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Three-Dimensional Printing of a Complex Aortic Anomaly

Published: November 1st, 2018



1Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 2Shanghai Institute of Cardiovascular Disease, 3State Key Laboratory of Molecular Engineering of Polymers, Fudan University, 4Institutes of Biomedical Sciences, Fudan University, 5Meditool Shanghai Enterprise Co., Ltd.

Here, we present a protocol to use three dimensional printed models for pre-operative planning and intra-operative reorganization of complicated vascular locations when handling a congenital aortic anomaly.

Complex congenital aortic anomalies include diverse types of malformations that may be clinically asymptomatic or present with respiratory or esophageal symptoms. These anomalies may be associated with other congenital heart diseases. It is hard to identify the accurate anatomic vessel location from two-dimensional imaging data, such as computed tomography. As an additive manufacturing method, three-dimensional (3-D) printing can covert the acquired imaging data into 3-D physical models. This protocol describes the procedure for modeling the volumetric DICOM imaging into 3-D data and printing it as an anatomically realistic 3-D model. Using this model, surgeons can identify the vessel location of complex aortic anomalies, which is helpful for pre-operative planning and intra-operative guidance.

Congenital aortic anomalies are extremely rare congenital malformations of the aortic arch system. They can be diagnosed either by imaging analysis or by evaluation of entities like dysphagia or subclavian steal1. In clinical scenarios, it is important to identify the anatomical anomaly in the confined surgical space that has limited visualization during the surgery2,3. Currently, conventional planar two-dimensional (2-D) imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), are usually presented to surgeons before the surgery. However, it is difficult for surg....

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The present study was approved by the ethics committee of Zhongshan Hospital Fudan University (B2016-142R) and all participants gave their informed consent.

1. Diagnosis of the Aortic Anomaly by Symptoms and Acquisition of Imaging Data

  1. Identify patients who have symptoms such as chest pain, dysphagia, or a blood pressure difference of the upper limbs in out-patient clinic. Exclude patients who may be intolerant of the operation.
  2. Perform CT angiography in these patients to.......

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Acquisition of CT angiography images, digital modeling and 3-D printing were all done in a hospital. Two hours were spent to get the 3-D model from the CT angiography image ready for the 3-D printing. Using the procedure and 3-D printer here, a patient-specific 3-D physical model can be sent to physicians quickly and the surgical decision can be made in time. The workflow from acquisition of CT angiography data to 3-D printing was shown in Figure 1. From the .......

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Congenital aortic anomalies comprise a rare spectrum of cardiovascular diseases, which often show complex aortic anomalies. Medical imaging, such as CT and MR, are required to elucidate complex aortic arch anomalies, the abnormal branching pattern, their relationship with the trachea and the esophagus, and other associated pathologies. Both CT and MR angiography can provide 2-D information of aortic vessel locations. With 3-D digital reconstruction of 2-D imaging, the anatomical relationship of the aortic vessels can be .......

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The authors acknowledge funding from National Natural Science Foundation of China (No. 81771971), Shanghai Pujiang Program (No. 14PJD008 and 17PJ1401500), "Chen Guang" Project Supported by Shanghai Municipal Education Commission and Shanghai Education Development Foundation (No. 14CG06), Natural Science Foundation of Shanghai (Nos. 17411962800 and 17ZR1432900), and Science and Technology Commission of Shanghai Municipality (17JC1400200). W.Z. acknowledges funding from the National Natural Science Foundation of China (31501555 and 81772007, and 21734003), the China's 1000 Young Talents Program, Education Commission of Shanghai Municipality (Young Eastern Pr....

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Name Company Catalog Number Comments
3D printer Meditool Enterprise Co., Ltd For 3D printing
Chaos Version 2.0 Meditool Enterprise Co., Ltd For 3D segmentation and reconstruction

  1. Tanaka, A., Milner, R., Ota, T. Kommerell's diverticulum in the current era: a comprehensive review. General Thoracic and Cardiovascular Surgery. 63 (5), 245-259 (2015).
  2. Rosu, C., Dorval, J. F., Abraham, C. Z., Cartier, R., Demers, P. Single-stage hybrid repair of right aortic arch with Kommerell's Diverticulum. The Annals of Thoracic Surgery. 103 (4), e381-e384 (2017).
  3. Idrees, J., et al. Hybrid repair of Kommerell diverticulum. The Journal of Thoracic and Cardiovascular Surgery. 147 (3), 973-976 (2014).
  4. Kankala, R. K., et al. Fabrication of arbitrary 3-D components in cardiac surgery: from macro-, micro- to nanoscale. Biofabrication. 9 (3), 032002 (2017).
  5. Vukicevic, M., Mosadegh, B., Min, J. K., Little, S. H. Cardiac 3-D printing and its future directions. JACC Cardiovascular Imaging. 10 (2), 171-184 (2017).
  6. Yoo, S. J., Spray, T., Austin, E. H., Yun, T. J., van Arsdell, G. S. Hands-on surgical training of congenital heart surgery using 3-dimensional print models. The Journal of Thoracic and Cardiovascular Surgery. 153 (6), 1530-1540 (2017).
  7. Hermsen, J. L., et al. Scan, print, practice, perform: Development and use of a patient-specific 3-dimensionalprinted model in adult cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery. 153 (1), 132-140 (2017).
  8. Sun, X., Zhang, H., Zhu, K., Wang, C. Patient-specific three-dimensional printing for Kommerell's diverticulum. International Journal of Cardiology. 255, 184-187 (2018).
  9. Ota, T., Okada, K., Takanashi, S., Yamamoto, S., Okita, Y. Surgical treatment for Kommerell's diverticulum. The Journal of Thoracic and Cardiovascular Surgery. 131 (3), 574-578 (2006).
  10. Agematsu, K., Ueda, T., Hoshino, S., Nishiya, Y. Rupture of Kommerell diverticulum after total arch replacement. Interactive Cardiovascular and Thoracic Surgery. 11 (6), 800-802 (2010).

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