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Three-Dimensional Printing for Planning Occlusion Procedure for a Double-Lobed Left Atrial Appendage

2016; Lippincott Williams & Wilkins; Volume: 9; Issue: 3 Linguagem: Inglês

10.1161/circinterventions.116.003561

1941-7632

Yiting Fan, Ka‐Wai Kwok, Yiqun Zhang, Gary Shing-Him Cheung, Anna Chan, Alex Pui‐Wai Lee,

Botulinum Toxin and Related Neurological Disorders

HomeCirculation: Cardiovascular InterventionsVol. 9, No. 3Three-Dimensional Printing for Planning Occlusion Procedure for a Double-Lobed Left Atrial Appendage Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessResearch ArticlePDF/EPUBThree-Dimensional Printing for Planning Occlusion Procedure for a Double-Lobed Left Atrial Appendage Yiting Fan, MM, Ka-Wai Kwok, PhD (Imp Lond), Yiqun Zhang, Gary Shing-Him Cheung, MBBS, Anna Kin-Yin Chan, MBChB and Alex Pui-Wai Lee, MD Yiting FanYiting Fan From the Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Y.F., G.S.-H.C., A.K.-Y.C., A.P.-W.L.); Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China (K.-W.K.); Cardiology Department, Renji Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, China (Y.F.); and Boston Scientific Institute for Advancing Science, Shanghai, China (Y.Z.). , Ka-Wai KwokKa-Wai Kwok From the Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Y.F., G.S.-H.C., A.K.-Y.C., A.P.-W.L.); Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China (K.-W.K.); Cardiology Department, Renji Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, China (Y.F.); and Boston Scientific Institute for Advancing Science, Shanghai, China (Y.Z.). , Yiqun ZhangYiqun Zhang From the Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Y.F., G.S.-H.C., A.K.-Y.C., A.P.-W.L.); Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China (K.-W.K.); Cardiology Department, Renji Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, China (Y.F.); and Boston Scientific Institute for Advancing Science, Shanghai, China (Y.Z.). , Gary Shing-Him CheungGary Shing-Him Cheung From the Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Y.F., G.S.-H.C., A.K.-Y.C., A.P.-W.L.); Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China (K.-W.K.); Cardiology Department, Renji Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, China (Y.F.); and Boston Scientific Institute for Advancing Science, Shanghai, China (Y.Z.). , Anna Kin-Yin ChanAnna Kin-Yin Chan From the Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Y.F., G.S.-H.C., A.K.-Y.C., A.P.-W.L.); Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China (K.-W.K.); Cardiology Department, Renji Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, China (Y.F.); and Boston Scientific Institute for Advancing Science, Shanghai, China (Y.Z.). and Alex Pui-Wai LeeAlex Pui-Wai Lee From the Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Y.F., G.S.-H.C., A.K.-Y.C., A.P.-W.L.); Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China (K.-W.K.); Cardiology Department, Renji Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, China (Y.F.); and Boston Scientific Institute for Advancing Science, Shanghai, China (Y.Z.). Originally published4 Mar 2016https://doi.org/10.1161/CIRCINTERVENTIONS.116.003561Circulation: Cardiovascular Interventions. 