Name: three-dimensional printing of a complex aortic anomaly
Uploaded: 2018-11-01T13:30:00
Description: Watch this Scientific Journal Video about Three-Dimensional Printing of a Complex Aortic Anomaly at JoVE.com

The authors acknowledge funding from National Natural Science Foundation of China (No. 81771971), Shanghai Pujiang Program (No. 14PJD008 and 17PJ1401500), &#34;Chen Guang&#34; 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&#39;s 1000 Young Talents Program, Education Commission of Shanghai Municipality (Young Eastern Professorship Award), and Science and Technology Commission of Shanghai Municipality (17JC1400200 and 16391903900).

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
<ol>
	<li>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.</li>
	<li>Perform CT angiography in these patients to...

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

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 ...

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 surgeons to image the anomaly based on the 2-D imaging. Consequently, they could encounter unpredictable difficulties while trying to separate the complex aortic vessels during surgery. Unpredictable injury to the vessel, the trachea and the esophagus could occur and result in disastrous outcomes.
In the last decade, 3-D imaging modeling has been used in cardiac surgery to help surgeons understand the complex anatomic anomaly4,5,6,7. Three-dimensional (3-D) printing technology can help convert the modeling data into a physical model. Compared with the digital reconstruction, 3-D printed physical models could present a better understanding of the anatomical details and provide an intuitional view of the malformation. For aortic anomaly surgery, the printed intuitional 3-D model is significant because poor understanding of aortic locations could be disastrous to patients. During the surgery, any mistake could lead to unpredictable bleeding and injury. Using the printed models, surgeons can fully understand the spatial relationships of aortic branches. During the surgery, the surgeons can also perform real-time review of the 3-D models to avoid confusion of the complex vascular locations.
Here, we present a protocol to apply 3-D printed models for pre-operative planning and intra-operative guidance while dealing with congenital aortic diseases. Kommerell&#39;s diverticulum, a type of complex congenital aortic anomaly, was selected as a case study. The steps include diagnosis based on computed tomography angiography (CTA) imaging, partitioning regions of interest, building 3-D models, preoperative surgical planning, and intra-operative reviewing of 3-D printed models8. This 3-D printing strategy could substantially reduce the risk of unpredictable tissue injury during the surgery.

<table border="0" cellpadding="0" cellspacing="0" width="911">
	<tbody>
		<tr height="25">
			<td height="25" style="height:25px;width:247px;">3D printer</td>
			<td style="width:231px;">Meditool Enterprise Co., Ltd</td>
			<td style="width:136px;"></td>
			<td style="width:297px;">For 3D printing</td>
		</tr>
		<tr height="25">
			<td height="25" style="height:25px;">Chaos Version 2.0</td>
			<td>Meditool Enterprise Co., Ltd</td>
			<td style="width:136px;"></td>
			<td>For 3D segmentation and reconstruction</td>
		</tr>
	</tbody>
</table>

three-dimensional printing of a complex 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.

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 ...

Watch this Scientific Journal Video about Three-Dimensional Printing of a Complex Aortic Anomaly at JoVE.com

Three-Dimensional Printing of a Complex Aortic Anomaly

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 ...

Research

JoVE Journal

Medicine

Heterotypic Three-dimensional In Vitro Modeling of Stromal-Epithelial Interactions During Ovarian Cancer Initiation and Progression

Heterotypic Three-dimensional In Vitro Modeling of Stromal-Epithelial Interactions During Ovarian Cancer Initiation and Progression

Epithelial ovarian cancers (EOCs) are the leading cause of death from gynecological malignancy in Western societies. Despite advances in surgical ...

Three-dimensional Imaging of Nociceptive Intraepidermal Nerve Fibers in Human Skin Biopsies

A punch biopsy of the skin is commonly used to quantify intraepidermal nerve fiber densities (IENFD) for the diagnosis of peripheral polyneuropathy 1,2. ...

Three Dimensional Cultures: A Tool To Study Normal Acinar Architecture vs. Malignant Transformation Of Breast Cells

Invasive breast carcinomas are a group of malignant epithelial tumors characterized by the invasion of adjacent tissues and propensity to metastasize. The ...

Quantification of Breast Cancer Cell Invasiveness Using a Three-dimensional (3D) Model

Quantification of Breast Cancer Cell Invasiveness Using a Three-dimensional 3D Model

It is now well known that the cellular and tissue microenvironment are critical regulators influencing tumor initiation and progression. Moreover, the ...

Three-dimensional Co-culture Model for Tumor-stromal Interaction

Cancer progression (initiation, growth, invasion and metastasis) occurs through interactions between malignant cells and the surrounding tumor stromal ...

Three-Dimensional (3D) Tumor Spheroid Invasion Assay

Three-Dimensional 3D Tumor Spheroid Invasion Assay

Invasion of surrounding normal tissues is generally considered to be a key hallmark of malignant (as opposed to benign) tumors. For some cancers in ...

Three-dimensional Alginate-bead Culture of Human Pituitary Adenoma Cells

A three-dimensional culture method is described in which primary pituitary adenoma cells are grown in alginate beads. Alginate is a polymer derived from ...

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

Multicolor 3D Printing of Complex Intracranial Tumors in Neurosurgery

Three-dimensional (3D) printing technologies offer the possibility of visualizing patient-specific pathologies in a physical model of correct dimensions. ...

Three-Dimensional Collagen Matrix Scaffold Implantation as a Liver Regeneration Strategy

Liver diseases are the leading cause of death worldwide. Excessive alcohol consumption, a high-fat diet, and hepatitis C virus infection promote fibrosis, ...