Application of and Prospects for 3-Dimensional Printing in Transcatheter Mitral Valve Interventions

Figures

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  Fig. 1.. The advantages and disadvantages between 3D printing and CT scan.

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  Fig. 2.. The process of making a patient-specific multimaterial heart model. The initial computed tomography images were collected to create a complete 3-dimensional reconstruction. Standard Tessellation Language files were imported into a 3-dimensional printer to print the model. CT, computed tomography; 3D, 3-dimensional.

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  Fig. 3.. Transcatheter edge-to-edge repair was simulated by a 3-dimensional printed pulsatile simulator. (A) The simulator was composed of the working segment and the driving segment. (B) The anatomical structures were printed clearly so the surgeons could simulate procedures intuitively and accurately. (C) The stent was inserted into the left atrium. (D) The stent was adjusted to the ideal position of anterior 2-posterior 2. 3D, 3-dimensional; IVC, inferior vena cava; LAA, left atrial appendage; MVA, mitral valve annulus; TEE, transesophageal echocardiography.

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  Fig. 4.. The 3-dimensional printed mitral valve model was used to simulate transcatheter edge-to-edge repair during the bench test. (A) The 3-dimensional printed mitral valve model from the left atrium plane. (B) The 3-dimensional printed mitral valve model from the left ventricle plane. (C) The MitraClip (Abbott Vascular, Santa Clara, CA, USA) was bent and positioned in the left atrium view. (D) The MitraClip was clamped to the leaflet in the left ventricle view. AL, anterior leaflet; PL, posterior leaflet.

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  Fig. 5.. The classification of transcatheter mitral valve replacement. (A) The mitral valve in a ring implant. (B) The mitral valve in the valve implant. (C) The implant in a case of mitral annulus calcification. (D) Implant in a native mitral valve.

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  Fig. 6.. The simulation of transcatheter mitral valve replacement during the bench test to make the procedural plan and determine the appropriate size of the stent. (A,B) The patient-specific 3-dimensional printed mitral valve model and the delivery system used for transcatheter mitral valve replacement simulation (Microport, Shanghai, China). (C,D) The implant process in the left atrium view and the left ventricle view, respectively. (E) The 3-dimensional printed model in the left ventricle view after the simulations.

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  Fig. 7.. The 3-dimensional printed model was used to assess the risk of left ventricular outflow tract obstruction after transcatheter mitral valve replacement. (A) The distribution of the mitral annulus calcification was observed clearly from the left atrium plane. (B) The left ventricular outflow tract was observed from the left ventricular plane. (C) The bioprosthesis was implanted during the bench test. (D) Left ventricular outflow tract obstruction occurred due to anterior leaflet displacement after the simulation. (E) The patency of the left ventricular outflow tract after anterior leaflet resection. (F) The left ventricular outflow tract was observed after anterior leaflet resection from the ascending aorta plane. AL, anterior leaflet; LVOT, left ventricular outflow tract; PL, posterior leaflet.

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  Fig. 8.. The 3-dimensional printed mitral valve model was used to demonstrate the effect of paravalvular leakage occlusion. (A,B) Paravalvular leakage was observed from the left atrium plane and the left ventricle plane, respectively. (C,D) The occluder was implanted during the bench test and was observed from the left atrium plane and the left ventricle plane, respectively. PVL, paravalvular leakage.