Abstract 17031: Noninvasive CT-Based Hemodynamic Assessment Using 3D Printing and Virtual Functional Assessment Index

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kranthi K Kolli ◽  
Abdul Zahid ◽  
Alexandre Caprio ◽  
Patricia Xu ◽  
Robert Shepherd ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Pressure Drop ◽  
3D Printing ◽  
Functional Assessment ◽  
Patient Specific ◽  
Fractional Flow ◽  
Flow Rates ◽  
Assessment Index ◽  
3D Printed

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.

Living the heart in three dimensions: applications of 3D printing in CHD

2019 ◽  
Vol 29 (06) ◽  
pp. 733-743 ◽  
Author(s):  
Mari Nieves Velasco Forte ◽  
Tarique Hussain ◽  
Arno Roest ◽  
Gorka Gomez ◽  
Monique Jongbloed ◽  
...  
Keyword(s):  
3D Printing ◽  
Heart Surgery ◽  
Wide Spectrum ◽  
Three Dimensional ◽  
Structural Heart Disease ◽  
Medical Personnel ◽  
Three Dimensions ◽  
Patient Specific ◽  
3D Printed

AbstractAdvances in biomedical engineering have led to three-dimensional (3D)-printed models being used for a broad range of different applications. Teaching medical personnel, communicating with patients and relatives, planning complex heart surgery, or designing new techniques for repair of CHD via cardiac catheterisation are now options available using patient-specific 3D-printed models. The management of CHD can be challenging owing to the wide spectrum of morphological conditions and the differences between patients. Direct visualisation and manipulation of the patients’ individual anatomy has opened new horizons in personalised treatment, providing the possibility of performing the whole procedure in vitro beforehand, thus anticipating complications and possible outcomes. In this review, we discuss the workflow to implement 3D printing in clinical practice, the imaging modalities used for anatomical segmentation, the applications of this emerging technique in patients with structural heart disease, and its limitations and future directions.

Assessment of Invasive Fractional Flow Reserve Procedures Using Computational Fluid Dynamics

2020 ◽  
Author(s):  
Yasser Abuouf ◽  
Muhamed Albadawi ◽  
Shinichi Ookawara ◽  
Mahmoud Ahmed
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Pressure Drop ◽  
Fractional Flow Reserve ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Patient Specific ◽  
Concomitant Treatment ◽  
Fractional Flow ◽  
Flow Reserve

Abstract Coronary artery disease is the abnormal contraction of heart supply blood vessel. It may lead to major consequences such as heart attack and death. This narrowing in the coronary artery limits the oxygenated blood flow to the heart. Thus, diagnosing its severity helps physicians to select the appropriate treatment plan. Fractional Flow Reserve (FFR) is one of the most accurate methods to pinpoint the stenosis severity. The advantages of FFR are high accuracy, immediate estimation of the severity of the stenosis, and concomitant treatment using balloon or stent. Nevertheless, the main disadvantage of the FFR is being an invasive procedure that requires an incision under anesthesia. Moreover, inserting the guidewire across the stenosis may result in a ‘tight-fit’ between the vessel lumen and the guidewire. This may cause an increase in the measured pressure drop, leading to a false estimation of the blood flow parameters. To estimate the errors in diagnosis procedures, a comprehensive three-dimensional model blood flow along with guidewire is developed. Reconstructed three-dimensional coronary artery geometry from a patient-specific scan is used. Blood is considered non-Newtonian and the flow is pulsatile. The comprehensive model is numerically simulated using boundary conditions. Based on the predicted results, the ratio between pressure drop and distal dynamic pressure (CDP) is studied. The predicted results for each case are compared with the control case (the case without guidewire) and analyzed. It was found that simulating the model by placing the guidewire at a full position prior to the simulation leads to an overestimation of the CDP as it increases by 34.3%. However, simulating the procedure of guidewire insertion is more accurate. It shows that the CDP value increases by 7%.

