Application of 3D printing technology in the diagnosis and treatment of valvular heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIN Jinli ^1,2 , DONG Zhu ² , ZHENG Yanchun ² ,  WANG Xiaowu ^1,2

1. Department of Cardiovascular Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, 510515, P. R. China;
2. Department of Cardiovascular Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, P. R. China;

Corresponding author：

WANG Xiaowu, Email: 1062877572@qq.com

Keywords：

3D printing; valvular heart disease; model; review

DOI：

10.7507/1007-4848.202009068

Video：

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The incidence of valvular heart disease (VHD) increases with age, and its principal therapy is valve replacement. However, in recent years, the emergence of transcatheter interventions has changed the traditional therapy, making high-risk patients of surgery see dawn of hope. 3D printing technology has developed rapidly since it was applied to the medical field in 1990. Moreover, it has been widely applied in many surgical majors via refined reduction technology. However, the application of 3D printing technology in cardiovascular surgery is still in the preliminary stage, especially in the field of VHD. This article aims to review basic principles of 3D printing technology, its advantages in the therapy of VHD, and its current status of clinical application. Furthermore, this article elaborates current problems and looks forward to the future development direction.

Citation： LIN Jinli, DONG Zhu, ZHENG Yanchun, WANG Xiaowu. Application of 3D printing technology in the diagnosis and treatment of valvular heart disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 267-271. doi: 10.7507/1007-4848.202009068 Copy

