3D Printing & Echocardiography
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1 ASE SOTA Feb 19, D Printing & Echocardiography Stephen H. Little, MD John S. Dunn Chair in Cardiovascular Research and Education, Associate professor, Weill Cornell Medicine Disclosures Personal research support: Abbott Structural Heart; Medtronic Institutional support: Abbott, Medtronic, Edwards, Boston Scientific 1
2 Rapid Prototyping 101 Complex Geometry + Multi-Material Fusion = Functional Anatomy (?) ARS Question # 1 Audience poll Finish this sentence.at my institution we use 3D printing to: 1. Plan all complex structural heart procedures. 2. Plan for selected complex structural heart procedures. 3. As a research tool with very little clinical usage. 4. What the heck is 3D printing? We never use it. 2
3 ARS Question # 1 Audience poll Finish this sentence.at my institution we use 3D printing to: 1. Plan all complex structural heart procedures. 2. Plan for selected complex structural heart procedures. 3. As a research tool with very little clinical usage. 4. What the heck is 3D printing? We never use it. = Correct / ideal answer CV 3D Print Applications Anatomic Teaching Tools Functional Flow Modeling Procedural Planning Device Innovation 3
4 The 3D printing steps AVA Replication 4
5 Aortic Root Replication Maragiannis et al. Circ Cardiovasc Imaging HeartBeat Simulator Setup Plan to TAVR Pressure Tx Arterial Compliance Chamber Arterial Resistance Clamp Patient-Specific LVOT Model Venous Reservoir Flow Probe Pressure Tx Mechanical Mitral Valve Flow Probe Pulsatile Pump 5
6 Stress (MPa) Stress (MPa) 2/20/2018 Patient-Specific LVOT Model Calcific Aortic Valve Stenosis Model Pulsatile flow across a 3D printed model Mechanical Testing of Print Materials Calcific Compression Test Tensile Test E= 62 MPa 0.1 E= 0.4 MPa Engineering Strain Engineering Strain Compression testing for rigid calcific nodules and tensile testing for soft tissue structures. 6
7 AVA (cm2) AVA (cm2) AVA (cm2) AVA (cm2) AVA (cm2) AVA (cm2) AVA (cm2) AVA (cm2) 2/20/2018 Replicating AS pressure gradients Replicated AVA flow dependency Patient 1 Patient 2 Patient 3 Patient Stoke Volume (ml/beat) Stoke Volume (ml/beat) Stoke Volume (ml/beat) Stoke Volume (ml/beat) Patient 5 Patient 6 Patient 7 Patient Stoke Volume (ml/beat) Stoke Volume (ml/beat) Stoke Volume (ml/beat) Stoke Volume (ml/beat) Model Clinical Gorlin AVA Doppler AVA Maragiannis et al. Circ Cardiovasc Imaging Doppler AVA 7
8 Aortic Regurgitation: Doppler Replication Patient AR LV 3D Model AR LV Hemodynamic Parameters: Patient Model Regurgitation Time: 460 ms 458 ms Peak Velocity: 4.6 m/s 4.7 m/s Pressure half time: 312 ms 331 ms Time-velocity index: 167 cm 162 cm Bench-top TAVR CoreValve Prosthesis Sheathed Transcatheter CoreValve Prosthesis Depth 4mm Crossing Stenotic Aortic Valve CoreValve Deployment CoreValve Expanded Within LVOT Model 8
9 Replicating PVL Patient Echo Model Echo Mitral Valve reconstruction from 3D TEE AP PL 3D TEE Data Digital patient-specific multi-layer 3D MV model Segmentation software Coronal plane Axial plane Segmentation of target anatomy STL file 3D printed multi-material mitral valve model 9
10 Mechanical Testing of Mitral Valve Materials AL AL PL PL Bending test Tension testing M. Vukicevic et al. Ann BioMed Eng. (2016) Mitral Leaflet Response to Stress Tension Testing Porcine mitral valve anterior leaflet Modulus = 3.7 MPa Porcine mitral valve posterior leaflet Modulus = 3.7 MPa Modulus = 2.6 MPa Tangoplus S35 Tangoplus S35+S27 Tangoplus S27 modulus = 0.53 MPa modulus = 0.46 MPa modulus = 0.38 MPa M. Vukicevic et al. Ann BioMed Eng. (2016) 10
11 P2 perforation & central MR Pre-procedural Planning of perforated mitral valve repair 11
12 Patient-Specific 3D Print P2 perforation What device will fit? 12
13 Patient-Specific 3D Print Modeling for Leaflet Repair Atrial View Replicating the calcium too Ventricular View 13
14 Guiding the practiced procedure A2/P2 ASD occluder within P2 Little et al. JACC Interventions (2016) A familiar result? The Never Ending story dog 14
15 Modeling LVOT obstruction M. Vukicevic, S.Little et al. JACC Img. (2017) CT-based patient-specific MV 15
16 Mitral valve 3D printing M. Vukicevic, S. Little et al. JACC Img. (2017) MitraClip implantation in a patient-specific 3D printed MV apparatus MV model MitraClip AL MitraClip implantation 16
17 Tricuspid Valve modeling from Echo images MitraClip implantation in echo based TV models Systole Diastole MitraClip Clinical MitraClip implantation in TV Benchtop MitraClip implantation in TV model 17
18 Right Heart and tricuspid valve modeling 2/20/2018 Why do we need models? 3D-Printed Valve models: Can replicate patient-specific geometry Can be coupled to physiologic flow Provide a reproducible testing environment Are a cheap arena for mistakes and innovation Have already changed how we practice and perfect structural heart interventions 18
19 Stephen H. Little, MD 19
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