Assessment of transfer of morphological characteristics of Anomalous Aortic Origin of a Coronary Artery from imaging to patient specific 3D Printed models: A feasibility study

Background: Virtual functional assessment index (vFAI), an alternative approach for assessing hemodynamic significance of stenosis has been shown to enhance the diagnostic performance of coronary computed tomography angiography (CCTA) based on evaluating the area under pressure drop-flow curve for a stenosis. Previously, this was assessed via computational fluid dynamics. We investigated the evaluation of vFAI from CCTA images using 3D printing and an in vitro flow loop and its efficacy as compared to the invasively measured fractional flow reserve (FFR). Methods and Results: Eighteen patients with varying degrees of coronary artery disease who underwent non-invasive CCTA scans and invasive FFR of their left anterior descending coronary artery (LAD) were included. The LAD artery was segmented and reconstructed using Mimics (Materialise inc.,). The segmented models were then 3D printed using Carbon 3D printer (Carbon Inc.,) with rigid resins. An in vitro flow circulation system representative of invasive measurements in a cardiac catheterization laboratory was developed to experimentally evaluate the hemodynamic parameters of pressure and flow (Fig A). For each model, a range of physiological flow rates was applied by a peristaltic steady flow pump and titrated by a flow sensor. The pressure drop and the pressure ratio (Pd/Pa) were assessed for patient-specific aortic pressure and differing flow rates. vFAI was evaluated as the normalized area under the P d /P a vs Q curve from 0 to 240 mL/min. There was a strong correlation between vFAI and FFR, (R = 0.83, p < 0.001; Fig B) and a very good agreement between the two parameters by Bland-Altman analysis. The mean difference of measurements from the two methods was 0.06 (SD = 0.08, p=0.0063; Fig C), indicating a small systematic overestimation of the FFR by vFAI. Conclusions: vFAI can be effectively derived from 3D CTCA datasets using 3D-printed in vitro models, based on evaluation over a range of hemodynamic conditions.

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BIOMECHANICAL FLOW MODELING USING PATIENT-SPECIFIC 3D PRINTED MODEDLS FOR SURGICAL DECISION-MAKING IN ANOMALOUS AORTIC ORIGIN OF CORONARY ARTERY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)01808-8 ◽

2021 ◽

Vol 77 (18) ◽

pp. 449

Author(s):

Yasaman Farsiani ◽

Jayanthi Parthasarathy ◽

Silvana Molossi ◽

Carlos Mery ◽

Atefeh Razavi ◽

...

Keyword(s):

Decision Making ◽

Coronary Artery ◽

Patient Specific ◽

Flow Modeling ◽

Surgical Decision ◽

3D Printed ◽

Surgical Decision Making

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Feasibility study of a 3D-printed personalized immobilization device integrating a patient-specific probe holder for prostate radiotherapy combined with adjuvant MR-guided transperineal ultrasound hyperthermia

10.21203/rs.3.rs-153144/v1 ◽

2021 ◽

Author(s):

Giovanna Dipasquale ◽

Pauline Coralie Guillemin ◽

Maud Jaccard ◽

Johannes W.E. Uiterwijk ◽

Orane Lorton ◽

...

Keyword(s):

Feasibility Study ◽

Transperineal Ultrasound ◽

Patient Specific ◽

Specific Probe ◽

Prostate Radiotherapy ◽

3D Printed ◽

Ultrasound Hyperthermia ◽

Immobilization Device ◽

Probe Holder

Abstract The authors have requested that this preprint be removed from Research Square.

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3D Printed Personalized External Aortic Root Model in Marfan Syndrome with Isolated Sinus of Valsalva Aneurysm Caused by a Novel Pathogenic FBN1 p.Gly1127Cys Variant

Diagnostics ◽

10.3390/diagnostics11061057 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1057

Author(s):

Jung Sun Cho ◽

Joonhong Park ◽

Jong Bum Kwon ◽

Dae-Won Kim ◽

Mahn-Won Park

Keyword(s):

Coronary Artery ◽

Marfan Syndrome ◽

Aortic Root ◽

Amino Acid Position ◽

Cardiovascular Complications ◽

Patient Specific ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm ◽

Root Model ◽

3D Printed

The major cause of death in Marfan syndrome (MFS) is cardiovascular complications, particularly progressive dilatation of the proximal aorta, rendering these patients at risk of aortic dissection or fatal rupture. We report a 3D printed personalized external aortic root model for MFS with an isolated sinus of Valsalva aneurysm caused by a novel pathogenic FBN1 variant. A 67-year-old female with a history of lens dislocation and retinal detachment in the left eye was admitted for the evaluation of resting dyspnea several months prior. Transesophageal and transthoracic echocardiography revealed severe aortic valve regurgitation and a large left coronary sinus of Valsalva aneurysm in the proband. Sanger sequencing identified a heterozygous p.Gly1127Cys variant in the FBN1 gene; previously, a mutation at this amino acid position was described as pathogenic (p.Gly1127Ser; rs137854468). A 3D printed personalized external aortic root model based on a multidetector computed tomography scan was constructed to illustrate the location of the ostium of the left main coronary artery on the aneurysm of the left coronary artery cusp. Aortic root replacement with the Bentall procedure matched the exact shape of the 3D printed model. Creation of a 3D printed patient-specific model could be useful in facilitating the development of next-generation medical devices and resolving the risks of postoperative complications and aortic root disease.

