a Major Burden of Undiagnosed Valvular Heart Disease in Older People: The OxVALVE Population Cohort Study,” European Heart Journal 37 (2016): 3515–3522. - PMC - PubMed
    1. Nkomo V. T., Gardin J. M., Skelton T. N., Gottdiener J. S., Scott C. G., and Enriquez‐Sarano M., “Burden of Valvular Heart Diseases: A Population‐Based Study,” Lancet 368 (2006): 1005–1011. - PubMed
    1. Dziadzko V., Clavel M., Dziadzko M., et al., “Outcome and Undertreatment of Mitral Regurgitation: A Community Cohort Study,” Lancet (London, England) 391 (2018): 960–969. - PMC - PubMed
    1. Sardari Nia P., Daemen J. H. T., and Maessen J. G., “Development of a High‐Fidelity Minimally Invasive Mitral Valve Surgery Simulator,” Journal of Thoracic and Cardiovascular Surgery 157 (2019): 1567–1574. - PubMed
    1. Vahanian A., Beyersdorf F., Praz F., et al., “2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease: Developed by the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio‐Thoracic Surgery (EACTS),” European Heart Journal 43 (2022): 561–632. - PubMed

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