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Comparison of 3D Echocardiogram-Derived 3D Printed Valve Models to Molded Models for Simulated Repair of Pediatric Atrioventricular Valves

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Abstract

Mastering the technical skills required to perform pediatric cardiac valve surgery is challenging in part due to limited opportunity for practice. Transformation of 3D echocardiographic (echo) images of congenitally abnormal heart valves to realistic physical models could allow patient-specific simulation of surgical valve repair. We compared materials, processes, and costs for 3D printing and molding of patient-specific models for visualization and surgical simulation of congenitally abnormal heart valves. Pediatric atrioventricular valves (mitral, tricuspid, and common atrioventricular valve) were modeled from transthoracic 3D echo images using semi-automated methods implemented as custom modules in 3D Slicer. Valve models were then both 3D printed in soft materials and molded in silicone using 3D printed “negative” molds. Using pre-defined assessment criteria, valve models were evaluated by congenital cardiac surgeons to determine suitability for simulation. Surgeon assessment indicated that the molded valves had superior material properties for the purposes of simulation compared to directly printed valves (p < 0.01). Patient-specific, 3D echo-derived molded valves are a step toward realistic simulation of complex valve repairs but require more time and labor to create than directly printed models. Patient-specific simulation of valve repair in children using such models may be useful for surgical training and simulation of complex congenital cases.

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Abbreviations

3D:

Three-dimensional

2D:

Two-dimensional

3DE:

Three-dimensional echocardiogram

Echo:

Echocardiogram

DICOM:

Digital imaging in medicine

CAVC:

Complete atrioventricular canal

HLHS:

Hypoplastic left heart syndrome

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Acknowledgements

We would like to thank the 3D core sonographers group at The Children’s Hospital of Philadelphia (CHOP) for their outstanding images as well as the 3D printing facility at CHOP and the congenital cardiac surgical fellows who tested the valves.

Funding

This work was supported by the Department of Anesthesia and Critical Care at The Children’s Hospital of Philadelphia, the National Institute of Biomedical Imaging and Bioengineering (NIBIB) (P41 EB015902), Cancer Care Ontario with funds provided by the Ontario Ministry of Health and Long-Term Care and the Natural Sciences and Engineering Research Council of Canada.

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Author notes

  1. Adam B. Scanlan and Alex V. Nguyen contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Adam B. Scanlan, Alex V. Nguyen, Linnea Cripe, Francis X. McGowan & Matthew A. Jolley

  2. Laboratory for Percutaneous Surgery, Queen’s University, Kingston, ON, USA

    Anna Ilina, Andras Lasso & Gabor Fichtinger

  3. Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Elizabeth Silvestro

  4. Division of Pediatric Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Anusha Jegatheeswaran, Meryl S. Cohen & Matthew A. Jolley

  5. Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Christopher E. Mascio, Stephanie Fuller & Thomas L. Spray

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  1. Adam B. Scanlan
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  2. Alex V. Nguyen
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  3. Anna Ilina
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  14. Matthew A. Jolley
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Corresponding author

Correspondence to Matthew A. Jolley.

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The authors declare they have no conflict of interest.

Ethical Approval

All procedures performed on humans were in accordance with the ethical standards of the Children’s Hospital of Philadelphia and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Scanlan, A.B., Nguyen, A.V., Ilina, A. et al. Comparison of 3D Echocardiogram-Derived 3D Printed Valve Models to Molded Models for Simulated Repair of Pediatric Atrioventricular Valves. Pediatr Cardiol 39, 538–547 (2018). https://doi.org/10.1007/s00246-017-1785-4

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