3D Printing & Echocardiography

Transcription

1 Echo Hawaii Jan 18, D Printing & Echocardiography Stephen H. Little, MD John S. Dunn Chair in Cardiovascular Research and Education, Associate professor, Weill Cornell Medicine Rapid Prototyping 101 Complex Geometry + Multi Material Fusion = Functional Anatomy (?) 1

2 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. 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 CV 3D Print Applications Anatomic Teaching Tools Functional Flow Modeling Procedural Planning Device Innovation The 3D printing steps 3

4 AVA Replication Aortic Root Replication Maragiannis et al. Circ Cardiovasc Imaging

5 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 Patient Specific LVOT Model Calcific Aortic Valve Stenosis Model Pulsatile flow across a 3D printed model 5

6 Mechanical Testing of Print Materials Stress (MPa) Calcific Compression Test E= 62 MPa 0.1 E= 0.4 MPa Engineering Strain Engineering Strain Stress (MPa) Tensile Test Compression testing for rigid calcific nodules and tensile testing for soft tissue structures. Replicating AS pressure gradients 6

7 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) AVA (cm2) AVA (cm2) AVA (cm2) AVA (cm2) AVA (cm2) Patient 5 Patient 6 Patient 7 Patient Stoke Volume (ml/beat) Stoke Volume (ml/beat) Stoke Volume (ml/beat) Stoke Volume (ml/beat) AVA (cm2) Model Clinical Gorlin AVA Doppler AVA Maragiannis et al. Circ Cardiovasc Imaging Doppler AVA AVA (cm2) AVA (cm2) 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 7

8 Bench top TAVR CoreValve Prosthesis Sheathed Transcatheter CoreValve Prosthesis Depth 4mm Crossing Stenotic Aortic Valve CoreValve Deployment CoreValve Expanded Within LVOT Model Replicating PVL Patient Echo Model Echo 8

9 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 Mechanical Testing of Mitral Valve Materials AL AL PL PL Bending test Tension testing M. Vukicevic et al. Ann BioMed Eng. (2016) 9

10 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) P2 perforation & central MR 10

11 Pre procedural Planning of perforated mitral valve repair Patient-Specific 3D Print P2 perforation 11

12 What device will fit? Patient-Specific 3D Print Modeling for Leaflet Repair Atrial View 12

13 Replicating the calcium too Ventricular View Guiding the practiced procedure A2/P2 ASD occluder within P2 Little et al. JACC Interventions (2016) 13

14 A familiar result? The Never Ending story dog Modeling LVOT obstruction M. Vukicevic, S.Little et al. JACC Img. (2017) 14

15 CT based patient specific MV Mitral valve 3D printing M. Vukicevic, S. Little et al. JACC Img. (2017) 15

16 MitraClip implantation in a patient specific 3D printed MV apparatus MV model MitraClip AL MitraClip implantation 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 16

17 Stephen H. Little, MD 17