The Journal of Thoracic and Cardiovascular Surgery

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1 Accepted Manuscript The 3D Cardiac Hype Cycle David P. Bichell, MD PII: S (18) DOI: /j.jtcvs Reference: YMTC To appear in: The Journal of Thoracic and Cardiovascular Surgery Received Date: 25 March 2018 Accepted Date: 28 March 2018 Please cite this article as: Bichell DP, The 3D Cardiac Hype Cycle, The Journal of Thoracic and Cardiovascular Surgery (2018), doi: /j.jtcvs This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

2 Title: The 3D Cardiac Hype Cycle David P. Bichell, MD Vanderbilt University Medical Center Division of Pediatric Cardiac Surgery Disclosure Statement: Author declares no conflicts of interest to report Word count: 467 Corresponding author: David P. Bichell, M.D. William S. Stoney, Jr. Chair in Cardiac Surgery Monroe Carell, Jr. Children s Hospital Vanderbilt University Medical Center 5247 Doctors Office Tower 2200 Children s Way Nashville, TN Office: Fax:

3 Invited commentary-pa-la fistula closure The maturation timeline of any new technology, according to Gartner s hype cycle, follows a predictable sequence starting with the highly visible peak of inflated expectations phase, followed by a lower profile slope of enlightenment, when hyperbole wanes and the technology s true capabilities are refined, ultimately to settle at a less glamourous plateau of utility where the innovation finds its honest and valued place. 1 The first CT scan images appeared in the 1970s. 2 Multi-slice scanners, doubling in the number of detector rows and image resolution every 2 years through the early 2000s, at each step became capable of producing more stunning and detailed 3D renderings of hidden parts of the human body. Stereolithography, or 3D printing, developed in the 1980s, also enjoyed explosive media popularity in the first decade of the 2000s, as on-demand 3D printing in various materials became widely available. Advances in 3D printing and CT imagery first combined in 2006 to build neonatal congenital heart defect models from CT image dot clouds. 3 An internet search for the sensational phrase 3D printing saved my life! turns up medical center promotional newsletter headlines and glossy ads with poster children holding up plastic heart models, touting formerly impossible operations made possible by preoperative planning around a plastic model. As spectacular 3D medical imaging has blossomed, captivating the attention of the public and of publicists, the images and their transformative promises adorn web sites, journal articles, slide presentations, and hold-in-your-hand 3D plastic models are available for both practical and fanciful purposes. Based on the density of internet posts, the

4 peak of exaggerated expectations for advanced 3D cardiac imaging seems to have been around The obligate first phase of the hype cycle for 3D CT and 3D cardiac printing has been realized. The progression from wow to utility follows. Pascal-Alexandre Thomas and colleagues describe sophisticated cardiac imaging that so perfectly defines the nature and location of a rare fistula between the right pulmonary artery and left atrium, that it directs with accuracy an approach to its ligation that is made with precision, minimal incision, confidence and safety. 4 An exploratory thoracotomy or sternotomy would be necessary if it not for the sophistication of 3D heart imagery, pinpointing the isthmus of the fistula and the geometry that permitted its simpler staple division. Sophisticated 3D imagery did not make a heretofore impossible operation possible, but it did lend precision and confidence to allow the procedure to be less invasive, more precise, and practical. Beyond the peak of inflated expectations and on to the more enduring business of defining the plateau of utility, Thomas, et al. contribute a light bulb to the slope of enlightenment. Threedimensional congenital cardiac imaging decorates fewer sensational headlines now, but it continues to inform such thoughtful and directed treatment strategies, conferring safety and certainty to formerly messier solutions.

5 References 1. Fenn J, Raskino M. Mastering the Hype Cycle: How to Choose the Right Innovation at the Right Time. Harvard Business School Publishing, Boston MA; Hounsfield GN. Computerized Transverse Axial Scanning (Tomography): Part I. Description of System Vol :H166-H Greil GF, Wolf I, Kuettner A, et al. Stereolithographic reproduction of complex cardiac morphology based on high spatial resolution imaging. Clin Res Cardiol. 2007;96(3): doi: /s Thomas P-A, Souatges C, Ovaert C, Mace L. Congenital right pulmonary artery to left atrial fistula: Elective video-thorascopic stapling. J Thorac Cardiovasc Surg

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