Abstract 13069: Prescribed Flow Reserve as a Novel Method for Diagnosis of Coronary Artery Ischemia Under Physiologically-Realistic Conditions

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kranthi Kolli ◽  
Guanglei Xiong ◽  
Hilary Soohoo ◽  
James Min
Keyword(s):  
Coronary Artery ◽  
Pressure Ratio ◽  
Needle Valve ◽  
Flow Loop ◽  
Fractional Flow ◽  
Flow Rates ◽  
Flow Reserve ◽  
Coronary Ischemia

Background. Failure to achieve maximal hyperemia in coronary arteries during fractional flow reserve (FFR) may result in under-estimation of pressure drop (ΔP) and over-estimation of FFR, and possibly lead to misdiagnosis of hemodynamically-significant lesions. Further, induction of hyperemia does not allow for precise determination of ischemic thresholds for physiologically-realistic conditions, such as for increasing levels of exercise. We investigated the influence of prescribed flow rates on the pressure ratio (P d /P a ) of coronary artery stenoses of varying severities. Methods. Prescribed flow reserves (PFR) were evaluated using an in vitro experimental flow loop with a pump circulating water at steady-state flow (Figure 1A). Three stenoses of 30%, 50% and 70% diameter stenosis (DS) severity with smooth Gaussian shapes were fabricated using VeroClear rigid material in an Objet260 Connex printer. Mean proximal pressure (P a ) was maintained at 90 and 140 mm Hg using a linear flow needle valve that allowed for adjustment of physiologically-realistic microcirculatory resistance. P d /P a at differing prescribed flow rates (Q), titrated by a flow meter, applied to each of the stenosis, were assessed for the 2 levels of P a . A PFR of P d /P a ≤0.80 was considered diagnostic of coronary ischemia. Results. The ΔP-Q characteristics demonstrated a quadratic relationship. The P d /P a -Q curve (Figure 1B and 1C) followed a similar trend, with decreasing slope. Further, the average slope of the P d /P a -Q decreased with increasing DS at either levels of the P a . When compared amongst lesions of increasing severity (Figure 1C and 1B), P d /P a -Q curve slopes at the 0.80 ischemic threshold increased by 9%, 20% and 25%, respectively, for 30%, 50% and 70% DS. Conclusions. Coronary artery ischemia, as determined by P d /P a , differs under increasing flow rates. PFR may be a potential alternative to FFR for determination of coronary ischemia under precise physiologically-realistic conditions.

scholarly journals 3D Printed Clamps for In Vitro Tensile Tests of Human Gracilis and the Superficial Third of Quadriceps Tendons

2021 ◽  
Vol 11 (6) ◽  
pp. 2563
Author(s):  
Ivan Grgić ◽  
Vjekoslav Wertheimer ◽  
Mirko Karakašić ◽  
Željko Ivandić
Keyword(s):  
3D Printing ◽  
Fused Deposition Modeling ◽  
Tensile Tests ◽  
Biomechanical Properties ◽  
Testing Procedure ◽  
Laboratory Equipment ◽  
Fused Deposition ◽  
Custom Made ◽  
3D Printed

Recent soft tissue studies have reported issues that occur during experimentation, such as the tissue slipping and rupturing during tensile loads, the lack of standard testing procedure and equipment, the necessity for existing laboratory equipment adaptation, etc. To overcome such issues and fulfil the need for the determination of the biomechanical properties of the human gracilis and the superficial third of the quadriceps tendons, 3D printed clamps with metric thread profile-based geometry were developed. The clamps’ geometry consists of a truncated pyramid pattern, which prevents the tendons from slipping and rupturing. The use of the thread application in the design of the clamp could be used in standard clamping development procedures, unlike in previously custom-made clamps. Fused deposition modeling (FDM) was used as a 3D printing technique, together with polylactic acid (PLA), which was used as a material for clamp printing. The design was confirmed and the experiments were conducted by using porcine and human tendons. The findings justify the usage of 3D printing technology for parts manufacturing in the case of tissue testing and establish independence from the existing machine clamp system, since it was possible to print clamps for each prepared specimen and thus reduce the time for experiment setup.

scholarly journals Three-dimensionally printed polycaprolactone/multicomponent bioactive glass scaffolds for potential application in bone tissue engineering

2020 ◽  
Vol 6 (1) ◽  
pp. 57-69
Author(s):  
Amirhosein Fathi ◽  
Farzad Kermani ◽  
Aliasghar Behnamghader ◽  
Sara Banijamali ◽  
Masoud Mozafari ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
3D Printing ◽  
Bone Tissue Engineering ◽  
Bone Tissue ◽  
Three Dimensional ◽  
Layer By Layer ◽  
Composite Scaffolds ◽  
3D Printed ◽  
Co Doped