2016;9:e003561A 78-year-old woman with atrial fibrillation and contraindication to oral anticoagulation because of high bleeding risk was referred for catheter-based left atrial appendage (LAA) occlusion. Preprocedural transesophageal echocardiography (TEE) using the biplane mode showed an LAA with double-lobed anatomy with a dominant posterior lobe (p) and an accessory anterior lobe (a; Figure [A]). It was thought that successful LAA occluder implantation may be made more challenging by this anatomy because it is necessary to occlude the ostia of both lobes with the device. For better planning, we decided to simulate the actual procedure using three-dimensional (3D) printing technology. A computer-based hollow cast of the LAA was created from the 3D TEE data set and then converted to a stereolithography file for 3D printing using dedicated software (Mimics, Materialize Software, Leuven, Belgium; Figure [B]). An LAA model made of silicon was fabricated by 3D printing (Figure [C]). When a 24-mm Watchman device (d) was deployed in the phantom LAA directing toward the anterior lobe (a; Figure [D]), a large peri-device gap remains (arrow; Figure [E]; Movie I in the Data Supplement). Limited by the depth of the LAA, a larger device was deemed impossible to fit in. We thus attempted to deploy the device from an alternative direction by placing the delivery sheath in the posterior lobe lobe (p). As a result, both the anterior (red dotted line) and posterior (black dotted line) lobes were adequately covered (Figure [F]). En face view of the device (d) showed complete LAA seal (Figure [G]). Guided by these simulation results, a 24-mm WATHCMAN device (d) was deployed, completely sealing both the anterior (a) and the posterior lobes (p) without any peri-device leak (arrow; Figure [H]). Postimplantation 3D TEE showed complete LAA seal by the device (d; Figure [I]). Final device position was accurately predicted by phantom testing.Download figureDownload PowerPointFigure. Three-dimensional printing of a double-lobed left atrial appendage for simulation of the occlusion procedure using a Watchman device. A, Preprocedural transesophageal echocardiography (TEE) using the biplane mode. B, Computer-based hollow cast. C, Model made of silicon was fabricated by 3D printing. D, Watchman device deployed in simulation. E, Peri-device gap. F, Simulation showed coverage of both anterior and posterior lobes. G, En face view. H, Watchman device deployed. I, Postimplantation 3D TEE showed complete seal. a indiactes anterior lobe; d, Watchman device; and p, posterior lobe.Catheter-based LAA occlusion has emerged as an alternative to oral anticoagulation for reducing atrial fibrillation–related stroke risk.1 Currently, procedural planning for LAA occlusion was guided by TEE and fluoroscopy and procedural success rate is high. However, marked age- and sex-related differences in LAA anatomy exist. The existence of multilobed appendages is important in the accurate TEE evaluation of LAA. Fifty-four percent of LAAs had 2 lobes.2 Because lobes exist in different planes, imaging must be done in multiple planes to visualize the entire LAA. Complexity and variability of LAA morphology sometimes pose challenges to device implantation, potentially leading to repeated deployment attempts, incomplete seal, procedural complications, and failure.3 The process of 3D printing refers to the conversion of 3D computerized models into physical replica.4 It is now feasible to 3D print patient-specific LAA models from 3D data sets acquired by 3D imaging techniques using materials that mechanically mimic atrial soft tissues. This report illustrates the techniques and advantages of 3D printing in facilitating LAA occlusion in cases with challenging LAA anatomy by enhancing appreciation of LAA morphology and enabling simulation of device deployment before the actual procedure.Sources of FundingThis work is partially supported by General Research Fund of the Research Grant Committee (467812) and internal funding of the Department of Medicine and Therapeutics, The Chinese University of Hong Kong.DisclosuresDr Lee received research equipment support and speaker honorarium from Philips Healthcare. Mr Zhang was an employee of Boston Scientific Inc. The other authors report no conflicts.FootnotesThe Data Supplement is available at http://circinterventions.ahajournals.org/lookup/suppl/doi:10.1161/CIRCINTERVENTIONS.116.003561/-/DC1.Correspondence to Alex Pui-Wai Lee, MD, 9/F Department of Medicine and Therapeutics, Lui Che Woo Clinical Sciences Bldg, Prince of Wales Hospital, 30–32 Ngan Shing St, Shatin, N.T., Hong Kong SAR, China. E-mail [email protected]References1. Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, Mullin CM, Sick P; PROTECT AF Investigators. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial.Lancet. 2009; 374:534–542. doi: 10.1016/S0140-6736(09)61343-X.CrossrefMedlineGoogle Scholar2. Veinot JP, Harrity PJ, Gentile F, Khandheria BK, Bailey KR, Eickholt JT, Seward JB, Tajik AJ, Edwards WD.Anatomy of the normal left atrial appendage: a quantitative study of age-related changes in 500 autopsy hearts: implications for echocardiographic examination.Circulation. 1997; 96:3112–3115.LinkGoogle Scholar3. Viles-Gonzalez JF, Kar S, Douglas P, Dukkipati S, Feldman T, Horton R, Holmes D, Reddy VY.The clinical impact of incomplete left atrial appendage closure with the Watchman Device in patients with atrial fibrillation: a PROTECT AF (Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation) substudy.J Am Coll Cardiol. 2012; 59:923–929. doi: 10.1016/j.jacc.2011.11.028.MedlineGoogle Scholar4. Kim MS, Hansgen AR, Wink O, Quaife RA, Carroll JD.Rapid prototyping: a new tool in understanding and treating structural heart disease.Circulation. 2008; 117:2388–2394. doi: 10.1161/CIRCULATIONAHA.107.740977.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By DeCampos D, Teixeira R, Saleiro C, Oliveira-Santos M, Paiva L, Costa M, Botelho A and Gonçalves L (2022) 3D printing for left atrial appendage closure: A meta-analysis and systematic review, International Journal of Cardiology, 10.1016/j.ijcard.2022.03.042, 356, (38-43), Online publication date: 1-Jun-2022. Fan Y, Lam Y and Lee A (2021) 3D Printing for LAA Occlusion Cardiovascular 3D Printing, 10.1007/978-981-15-6957-9_7, (111-117), . Borracci R, Ferreira L, Alvarez Gallesio J, Tenorio Núñez O, David M and Eyheremendy E (2020) Three-dimensional virtual and printed models for planning adult cardiovascular surgery, Acta Cardiologica, 10.1080/00015385.2020.1852754, 76:5, (534-543), Online publication date: 16-Jul-2021. Ma Y, Ding P, Li L, Liu Y, Jin P, Tang J and Yang J (2021) Three-dimensional printing for heart diseases: clinical application review, Bio-Design and Manufacturing, 10.1007/s42242-021-00125-8, 4:3, (675-687), Online publication date: 1-Sep-2021. Ali A, Ballard D, Althobaity W, Christensen A, Geritano M, Ho M, Liacouras P, Matsumoto J, Morris J, Ryan J, Shorti R, Wake N, Rybicki F and Sheikh A (2020) Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions, 3D Printing in Medicine, 10.1186/s41205-020-00078-1, 6:1, Online publication date: 1-Dec-2020. Cheung G, So K, Chan C, Chan A, Lee A, Lam Y and Yan B (2019) Comparison of three left atrial appendage occlusion devices for stroke prevention in patients with non-valvular atrial fibrillation: a single-centre seven-year experience with WATCHMAN, AMPLATZER Cardiac Plug/Amulet, LAmbre, AsiaIntervention, 10.4244/AIJ-D-18-00013, 5:1, (57-63), Online publication date: 1-Feb-2019. Oliveira-Santos M, Oliveira-Santos E, Gonçalves L and Silva Marques J (2019) Cardiovascular Three-Dimensional Printing in Non-Congenital Percutaneous Interventions, Heart, Lung and Circulation, 10.1016/j.hlc.2019.04.020, 28:10, (1525-1534), Online publication date: 1-Oct-2019. Fan