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2.	Farooqi KM, Sengupta PP. Echocardiography and three-dimensional printing: Sound ideas to touch a heart. J Am Soc Echocardiogr, 2015, 28(4): 398-403.
3.	Ventola CL. Medical applications for 3D printing: Current and projected uses. P T, 2014, 39(10): 704-711.
4.	Nasis A, Mottram PM, Cameron JD, et al. Current and evolving clinical applications of multidetector cardiac CT in assessment of structural heart disease. Radiology, 2013, 267(1): 11-25.
5.	Vukicevic M, Mosadegh B, Min JK, et al. Cardiac 3D printing and its future directions. JACC Cardiovasc Imaging, 2017, 10(2): 171-184.
6.	Byrne N, Velasco Forte M, Tandon A, et al. A systematic review of image segmentation methodology, used in the additive manufacture of patient-specific 3D printed models of the cardiovascular system. JRSM Cardiovasc Dis, 2016, 5: 2048004016645467.
7.	陈思楷, 周青, 宋宏宁, 等. 多模态医学影像融合技术 3D 打印心脏模型方法学及精准度研究. 中华超声影像学杂志, 2018, 27(11): 924-930.
8.	Giannopoulos AA, Steigner ML, George E, et al. Cardiothoracic applications of 3-dimensional printing. J Thorac Imaging, 2016, 31(5): 253-272.
9.	Binder RK, Dweck M, Prendergast B. The year in cardiology: Valvular heart disease. Eur Heart J, 2020, 41(8): 912-920.
10.	Cui H, Miao S, Esworthy T, et al. 3D bioprinting for cardiovascular regeneration and pharmacology. Adv Drug Deliv Rev, 2018, 132: 252-269.
11.	高强, 庄建, 岑坚正, 等. 3D 打印技术在复杂先天性心脏病外科诊疗中的应用. 中国胸心血管外科临床杂志, 2018, 25(8): 654-658.
12.	Hann SY, Cui H, Esworthy T, et al. Recent advances in 3D printing: Vascular network for tissue and organ regeneration. Transl Res, 2019, 211: 46-63.
13.	Singh D, Singh D, Han SS, et al. 3D printing of scaffold for cells delivery: Advances in skin tissue engineering. Polymers (Basel), 2016, 8(1): 19.
14.	Dragone V, Sans V, Rosnes MH, et al. 3D-printed devices for continuous-flow organic chemistry. Beilstein J Org Chem, 2013, 9: 951-959.
15.	Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: A population-based study. Lancet, 2006, 368(9540): 1005-1011.
16.	Wang DD, Gheewala N, Shah R, et al. Three-dimensional printing for planning of structural heart interventions. Interv Cardiol Clin, 2018, 7(3): 415-423.
17.	Rojas GM, Gálvez M, Potler NV, et al. Stereoscopic three-dimensional visualization applied to multimodal brain images: Clinical applications and a functional connectivity atlas. Front Neurosci, 2014, 8: 328.
18.	Daemen JHT, Heuts S, Olsthoorn JR, et al. Mitral valve modelling and three-dimensional printing for planning and simulation of mitral valve repair. Eur J Cardiothorac Surg, 2019, 55(3): 543-551.
19.	Hernández-Enríquez M, Brugaletta S, Andreu D, et al. Three-dimensional printing of an aortic model for transcatheter aortic valve implantation: Possible clinical applications. Int J Cardiovasc Imaging, 2017, 33(2): 283-285.
20.	Valverde I, Sarnago F, Prieto R, et al. Three-dimensional printing in vitro simulation of percutaneous pulmonary valve implantation in large right ventricular outflow tract. Eur Heart J, 2017, 38(16): 1262-1263.
21.	Wamala I, Brüning J, Dittmann J, et al. Simulation of a right anterior thoracotomy access for aortic valve replacement using a 3D printed model. Innovations (Phila), 2019, 14(5): 428-435.
22.	Benke K, Barabás JI, Daróczi L, et al. Routine aortic valve replacement followed by a myriad of complications: Role of 3D printing in a difficult cardiac surgical case. J Thorac Dis, 2017, 9(11): E1021-E1024.
23.	Basman C, Seetharam K, Pirelli L, et al. Transcatheter aortic valve-in-valve-in-valve implantation with three-dimensional printing guidance: A case report. J Card Surg, 2020, 35(7): 1676-1680.
24.	Qian Z, Wang K, Liu S, et al. Quantitative prediction of paravalvular leak in transcatheter aortic valve replacement based on tissue-mimicking 3D printing. JACC Cardiovasc Imaging, 2017, 10(7): 719-731.
25.	Kim MS, Hansgen AR, Wink O, et al. Rapid prototyping: A new tool in understanding and treating structural heart disease. Circulation, 2008, 117(18): 2388-2394.
26.	Booher AM, Bach DS. Exercise hemodynamics in valvular heart disease. Curr Cardiol Rep, 2011, 13(3): 226-233.
27.	王浩, 张斌, 宋宏宁, 等. 超声影像数据源 3D 打印结合模拟循环系统制作体外动态二尖瓣模型的可行性研究. 中华超声影像学杂志, 2020, 29(3): 206-212.
28.	Ferrari G, Balasubramanian P, Tubaldi E, et al. Experiments on dynamic behaviour of a Dacron aortic graft in a mock circulatory loop. J Biomech, 2019, 86: 132-140.
29.	Harb SC, Xu B, Klatte R, et al. Haemodynamic assessment of severe aortic stenosis using a three-dimensional (3D) printed model incorporating a flow circuit. Heart Lung Circ, 2018, 27(11): e105-e107.
30.	Duan B. State-of-the-art review of 3D bioprinting for cardiovascular tissue engineering. Ann Biomed Eng, 2017, 45(1): 195-209.
31.	Pati F, Jang J, Ha DH, et al. Printing three-dimensional tissue analogues with decellularized extracellular matrix bioink. Nat Commun, 2014, 5: 3935.
32.	Loo Y, Lakshmanan A, Ni M, et al. Peptide bioink: Self-assembling nanofibrous scaffolds for three-dimensional organotypic cultures. Nano Lett, 2015, 15(10): 6919-6925.
33.	Hockaday LA, Kang KH, Colangelo NW, et al. Rapid 3D printing of anatomically accurate and mechanically heterogeneous aortic valve hydrogel scaffolds. Biofabrication, 2012, 4(3): 035005.
34.	Sodian R, Hoerstrup SP, Sperling JS, et al. Early in vivo experience with tissue-engineered trileaflet heart valves. Circulation, 2000, 102(19 Suppl 3): Ⅲ22-Ⅲ29.
35.	Sodian R, Schmauss D, Markert M, et al. Three-dimensional printing creates models for surgical planning of aortic valve replacement after previous coronary bypass grafting. Ann Thorac Surg, 2008, 85(6): 2105-2108.
36.	Sodian R, Loebe M, Hein A, et al. Application of stereolithography for scaffold fabrication for tissue engineered heart valves. ASAIO J, 2002, 48(1): 12-16.
37.	Duan B, Hockaday LA, Kang KH, et al. 3D bioprinting of heterogeneous aortic valve conduits with alginate/gelatin hydrogels. J Biomed Mater Res A, 2013, 101(5): 1255-1264.
38.	Duan B, Hockaday LA, Kapetanovic E, et al. Stiffness and adhesivity control aortic valve interstitial cell behavior within hyaluronic acid based hydrogels. Acta Biomater, 2013, 9(8): 7640-7650.
39.	Duan B, Kapetanovic E, Hockaday LA, et al. Three-dimensional printed trileaflet valve conduits using biological hydrogels and human valve interstitial cells. Acta Biomater, 2014, 10(5): 1836-1846.
40.	Mahmood F, Owais K, Taylor C, et al. Three-dimensional printing of mitral valve using echocardiographic data. JACC Cardiovasc Imaging, 2015, 8(2): 227-229.
41.	Mashari A, Knio Z, Jeganathan J, et al. Hemodynamic testing of patient-specific mitral valves using a pulse duplicator: A clinical application of three-dimensional printing. J Cardiothorac Vasc Anesth, 2016, 30(5): 1278-1285.
42.	加丹, 周青, 邓倾. 3D 打印心血管功能流体模型的研究进展. 中华心血管病杂志, 2018, 46(4): 318-322.
43.	Rybicki FJ. Medical 3D printing and the physician-artist. Lancet, 2018, 391(10121): 651-652.

