Key result
Multimodality 3D fusion pipeline proves feasible for mitral planning with a ~71 usability score.
Why the study?
Computed tomography has been proposed as a standard screening tool for mitral valve interventions to assess risk, but integration with transesophageal echocardiography for enhanced planning was needed.
A novel semi-automatic imaging pipeline fusing CT and 3D TEE scans to generate flexible, patient-specific 3D-printed mitral valve models demonstrates moderately good usability for interventional planning among multidisciplinary clinicians.
May warrant pilot testing in mitral valve teams; leaves open effects on procedural outcomes.
AIM: Transesophageal echocardiography (TEE) is the modality of choice for mitral valve (MV) interventional planning. However, computed tomography (CT) has been proposed as a standard screening tool for MV interventions to assess the risk of injury to the left circumflex artery. We aimed to develop a pipeline to fuse CT and MV modalities and create three-dimensional (3D) printable models of the MV apparatus to enhance interventional planning and assessed its usability among clinicians. METHODS AND RESULTS: The design, production, and assessment of the 3D-printed personalized models were based on TEE enriched with data from CT. The digital pipeline consisted of fusion with a mutual information algorithm using 3D Slicer (Slicer) and Elastix toolboxes. Flexible 3D printing was performed using Agilus 30 Clear. The pipeline was feasible for achieving semiautomatic fusion of anatomical structures related to MV interventional planning. Visualization of fused synergistic information for 3D planning could be provided in three distinct cases of MV regurgitation (secondary MR with tenting, flail leaflet, and prolapse). The 3D printing resulted in a flexibility in line with actual tissue allowing for tactile modification. An average System Usability Score of 71 indicates a moderately good usability among imaging cardiologists, intervention cardiologists, and cardiac surgeons. CONCLUSION: The presented pipeline with digital planning and personalized 3D printing has reached the technology readiness level for application in mitral valve interventions, and prospective clinical trials with endpoints of surgical effectiveness. Comprehensive and efficient interactions between clinicians and technical staff are essential to establish well-designed patient-specific interventions.
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Man et al. (2025) studied Severe mitral valve regurgitation (assessed by clinicians) (n=14). Digital pipeline fusing computed tomography (CT) and transesophageal echocardiography (TEE) for personalized 3D printing of the mitral valve apparatus was evaluated on System Usability Score (SUS). The multimodality 3D fusion and printing pipeline was feasible and achieved a moderately good mean System Usability Score of 71 among clinicians for mitral valve interventional planning.
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