Y, Yang F, Cheung G, Chan A, Wang D, Lam Y, Chow M, Leong M, Kam K, So K, Tse G, Qiao Z, He B, Kwok K and Lee A (2019) Device Sizing Guided by Echocardiography-Based Three-Dimensional Printing Is Associated with Superior Outcome after Percutaneous Left Atrial Appendage Occlusion, Journal of the American Society of Echocardiography, 10.1016/j.echo.2019.02.003, 32:6, (708-719.e1), Online publication date: 1-Jun-2019. Bauch T, Connuck D, Mascarenhas V, Patel A, Stefanowicz E, Vijayaraman P and Harjai K (2019) Added Value of Practicing Cardiac Interventions Under Fluoroscopy Using Patient-Specific 3D Printed Cardiac Models, Structural Heart, 10.1080/24748706.2019.1628379, 3:5, (401-405), Online publication date: 1-Sep-2019. Fauchier L, Cinaud A, Brigadeau F, Lepillier A and Defaye P (2018) Reply, Journal of the American College of Cardiology, 10.1016/j.jacc.2018.05.028, 72:4, (474-475), Online publication date: 1-Jul-2018. Jin C, Yu H, Feng J, Wang L, Lu J and Zhou J (2018) Left Atrial Appendage Neck Modeling for Closure Surgery Statistical Atlases and Computational Models of the Heart. ACDC and MMWHS Challenges, 10.1007/978-3-319-75541-0_4, (32-41), . El Sabbagh A, Eleid M, Al-Hijji M, Anavekar N, Holmes D, Nkomo V, Oderich G, Cassivi S, Said S, Rihal C, Matsumoto J and Foley T (2018) The Various Applications of 3D Printing in Cardiovascular Diseases, Current Cardiology Reports, 10.1007/s11886-018-0992-9, 20:6, Online publication date: 1-Jun-2018. Anwar S, Singh G, Miller J, Sharma M, Manning P, Billadello J, Eghtesady P and Woodard P (2018) 3D Printing is a Transformative Technology in Congenital Heart Disease, JACC: Basic to Translational Science, 10.1016/j.jacbts.2017.10.003, 3:2, (294-312), Online publication date: 1-Apr-2018. Bartel T, Rivard A, Jimenez A, Mestres C and Müller S (2017) Medical three-dimensional printing opens up new opportunities in cardiology and cardiac surgery, European Heart Journal, 10.1093/eurheartj/ehx016, 39:15, (1246-1254), Online publication date: 14-Apr-2018. Foley T, El Sabbagh A, Anavekar N, Williamson E and Matsumoto J (2017) 3D-Printing: Applications in Cardiovascular Imaging, Current Radiology Reports, 10.1007/s40134-017-0239-3, 5:9, Online publication date: 1-Sep-2017. Grant E and Olivieri L (2017) The Role of 3-D Heart Models in Planning and Executing Interventional Procedures, Canadian Journal of Cardiology, 10.1016/j.cjca.2017.02.009, 33:9, (1074-1081), Online publication date: 1-Sep-2017. Meier L, Meineri M, Qua Hiansen J and Horlick E (2017) Structural and congenital heart disease interventions: the role of three-dimensional printing, Netherlands Heart Journal, 10.1007/s12471-016-0942-3, 25:2, (65-75), Online publication date: 1-Feb-2017. Zhu Y, Liu J, Wang L, Guan X, Luo Y, Geng J, Geng Q, Lin Y, Zhang L, Li X and Lu Y (2017) Preliminary study of the application of transthoracic echocardiography-guided three-dimensional printing for the assessment of structural heart disease, Echocardiography, 10.1111/echo.13715, 34:12, (1903-1908), Online publication date: 1-Dec-2017. Kim W, Cho I, Kim Y, Cha M, Kim S, Choi Y and Shin S (2022) Improving Left Atrial Appendage Occlusion Device Size Determination by Three-Dimensional Printing-Based Preprocedural Simulation, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2022.830062, 9 March 2016Vol 9, Issue 3 Advertisement Article InformationMetrics © 2016 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.116.003561PMID: 26945027 Manuscript receivedJanuary 3, 2016Manuscript acceptedFebruary 8, 2016Originally publishedMarch 4, 2016 Keywordsatrial fibrillationprintingatrial appendagePDF download Advertisement SubjectsAtrial FibrillationEchocardiographyTreatment