AbstractOver the last years, three-dimensional (3D) printing has been successfully applied to produce suitable substitutes for treating bone defects. In this work, 3D printed composite scaffolds of polycaprolactone (PCL) and strontium (Sr)- and cobalt (Co)-doped multi-component melt-derived bioactive glasses (BGs) were prepared for bone tissue engineering strategies. For this purpose, 30% of as-prepared BG particles (size <38 μm) were incorporated into PCL, and then the obtained composite mix was introduced into a 3D printing machine to fabricate layer-by-layer porous structures with the size of 12 × 12 × 2 mm3.The scaffolds were fully characterized through a series of physico-chemical and biological assays. Adding the BGs to PCL led to an improvement in the compressive strength of the fabricated scaffolds and increased their hydrophilicity. Furthermore, the PCL/BG scaffolds showed apatite-forming ability (i.e., bioactivity behavior) after being immersed in simulated body fluid (SBF). The in vitro cellular examinations revealed the cytocompatibility of the scaffolds and confirmed them as suitable substrates for the adhesion and proliferation of MG-63 osteosarcoma cells. In conclusion, 3D printed composite scaffolds made of PCL and Sr- and Co-doped BGs might be potentially-beneficial bone replacements, and the achieved results motivate further research on these materials.

scholarly journals Accessing 3D Printed Vascular Phantoms for Procedural Simulation

2021 ◽  
Vol 7 ◽  
Author(s):  
Jasamine Coles-Black ◽  
Damien Bolton ◽  
Jason Chuen
Keyword(s):  
3D Printing ◽  
Endovascular Procedures ◽  
Low Cost ◽  
3D Models ◽  
Routine Care ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Ct Angiogram ◽  
Abdominal Aortic ◽  
3D Printed

Introduction: 3D printed patient-specific vascular phantoms provide superior anatomical insights for simulating complex endovascular procedures. Currently, lack of exposure to the technology poses a barrier for adoption. We offer an accessible, low-cost guide to producing vascular anatomical models using routine CT angiography, open source software packages and a variety of 3D printing technologies.Methods: Although applicable to all vascular territories, we illustrate our methodology using Abdominal Aortic Aneurysms (AAAs) due to the strong interest in this area. CT aortograms acquired as part of routine care were converted to representative patient-specific 3D models, and then printed using a variety of 3D printing technologies to assess their material suitability as aortic phantoms. Depending on the technology, phantoms cost $20–$1,000 and were produced in 12–48 h. This technique was used to generate hollow 3D printed thoracoabdominal aortas visible under fluoroscopy.Results: 3D printed AAA phantoms were a valuable addition to standard CT angiogram reconstructions in the simulation of complex cases, such as short or very angulated necks, or for positioning fenestrations in juxtarenal aneurysms. Hollow flexible models were particularly useful for device selection and in planning of fenestrated EVAR. In addition, these models have demonstrated utility other settings, such as patient education and engagement, and trainee and anatomical education. Further study is required to establish a material with optimal cost, haptic and fluoroscopic fidelity.Conclusion: We share our experiences and methodology for developing inexpensive 3D printed vascular phantoms which despite material limitations, successfully mimic the procedural challenges encountered during live endovascular surgery. As the technology continues to improve, 3D printed vascular phantoms have the potential to disrupt how endovascular procedures are planned and taught.

scholarly journals Development of 3D Printed Symbrachydactyly Prosthetic Hand

2019 ◽  
Vol 9 (1) ◽  
pp. 5943-5947
Keyword(s):  
3D Printing ◽  
Minimum Cost ◽  
Acrylonitrile Butadiene Styrene ◽  
Design Stage ◽  
Patient Specific ◽  
Prosthetic Hand ◽  
Simple Task ◽  
3D Printed ◽  
Electrical Component ◽  
Hand Geometry

Symbrachydactyly is a genetical problem occurred to newborn where the newborn experienced underdeveloped or shorten fingers. This condition will limit their normal as even a simple task of holding an item or pushing a button. A device is needed to help them gain a better life. The aim of this project is to fabricate a customized prosthesis hand using 3D printing technology at minimum cost. The proposed prosthetic was not embedded with any electrical component. The patient can only use the wrist to control the prosthetic part which is the prosthetic fingers. The prosthetic hand was also being developed with the patient specific features, which the initial design stage was adapted from a person’s hand geometry using a 3D scanner. Next the model of the prosthesis was analyzed computationally to predict the performance of the product. Different material properties are considered in the analysis to present Polylactic Acid (PLA) and Acrylonitrile Butadiene Styrene (ABS) materials. Then, the prosthesis was fabricated using the 3D printing. The results suggested that PLA material indicated better findings and further be fabricated.

