Designing Customized 3D Printed Models for Surgical Planning in Repair of Congenital Heart Defects
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2017-03-23
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Johns Hopkins University
Abstract
Congenital heart defects (CHD) present with a wide variety of structural anomalies that range in severity, creating a need for personalized, precision treatment. Recent advances in diagnostic imaging and 3D printing technology have enabled the creation of patient-specific models, which have revolutionized the understanding and management of these conditions.
The objective of this research was to explore each step of generating such prints, and to establish a novel workflow for creating CHD models. The research focused specifically on creating aortic arch models optimized for surgical planning for patients with hypoplastic left heart syndrome (HLHS), a CHD in which the left heart and aorta are severely underdeveloped. Like most CHDs, there is substantial variability in HLHS anatomy, and the 3D shape of the aortic arch after reconstruction is critical in determining proper cardiac output, justifying a need to create custom 3D prints for improved surgical outcome.
While several software options exist for segmentation, this project concentrated on evaluating the following six to segment anatomy: Mimics, inPrint, OsiriX MD, Vitrea, D2P, and 3D Slicer. Meshmixer and 3-matic were used to manipulate the data exported from the segmentation software, to create life-sized models of pre-operative anatomy, an approximation of desired post-operative anatomy, and a customized homograft patch for aortic arch reconstruction. The models were printed on a Stratasys Connex3 Object260 printer using Tango Plus flexible material to allow surgical suturing.
Although some models were segmented from CT acquired data, emphasis was placed on establishing methods for utilizing 3D ultrasound derived data. This alternative provides a safe, cost-effective, and accessible imaging modality without harmful radiation, contrast, or anesthesia in vulnerable pediatric patients. Additional proof of concept models were derived from 3D fetal cardiac ultrasound data, since the first stage operation for HLHS—as well as other complex CHDs—must often be performed days after birth. Customized 3D printed models have the potential to improve treatment planning, reduce procedure time and improve patient outcomes. Workflows proposed in this project facilitate a safer and more effective method for producing 3D printed models of a pediatric heart.
Author: Sarah A. Chen
Preceptor: Narutoshi Hibino, MD, PhD
Faculty Advisor: Juan Garcia, MA, CCA
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3D Printing