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PATIENT-SPECIFIC BIOFIDELIC HUMAN CORONARY ARTERY SURROGATES

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519418500495 ◽

2018 ◽

Vol 18 (05) ◽

pp. 1850049 ◽

Cited By ~ 5

Author(s):

ARNAB CHANDA ◽

KAITLYN CURRY

Keyword(s):

Coronary Artery ◽

Experimental Studies ◽

The United States ◽

Surrogate Models ◽

Thin Layers ◽

Patient Specific ◽

Material System ◽

Biomechanical Behavior ◽

Arterial Lumen ◽

3D Printed

Coronary artery disease (CAD) is the number one killer for both men and women in the United States. To date, unavailability of human coronary arteries due to ethical and biosafety issues has not allowed for many experimental studies on understanding the pathophysiology of CAD. Also, patient-specific arterial blockage conditions are very difficult to estimate using 2D imaging, which prevents the development of effective surgical mitigation steps. Additionally, to date, a majority of stent surgery failures (over 50%), mainly attributed to poor stent design (such as an oversized stent causing local damage of arterial wall and subsequent growth of scar tissue through the stent leading to re-blocking the artery, or in-stent restenosis), are impossible to evaluate. In the current work, a methodology to fabricate patient-specific three-layer biofidelic coronary artery surrogates was developed. This novel method involves the generation of a true-scale MRI-based patient-specific 3D arterial lumen model, which is 3D printed. A four-part silicone material system is developed, which precisely mimics the nonlinear biomechanical behavior of arterial layers, namely the intima (innermost), media (middle) and adventitia (outer). Using the 3D printed arterial lumen model as a positive mold, thin layers ([Formula: see text][Formula: see text]mm) of the layer-specific silicone-based materials are deposited, and subsequently pulled out once cured. The final product is a three-layer coronary artery model which is exactly of the same size and dimensions, and similar mechanical property as that of the actual coronary artery of a patient. Such surrogate models would be extremely helpful for cardiologists and heart surgeons to understand patient-specific atherosclerotic conditions (based on the location and size of blockages), simulate CAD-based surgeries and also evaluate stent implantation procedures. Additionally, these coronary artery surrogate models will allow stent manufacturers to design better and more reliable stents in the future to avoid stent oversizing-based arterial damage conditions and improve stent deployment techniques.

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OCT Findings in MINOCA

Journal of Clinical Medicine ◽

10.3390/jcm10132759 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2759

Author(s):

Krzysztof Bryniarski ◽

Pawel Gasior ◽

Jacek Legutko ◽

Dawid Makowicz ◽

Anna Kedziora ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Imaging Modality ◽

Obstructive Coronary Artery Disease ◽

Coronary Artery Spasm ◽

Morphological Characteristics ◽

Artery Dissection ◽

Plaque Disruption ◽

Artery Disease

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

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Quality Control in 3D Printing: Accuracy Analysis of 3D-Printed Models of Patient-Specific Anatomy

Materials ◽

10.3390/ma14041021 ◽

2021 ◽

Vol 14 (4) ◽

pp. 1021

Author(s):

Bernhard Dorweiler ◽

Pia Elisabeth Baqué ◽

Rayan Chaban ◽

Ahmed Ghazy ◽

Oroa Salem

Keyword(s):

Wall Thickness ◽

Large Scale ◽

Fused Deposition Modeling ◽

Vascular Anatomy ◽

3D Models ◽

Patient Specific ◽

Stl File ◽

Fused Deposition ◽

3D Printed ◽

The Mean

As comparative data on the precision of 3D-printed anatomical models are sparse, the aim of this study was to evaluate the accuracy of 3D-printed models of vascular anatomy generated by two commonly used printing technologies. Thirty-five 3D models of large (aortic, wall thickness of 2 mm, n = 30) and small (coronary, wall thickness of 1.25 mm, n = 5) vessels printed with fused deposition modeling (FDM) (rigid, n = 20) and PolyJet (flexible, n = 15) technology were subjected to high-resolution CT scans. From the resulting DICOM (Digital Imaging and Communications in Medicine) dataset, an STL file was generated and wall thickness as well as surface congruency were compared with the original STL file using dedicated 3D engineering software. The mean wall thickness for the large-scale aortic models was 2.11 µm (+5%), and 1.26 µm (+0.8%) for the coronary models, resulting in an overall mean wall thickness of +5% for all 35 3D models when compared to the original STL file. The mean surface deviation was found to be +120 µm for all models, with +100 µm for the aortic and +180 µm for the coronary 3D models, respectively. Both printing technologies were found to conform with the currently set standards of accuracy (<1 mm), demonstrating that accurate 3D models of large and small vessel anatomy can be generated by both FDM and PolyJet printing technology using rigid and flexible polymers.

