A Patient-Specific Hollow Three-Dimensional Model for Simulating Percutaneous Occlusion of Patent Ductus Arteriosus

Abstract

Percutaneous catheter closure of patent ductus arteriosus (PDA) is difficult when the ductus is large and long or shows calcification. We created a patient-specific 3-dimensional (3D) model for PDA, with which we simulated device deployment, thereby selecting the device/size in a patient-by-patient manner. We assessed whether this 3D model is effective for catheter PDA closure. The 3D model was created in this institute, requiring 3 days and 90 US dollars. After its introduction, 7 consecutive patients (the study group) with severe PDA underwent closure with the aid of the 3D model. The control group consisted of 4 patients before 3D-model introduction, with all having severe PDA: the requirement of computed tomography was considered a criterion of severe or difficult-procedure-requiring PDA. In all study group patients, the devices/sizes could be pre-selected based on the simulation, whereas devices were changed during the procedure in 2 of 4 in the control group. In the study group, compared with the control group, the fluoroscopic (median 31 [interquartile range of 16-42] versus 39 [19-71] minutes, respectively) and total procedural times (median 107 [interquartile range 67-114] versus 124 [78-184] minutes, respectively) were shorter. A questionnaire confirmed the doctors' understanding of the procedure. This 3D model may be effective for percutaneous catheter closure of PDA. This may be especially true in cases of severe or difficult-procedure-requiring PDA.

Imaging-Based, Patient-Specific Three-Dimensional Printing to Plan, Train, and Guide Cardiovascular Interventions: A Systematic Review and Meta-Analysis

“…Valverde et al [9] extended the use of 3DPSP to the field of transcatheter cardiovascular interventions and reported 3DPSP being a valuable adjunct in planning and simulating endovascular stenting in transverse aortic arch hypoplasia. Following this approach, feasibility of 3DPSP to identify the optimal prosthesis in terms of size for transcatheter closure of atrial septal defect or patent ductus arteriosus was demonstrated [10,11]. Also, 3DPSP can enrich patient counselling [12][13][14] and affect clinical decision making [15].…”

Non-invasive Imaging in the Evaluation of Cardiac Shunts for Interventional Closure

“…This allows for better patient selection and appropriate selection of devices ahead of the procedure (32). Although PDA device occlusion is largely performed based on pre-procedural 2D echocardiography data alone or CT and CMR in some cases, 3D printing has been used for planning these interventions, allowing interventionalists to simulate and practice device deployment within the models themselves, thereby decreasing fluoroscopic and procedural times (33). In a surgical planning study, 3D visualization from static 3D printed models was found to improve understanding of anatomy and helped redefine the surgical approach in up to 47% of cases with complex congenital heart disease with significant modifications in 25% of cases (29).…”

3D printing applications for percutaneous structural interventions in congenital heart disease

“…Particularly in adult cases, the PDA can be long, tortuous, and calcified, which makes catheter-based device placement challenging. Matsubara and colleagues presented a case in which patient-specific 3D printed models were created to detail the precise anatomy of the proximal aorta, aortic arch, PDA, and pulmonary artery [22] . These models allowed for selection of a particular device and exact size.…”

“…These models allowed for selection of a particular device and exact size. They also allowed the interventionalists to simulate and practice device deployment within the models themselves, thereby decreasing fluoroscopic and procedural times [22] . 3D models can be instrumental in decision making to determine feasibility of transcatheter intervention.…”