1. Michalski MH, Ross JS. The shape of things to come: 3D printing in medicine. JAMA, 2014, 312(21): 2213-2214.
2. Farooqi KM, Sengupta PP. Echocardiography and three-dimensional printing: Sound ideas to touch a heart. J Am Soc Echocardiogr, 2015, 28(4): 398-403.
3. Ventola CL. Medical applications for 3D printing: Current and projected uses. P T, 2014, 39(10): 704-711.
4. Nasis A, Mottram PM, Cameron JD, et al. Current and evolving clinical applications of multidetector cardiac CT in assessment of structural heart disease. Radiology, 2013, 267(1): 11-25.
5. Vukicevic M, Mosadegh B, Min JK, et al. Cardiac 3D printing and its future directions. JACC Cardiovasc Imaging, 2017, 10(2): 171-184.
6. Byrne N, Velasco Forte M, Tandon A, et al. A systematic review of image segmentation methodology, used in the additive manufacture of patient-specific 3D printed models of the cardiovascular system. JRSM Cardiovasc Dis, 2016, 5: 2048004016645467.
7. 陈思楷, 周青, 宋宏宁, 等. 多模态医学影像融合技术 3D 打印心脏模型方法学及精准度研究. 中华超声影像学杂志, 2018, 27(11): 924-930.
8. Giannopoulos AA, Steigner ML, George E, et al. Cardiothoracic applications of 3-dimensional printing. J Thorac Imaging, 2016, 31(5): 253-272.
9. Binder RK, Dweck M, Prendergast B. The year in cardiology: Valvular heart disease. Eur Heart J, 2020, 41(8): 912-920.
10. Cui H, Miao S, Esworthy T, et al. 3D bioprinting for cardiovascular regeneration and pharmacology. Adv Drug Deliv Rev, 2018, 132: 252-269.
11. 高强, 庄建, 岑坚正, 等. 3D 打印技术在复杂先天性心脏病外科诊疗中的应用. 中国胸心血管外科临床杂志, 2018, 25(8): 654-658.
12. Hann SY, Cui H, Esworthy T, et al. Recent advances in 3D printing: Vascular network for tissue and organ regeneration. Transl Res, 2019, 211: 46-63.
13. Singh D, Singh D, Han SS, et al. 3D printing of scaffold for cells delivery: Advances in skin tissue engineering. Polymers (Basel), 2016, 8(1): 19.
14. Dragone V, Sans V, Rosnes MH, et al. 3D-printed devices for continuous-flow organic chemistry. Beilstein J Org Chem, 2013, 9: 951-959.
15. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: A population-based study. Lancet, 2006, 368(9540): 1005-1011.
16. Wang DD, Gheewala N, Shah R, et al. Three-dimensional printing for planning of structural heart interventions. Interv Cardiol Clin, 2018, 7(3): 415-423.
17. Rojas GM, Gálvez M, Potler NV, et al. Stereoscopic three-dimensional visualization applied to multimodal brain images: Clinical applications and a functional connectivity atlas. Front Neurosci, 2014, 8: 328.
18. Daemen JHT, Heuts S, Olsthoorn JR, et al. Mitral valve modelling and three-dimensional printing for planning and simulation of mitral valve repair. Eur J Cardiothorac Surg, 2019, 55(3): 543-551.
19. Hernández-Enríquez M, Brugaletta S, Andreu D, et al. Three-dimensional printing of an aortic model for transcatheter aortic valve implantation: Possible clinical applications. Int J Cardiovasc Imaging, 2017, 33(2): 283-285.
20. Valverde I, Sarnago F, Prieto R, et al. Three-dimensional printing in vitro simulation of percutaneous pulmonary valve implantation in large right ventricular outflow tract. Eur Heart J, 2017, 38(16): 1262-1263.
21. Wamala I, Brüning J, Dittmann J, et al. Simulation of a right anterior thoracotomy access for aortic valve replacement using a 3D printed model. Innovations (Phila), 2019, 14(5): 428-435.
22. Benke K, Barabás JI, Daróczi L, et al. Routine aortic valve replacement followed by a myriad of complications: Role of 3D printing in a difficult cardiac surgical case. J Thorac Dis, 2017, 9(11): E1021-E1024.
