Utility of Three-Dimensional (3D) Modeling for Planning Structural Heart Interventions (with an Emphasis on Valvular Hea
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STRUCTURAL HEART DISEASE (RJ SIEGEL AND NC WUNDERLICH, SECTION EDITORS)
Utility of Three-Dimensional (3D) Modeling for Planning Structural Heart Interventions (with an Emphasis on Valvular Heart Disease) Ruchira Garg 1
&
Evan M. Zahn 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Advanced imaging has played a vital role in the contemporary, rapid rise of structural heart interventions. 3D modeling and printing has emerged as one of the most recent imaging tools and the implementation of 3D modeling is expected to increase with further advances in imaging, print hardware, and materials. Recent Findings 3D modeling can be used to educate patients and clinical teams, provide ex vivo procedural simulation, and improve outcomes. Intra-procedural success rates may be improved, and post-procedural complications can be predicted more robustly with appropriate application of 3D modeling. Recent advances in technology have increased the availability of this tool, such that there can be more ready adoption into a routine clinical workflow. Summary Familiarity with 3D modeling and its current utilization and role in structural interventions will help inform how to approach and adapt this exciting new technology. Keywords Structural . 3D modeling . 3D printing . Valve . Intervention . Transesophageal echocardiography
Introduction The last three decades have seen a shift in cardiovascular interventions bringing an increasing number of patients from the operating room to the catheterization suite. Transcatheter devices are now available to eliminate valvular regurgitation and stenosis, expand stenotic vessels, and occlude an everincreasing number of shunts and other vascular structures. This rapid rise in structural heart interventions has been greatly facilitated by commensurate advancements in imaging. Most recently, three-dimensional (3D) modeling has further enhanced our understanding of patient-specific cardiac anatomy as an educational tool, to predict intra-procedural behavior of catheter-implanted devices and improve post-procedural outcomes. This article is part of the Topical Collection on Structural Heart Disease * Ruchira Garg [email protected] Evan M. Zahn [email protected] 1
Smidt Heart Institute, Guerin Family Congenital Heart Program, Department of Cardiology and Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
3D models of cardiac structures can be generated from high-quality transesophageal echocardiography (TEE), CT, and magnetic resonance imaging (MRI) volumetric datasets (Fig. 1). Rotational angiography can also provide source data, with the caveat that high-quality source image data, irrespective of modality, is essential for 3D print quality. The images are exported from Digital Imaging and Communications in Medicine (DICOM) format into a commercial or open-source image processing software platform. Comprehensive analysis and post-processing then ensues which includes “segmentation,” a process of identifying target an
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