Catheterization and Cardiovascular Interventions

Pediatric and Congenital Heart Disease

Three-dimensional printing assisted transcatheter closure of atrial septal defect with deficient posterior–inferior rim

Corresponding Author

Chaowu Yan PhD, MD

[email protected]

orcid.org/0000-0001-8864-5505

Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

CorrespondenceYan Chaowu, Department of Structural Heart Disease, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China. Email: [email protected]Search for more papers by this author

Cheng Wang PhD, MD,

Cheng Wang PhD, MD

Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

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Xiangbin Pan PhD, MD,

Xiangbin Pan PhD, MD

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Shiguo Li PhD, MD,

Shiguo Li PhD, MD

Search for more papers by this author

Huijun Song PhD, MD,

Huijun Song PhD, MD

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Qiong Liu PhD, MD,

Qiong Liu PhD, MD

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Nan Xu PhD, MD,

Nan Xu PhD, MD

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Jianpeng Wang PhD, MD,

Jianpeng Wang PhD, MD

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Chaowu Yan PhD, MD,

Corresponding Author

Chaowu Yan PhD, MD

[email protected]

orcid.org/0000-0001-8864-5505

CorrespondenceYan Chaowu, Department of Structural Heart Disease, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China. Email: [email protected]Search for more papers by this author

Cheng Wang PhD, MD,

Cheng Wang PhD, MD

Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

Search for more papers by this author

Xiangbin Pan PhD, MD,

Xiangbin Pan PhD, MD

Search for more papers by this author

Shiguo Li PhD, MD,

Shiguo Li PhD, MD

Search for more papers by this author

Huijun Song PhD, MD,

Huijun Song PhD, MD

Search for more papers by this author

Qiong Liu PhD, MD,

Qiong Liu PhD, MD

Search for more papers by this author

Nan Xu PhD, MD,

Nan Xu PhD, MD

Search for more papers by this author

Jianpeng Wang PhD, MD,

Jianpeng Wang PhD, MD

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First published: 24 September 2018

https://doi.org/10.1002/ccd.27799

Citations: 10

Funding information: Beijing Natural Science Foundation, Grant/Award Number: 7162160; National Natural Science Foundation of China, Grant/Award Number: 81670283; Beijing Municipal Science & Technology Commission, Grant/Award Number: Z171100001017194

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Abstract

Objective

Though successful transcatheter closure has been reported in secundum atrial septal defect (ASD) with deficient posterior–inferior rim, it is still difficult to screen the appropriate candidates. Three-dimensional printing (3DP) makes in vitro trial occlusion possible, and might provide a feasible method in the prediction of successful closure.

Methods

Thirty-five consecutive ASD patients (10M/25F, age, 47.7 ± 11.8 years) with deficient posterior–inferior rim (≤3 mm) were referred for attempted transcatheter closure, and personalized heart model (elastic rubber) was produced based on end-systolic MSCT images. The in vitro measurement and trial occlusion were performed for preoperative evaluation (in vitro successful/unsuccessful group), and the results were compared with postoperative outcomes.

Results

Successful in vitro occlusion was achieved in 30 patients (7M/23F), and the size of ASD was 27.1 ± 4.4 mm. The posterior–inferior rim was 0.95 ± 1.22 mm (rim defect in 17 patients), and 12 patients were associated with aortic rim deficiency. The subsequent transcatheter closure was performed successfully in 29 patients, and the occluder-diameter was identical to that of in vitro occlusion (35.0 ± 4.4 mm). The follow-up (1.4 ± 0.58 years) showed no residual shunt and related-complications. In unsuccessful in vitro group (n = 5), the range of rim deficiency was wider (P = 0.019) and the rim to inferior vena cava was shorter (4.60 ± 2.07 mm vs. 10.71 ± 5.28 mm, P = 0.016). Furthermore, transcatheter closure failed in all patients.

Conclusions

In ASD with deficient posterior–inferior rim, 3DP allows accurate determination of the size and surrounding rims of ASD. Based on personalized heart model, in vitro trial occlusion is an effective method to identify the appropriate candidates for transcatheter closure.

CONFLICT OF INTEREST

None.

Supporting Information

Filename	Description
ccd27799-sup-0001-VideoS1.avivideo/avi, 4.2 MB	Video 1 The end-systolic images of MSCT showed a large ASD with no posterior–inferior rim
ccd27799-sup-0001-VideoS2.avivideo/avi, 1.5 MB	Video 2 The movie of digital model was derived from the end-systolic MSCT images. To view the ASD, a window was opened in the anterior wall of right atrium. In this patient, 3D movie showed the large ASD and partial defect in the posterior–inferior rim. Furthermore, the other surrounding rims of ASD were sufficient
ccd27799-sup-0001-VideoS3.avivideo/avi, 1.5 MB	Video 3 The personalized heart model was produced with 3DP. To mimic the flexible cardiac tissue as true as possible, the model was made of elastic rubber. So, it was flexible with high elasticity
ccd27799-sup-0001-VideoS4.avivideo/avi, 1.5 MB	Video 4 The push–pull test was performed to evaluate the stability of the occluder. In this patient, it was stable
ccd27799-sup-0001-VideoS5.avivideo/avi, 1.7 MB	Video 5 In this patient, in vitro trial occlusion was unsuccessful in the heart model. The subsequent transcatheter closure was performed, and the occluder (38 mm) appeared stable before the release. The push–pull test looked good
ccd27799-sup-0001-VideoS6.avivideo/avi, 880 KB	Video 6 After the release, device embolization occurred immediately and surgical removal was performed
ccd27799-sup-0001-FigureS1.tifTIFF image, 5 MB	Supplementary Figure 1
ccd27799-sup-0001-FigureS2.tifTIFF image, 1.7 MB	Supplementary Figure 2
ccd27799-sup-0001-supinfo.docxWord 2007 document , 16.6 KB	Supp Info

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Citing Literature

Volume92, Issue7

December 1, 2018

Pages 1309-1314

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Three-dimensional printing assisted transcatheter closure of atrial septal defect with deficient posterior–inferior rim

Abstract

Objective

Methods

Results

Conclusions

CONFLICT OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Information

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Three-dimensional printing assisted transcatheter closure of atrial septal defect with deficient posterior–inferior rim

Abstract

Objective

Methods

Results

Conclusions

CONFLICT OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Related

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