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Total Meniscus Reconstruction Using a Polymeric Hybrid-Scaffold: Combined with 3D-Printed Biomimetic Framework and Micro-Particle

Polymers ◽

10.3390/polym13121910 ◽

2021 ◽

Vol 13 (12) ◽

pp. 1910

Author(s):

Hun-Jin Jeong ◽

Se-Won Lee ◽

Myoung Wha Hong ◽

Young Yul Kim ◽

Kyoung Duck Seo ◽

...

Keyword(s):

Shape Matching ◽

Femoral Condyle ◽

Immunohistochemical Analysis ◽

Cartilage Degeneration ◽

Patient Specific ◽

Hybrid Scaffold ◽

Meniscus Tissue ◽

Cell Source ◽

3D Printed ◽

Meniscus Regeneration

The meniscus has poor intrinsic regenerative capability, and its injury inevitably leads to articular cartilage degeneration. Although there are commercialized off-the-shelf alternatives to achieve total meniscus regeneration, each has its own shortcomings such as individualized size matching issues and inappropriate mechanical properties. We manufactured a polycaprolactone-based patient-specific designed framework via a Computed Tomography scan images and 3D-printing technique. Then, we completed the hybrid-scaffold by combining the 3D-printed framework and mixture micro-size composite which consists of polycaprolactone and sodium chloride to create a cell-friendly microenvironment. Based on this hybrid-scaffold with an autograft cell source (fibrochondrocyte), we assessed mechanical and histological results using the rabbit total meniscectomy model. At postoperative 12-week, hybrid-scaffold achieved neo-meniscus tissue formation, and its shape was maintained without rupture or break away from the knee joint. Histological and immunohistochemical analysis results showed obvious ingrowth of the fibroblast-like cells and chondrocyte cells as well as mature lacunae that were embedded in the extracellular matrix. Hybrid-scaffolding resulted in superior shape matching as compared to original meniscus tissue. Histological analysis showed evidence of extensive neo-meniscus cell ingrowth. Additionally, the hybrid-scaffold did not induce osteoarthritis on the femoral condyle surface. The 3D-printed hybrid-scaffold may provide a promising approach that can be applied to those who received total meniscal resection, using patient-specific design and autogenous cell source.

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Design, Fabrication, and Accuracy of a Novel Noncovering Lock-Mechanism Bilateral Patient-Specific Drill Guide Template for Nondeformed and Deformed Thoracic Spines

HSS Journal ® ◽

10.1177/1556331621996331 ◽

2021 ◽

pp. 155633162199633

Author(s):

Mehran Ashouri-Sanjani ◽

Shima Mohammadi-Moghadam ◽

Parisa Azimi ◽

Navid Arjmand

Keyword(s):

Thoracic Spine ◽

Sagittal Plane ◽

Ct Scanning ◽

Entry Point ◽

In Vivo Studies ◽

Patient Specific ◽

Plane Angle ◽

Severe Scoliosis ◽

3D Printed

Background: Pedicle screw (PS) placement has been widely used in fusion surgeries on the thoracic spine. Achieving cost-effective yet accurate placements through nonradiation techniques remains challenging. Questions/Purposes: Novel noncovering lock-mechanism bilateral vertebra-specific drill guides for PS placement were designed/fabricated, and their accuracy for both nondeformed and deformed thoracic spines was tested. Methods: One nondeformed and 1 severe scoliosis human thoracic spine underwent computed tomographic (CT) scanning, and 2 identical proportions of each were 3-dimensional (3D) printed. Pedicle-specific optimal (no perforation) drilling trajectories were determined on the CT images based on the entry point/orientation/diameter/length of each PS. Vertebra-specific templates were designed and 3D printed, assuring minimal yet firm contacts with the vertebrae through a noncovering lock mechanism. One model of each patient was drilled using the freehand and one using the template guides (96 pedicle drillings). Postoperative CT scans from the models with the inserted PSs were obtained and superimposed on the preoperative planned models to evaluate deviations of the PSs. Results: All templates fitted their corresponding vertebra during the simulated operations. As compared with the freehand approach, PS placement deviations from their preplanned positions were significantly reduced: for the nonscoliosis model, from 2.4 to 0.9 mm for the entry point, 5.0° to 3.3° for the transverse plane angle, 7.1° to 2.2° for the sagittal plane angle, and 8.5° to 4.1° for the 3D angle, improving the success rate from 71.7% to 93.5%. Conclusions: These guides are valuable, as the accurate PS trajectory could be customized preoperatively to match the patients’ unique anatomy. In vivo studies will be required to validate this approach.

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