Investigation of three-dimensional printing materials for printing aorta model replicating Type B aortic dissection

2021 ◽  
Vol 17 ◽  
Author(s):  
Chia-An Wu ◽  
Andrew Squelch ◽  
Zhonghua Sun
Keyword(s):  
3D Printing ◽  
Aortic Dissection ◽  
Three Dimensional ◽  
Ct Images ◽  
Patient Specific ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Ct Attenuation ◽  
Significant Difference ◽  
3D Printed

Aim: To determine a printing material that has both elastic property and radiology equivalence close to real aorta for simulation of endovascular stent graft repair of aortic dissection. Background: With the rapid development of three-dimensional (3D) printing technology, a patient-specific 3D printed model is able to help surgeons to make better treatment plan for Type B aortic dissection patients. However, the radiological properties of most 3D printing materials have not been well characterized. This study aims to investigate the appropriate materials for printing human aorta with mechanical and radiological properties similar to the real aortic computed tomography (CT) attenuation. Objective: Quantitative assessment of CT attenuation of different materials used in 3D printed models of aortic dissection for developing patient-specific 3D printed aorta models to simulate type B aortic dissection. Method: A 25-mm length of aorta model was segmented from a patient’s image dataset with diagnosis of type B aortic dissection. Four different elastic commercial 3D printing materials, namely Agilus A40 and A50, Visijet CE-NT A30 and A70 were selected and printed with different hardness. Totally four models were printed out and conducted CT scanned twice on a 192-slice CT scanner using the standard aortic CT angiography protocol, with and without contrast inside the lumen.Five reference points with region of interest (ROI) of 1.77 mm2 were selected at the aortic wall and intimal flap and their Hounsfield units (HU) were measured and compared with the CT attenuation of original CT images. The comparison between the patient’s aorta and models was performed through a paired-sample t-test to determine if there is any significant difference. Result: The mean CT attenuation of aortic wall of the original CT images was 80.7 HU. Analysis of images without using contrast medium showed that the material of Agilus A50 produced the mean CT attenuation of 82.6 HU, which is similar to that of original CT images. The CT attenuation measured at images acquired with other three materials was significantly lower than that of original images (p<0.05). After adding contrast medium, Visijet CE-NT A30 had an average CT attenuation of 90.6 HU, which is close to that of the original images with statistically significant difference (p>0.05). In contrast, the CT attenuation measured at images acquired with other three materials (Agilus A40, A50 and Visiject CE-NT A70) was 129 HU, 135 HU and 129.6 HU, respectively, which is significantly higher than that of original CT images (p<0.05). Conclusion: Both Visijet CE-NT and Agilus have tensile strength and elongation close to real patient’s tissue properties producing similar CT attenuation. Visijet CE-NT A30 is considered the appropriate material for printing aorta to simulate contrast-enhanced CT imaging of type B aortic dissection. Due to lack of body phantom in the experiments, further research with simulation of realistic anatomical body environment should be conducted.

scholarly journals Evaluation of the 3D Printing Accuracy of a Dental Model According to Its Internal Structure and Cross-Arch Plate Design: An In Vitro Study

Materials ◽  
2020 ◽  
Vol 13 (23) ◽  
pp. 5433
Author(s):  
Seung-Ho Shin ◽  
Jung-Hwa Lim ◽  
You-Jung Kang ◽  
Jee-Hwan Kim ◽  
June-Sung Shim ◽  
...  
Keyword(s):  
3D Printing ◽  
Internal Structure ◽  
Three Dimensional ◽  
In Vitro Study ◽  
Thick Shell ◽  
Plate Design ◽  
Dental Model ◽  
3D Printed ◽  
Modeling Data

The amount of photopolymer material consumed during the three-dimensional (3D) printing of a dental model varies with the volume and internal structure of the modeling data. This study analyzed how the internal structure and the presence of a cross-arch plate influence the accuracy of a 3D printed dental model. The model was designed with a U-shaped arch and the palate removed (Group U) or a cross-arch plate attached to the palate area (Group P), and the internal structure was divided into five types. The trueness and precision were analyzed for accuracy comparisons of the 3D printed models. Two-way ANOVA of the trueness revealed that the accuracy was 135.2 ± 26.3 µm (mean ± SD) in Group U and 85.6 ± 13.1 µm in Group P. Regarding the internal structure, the accuracy was 143.1 ± 46.8 µm in the 1.5 mm-thick shell group, which improved to 111.1 ± 31.9 µm and 106.7 ± 26.3 µm in the roughly filled and fully filled models, respectively. The precision was 70.3 ± 19.1 µm in Group U and 65.0 ± 8.8 µm in Group P. The results of this study suggest that a cross-arch plate is necessary for the accurate production of a model using 3D printing regardless of its internal structure. In Group U, the error during the printing process was higher for the hollowed models.

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