23. Basman C, Seetharam K, Pirelli L, et al. Transcatheter aortic valve-in-valve-in-valve implantation with three-dimensional printing guidance: A case report. J Card Surg, 2020, 35(7): 1676-1680.
24. Qian Z, Wang K, Liu S, et al. Quantitative prediction of paravalvular leak in transcatheter aortic valve replacement based on tissue-mimicking 3D printing. JACC Cardiovasc Imaging, 2017, 10(7): 719-731.
25. Kim MS, Hansgen AR, Wink O, et al. Rapid prototyping: A new tool in understanding and treating structural heart disease. Circulation, 2008, 117(18): 2388-2394.
26. Booher AM, Bach DS. Exercise hemodynamics in valvular heart disease. Curr Cardiol Rep, 2011, 13(3): 226-233.
27. 王浩, 张斌, 宋宏宁, 等. 超声影像数据源 3D 打印结合模拟循环系统制作体外动态二尖瓣模型的可行性研究. 中华超声影像学杂志, 2020, 29(3): 206-212.
28. Ferrari G, Balasubramanian P, Tubaldi E, et al. Experiments on dynamic behaviour of a Dacron aortic graft in a mock circulatory loop. J Biomech, 2019, 86: 132-140.
29. Harb SC, Xu B, Klatte R, et al. Haemodynamic assessment of severe aortic stenosis using a three-dimensional (3D) printed model incorporating a flow circuit. Heart Lung Circ, 2018, 27(11): e105-e107.
30. Duan B. State-of-the-art review of 3D bioprinting for cardiovascular tissue engineering. Ann Biomed Eng, 2017, 45(1): 195-209.
31. Pati F, Jang J, Ha DH, et al. Printing three-dimensional tissue analogues with decellularized extracellular matrix bioink. Nat Commun, 2014, 5: 3935.
32. Loo Y, Lakshmanan A, Ni M, et al. Peptide bioink: Self-assembling nanofibrous scaffolds for three-dimensional organotypic cultures. Nano Lett, 2015, 15(10): 6919-6925.
33. Hockaday LA, Kang KH, Colangelo NW, et al. Rapid 3D printing of anatomically accurate and mechanically heterogeneous aortic valve hydrogel scaffolds. Biofabrication, 2012, 4(3): 035005.
34. Sodian R, Hoerstrup SP, Sperling JS, et al. Early in vivo experience with tissue-engineered trileaflet heart valves. Circulation, 2000, 102(19 Suppl 3): Ⅲ22-Ⅲ29.
35. Sodian R, Schmauss D, Markert M, et al. Three-dimensional printing creates models for surgical planning of aortic valve replacement after previous coronary bypass grafting. Ann Thorac Surg, 2008, 85(6): 2105-2108.
36. Sodian R, Loebe M, Hein A, et al. Application of stereolithography for scaffold fabrication for tissue engineered heart valves. ASAIO J, 2002, 48(1): 12-16.
37. Duan B, Hockaday LA, Kang KH, et al. 3D bioprinting of heterogeneous aortic valve conduits with alginate/gelatin hydrogels. J Biomed Mater Res A, 2013, 101(5): 1255-1264.
38. Duan B, Hockaday LA, Kapetanovic E, et al. Stiffness and adhesivity control aortic valve interstitial cell behavior within hyaluronic acid based hydrogels. Acta Biomater, 2013, 9(8): 7640-7650.
39. Duan B, Kapetanovic E, Hockaday LA, et al. Three-dimensional printed trileaflet valve conduits using biological hydrogels and human valve interstitial cells. Acta Biomater, 2014, 10(5): 1836-1846.
40. Mahmood F, Owais K, Taylor C, et al. Three-dimensional printing of mitral valve using echocardiographic data. JACC Cardiovasc Imaging, 2015, 8(2): 227-229.
41. Mashari A, Knio Z, Jeganathan J, et al. Hemodynamic testing of patient-specific mitral valves using a pulse duplicator: A clinical application of three-dimensional printing. J Cardiothorac Vasc Anesth, 2016, 30(5): 1278-1285.
42. 加丹, 周青, 邓倾. 3D 打印心血管功能流体模型的研究进展. 中华心血管病杂志, 2018, 46(4): 318-322.
43. Rybicki FJ. Medical 3D printing and the physician-artist. Lancet, 2018, 391(10121): 651-652.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of 3D printing technology in the diagnosis and treatment of valvular heart disease

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