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3D printed cardiovascular models for surgical planning in complex congenital heart diseases

Authors:
Israel Valverde at Hospital Universitario Virgen del Rocío
Israel Valverde
Gorka Gomez-Ciriza at Hospital Universitario Virgen del Rocío
Gorka Gomez-Ciriza
Cristina Suárez at Servicio Andaluz de Salud
Cristina Suárez
Amir-Reza Hosseinpour
Amir-Reza Hosseinpour
Amir-Reza Hosseinpour
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Abstract and Figures

A precise understanding of the anatomical structures of the heart and great vessels is essential for surgical planning in order to avoid unexpected findings. Rapid prototyping techniques are used to print three-dimensional (3D) replicas of patients' cardiovascular anatomy based on 3D clinical images such as MRI. The purpose of this study is to explore the use of 3D patient-specific cardiovascular models using rapid prototyping techniques to improve surgical planning in patients with complex congenital heart disease.
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3D printed cardiovascular models for surgical planning in complex congenital heart diseas
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POSTER PRESENTATION Open Access
3D printed cardiovascular models for surgical
planning in complex congenital heart diseases
Israel Valverde
1,2*
, Gorka Gomez
3
, Cristina Suarez-Mejias
3
, Amir-Reza Hosseinpour
4
, Mark Hazekamp
5
, Arno Roest
6
,
Jaime F Vazquez-Jimenez
8
, Issam El-Rassi
7
, Sergio Uribe
9
, Tomas Gomez-Cia
3
From 18th Annual SCMR Scientific Sessions
Nice, France. 4-7 February 2015
Background
A precise understanding of the anatomical structures of
the heart and great vessels is essential for surgical plan-
ning in order to avoid unexpected findings. Rapid proto-
typing techniques are used to print three-dimensional
(3D) replicas of patients’cardiovascular anatomy based
on 3D clinical images such as MRI. The purpose of this
study is to explore the use of 3D patient-specific cardio-
vascular models using rapid prototyping techniques to
improve surgical planning in patients with complex con-
genital heart disease.
Methods
This European prospective multicenter study included 8
patients with complex congenital heart diseases (Figure 1).
Magnetic resonance imaging (MRI) and computed tomo-
graphy (CT) were used to acquire 3D cardiovascular anat-
omy. Images were segmented and 3D mesh was created
using AYRA software (IKIRIA, Spain). Fused deposition
technique using polylactic acid was used. A Bland-Altman
analysis was used to evaluate the diameters measurement
agreement between the 3D printed model and the patient’s
MRI and CT. 3D-models were used to plan the surgery.
After the procedure, surgeons involved filled a question-
naire form to evaluate the usefulness of the 3D printed
models to plan the surgery.
Results
The Bland-Altman analysis showed accurate agreement in
the diameter between medical images and 3D-models
(-0.12±1.40 mm, mean bias ± standard deviation, Figure 2).
3D-models showed the spatial relationships between the
ventricular septal defect and great vessels (Case2,Case-6,
Case-7,Case-8), re-appraisal for biventricular repair (Case-
1,Case-8), planning of lateral tunnel completion (Case3),
re-opening of a restrictive VSD and its relationship with
theconductivetissue(Case4)andevaluationofRVOT
aneurysm and pulmonary artery origin (Case 5). Surgeons
found the 3D models to be very useful for surgical planning
with an overall level of satisfaction of 8.5 out of 10, all
agreed (score 4 out of 5) that 3D-models they were helpful
to decrease possible surgical complications, strongly agree
(score 5 out of 5) that would recommend it to other collea-
gues as well as teaching for trainees.
Conclusions
3D-printed cardiovascular models accurately replicate
the patient’s anatomy and are extremely helpful for
planning surgery in complex congenital heart disease.
They may potentially reduce operative time and morbi-
mortality.
Funding
This research has been co-financed by Institute of
Health Carlos III - FIS research grant number PI13/
02319 from the Spanish Ministry of Science and
Innovation.
Authors’details
1
Cardiovascular Pathology Unit, Institute of Biomedicine of Seville (IBIS),
Seville, Spain.
2
Paediatric Cardiology, Hospital Virgen del Rocio, Seville, Spain.
3
Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain.
4
Cardiac Surgery Unit, Hospital Virgen del Rocio, Seville, Spain.
5
Department
of Cardiothoracic Surgery, University Hospital Leiden, Leiden, Netherlands.
6
Paediatric Cardiology, University Hospital Leiden, Leiden, Netherlands.
7
Pediatric Cardiac Surgery, American University Hospital Medical Center,
Beirut, Lebanon.
8
Pediatric Cardiac Surgery, University Hospital RWTH
Aachen, Aachen, Germany.
9
Department of Radiology and Biomedical
Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile.
Published: 3 February 2015
1
Cardiovascular Pathology Unit, Institute of Biomedicine of Seville (IBIS),
Seville, Spain
Full list of author information is available at the end of the article
Valverde et al.Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P196
http://www.jcmr-online.com/content/17/S1/P196
© 2015 Valverde et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attri bution License (http://c reativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and
reproductio n in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made availab le in this article, unless other wise stated.
doi:10.1186/1532-429X-17-S1-P196
Cite this article as: Valverde et al.: 3D printed cardiovascular models for
surgical planning in complex congenital heart diseases. Journal of
Cardiovascular Magnetic Resonance 2015 17(Suppl 1):P196.
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Figure 1 Study population demographics, medical images and 3D-models.
Figure 2 Bland-Altman analysis of 3D printed model
measurement accuracy. Measurement agreement between 3D
printed model direct calliper and medical images (MRI and CT) at
analogous anatomical locations. Mean (mean bias of difference),
LOA (limits of agreement, ±1.96 standard deviations). Values are
expressed as mm.
Valverde et al.Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P196
http://www.jcmr-online.com/content/17/S1/P196
Page 2 of 2
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