DOI QR코드

DOI QR Code

Novel Resectable Myocardial Model Using Hybrid Three-Dimensional Printing and Silicone Molding for Mock Myectomy for Apical Hypertrophic Cardiomyopathy

  • Wooil Kim (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Minje Lim (Anymedi Inc.) ;
  • You Joung Jang (Anymedi Inc.) ;
  • Hyun Jung Koo (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Joon-Won Kang (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Sung-Ho Jung (Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Dong Hyun Yang (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2020.09.25
  • 심사 : 2020.12.01
  • 발행 : 2021.07.01

초록

Objective: We implemented a novel resectable myocardial model for mock myectomy using a hybrid method of three-dimensional (3D) printing and silicone molding for patients with apical hypertrophic cardiomyopathy (ApHCM). Materials and Methods: From January 2019 through May 2020, 3D models from three patients with ApHCM were generated using the end-diastolic cardiac CT phase image. After computer-aided designing of measures to prevent structural deformation during silicone injection into molding, 3D printing was performed to reproduce anatomic details and molds for the left ventricular (LV) myocardial mass. We compared the myocardial thickness of each cardiac segment and the LV myocardial mass and cavity volumes between the myocardial model images and cardiac CT images. The surgeon performed mock surgery, and we compared the volume and weight of the resected silicone and myocardium. Results: During the mock surgery, the surgeon could determine an ideal site for the incision and the optimal extent of myocardial resection. The mean differences in the measured myocardial thickness of the model (0.3, 1.0, 6.9, and 7.3 mm in the basal, midventricular, apical segments, and apex, respectively) and volume of the LV myocardial mass and chamber (36.9 mL and 14.8 mL, 2.9 mL and -9.4 mL, and 6.0 mL and -3.0 mL in basal, mid-ventricular and apical segments, respectively) were consistent with cardiac CT. The volume and weight of the resected silicone were similar to those of the resected myocardium (6 mL [6.2 g] of silicone and 5 mL [5.3 g] of the myocardium in patient 2; 12 mL [12.5 g] of silicone and 11.2 mL [11.8 g] of the myocardium in patient 3). Conclusion: Our 3D model created using hybrid 3D printing and silicone molding may be useful for determining the extent of surgery and planning surgery guided by a rehearsal platform for ApHCM.

키워드

과제정보

This research was supported by the Basic Science Research Program, through the National Research Foundation of Korea (NRF), funded by the Ministry of Science, ICT & Future Planning (NRF-2020R1A2C2003843).

참고문헌

  1. Baxi AJ, Restrepo CS, Vargas D, Marmol-Velez A, Ocazionez D, Murillo H. Hypertrophic cardiomyopathy from A to Z: genetics, pathophysiology, imaging, and management. Radiographics 2016;36:335-354  https://doi.org/10.1148/rg.2016150137
  2. Klarich KW, Attenhofer Jost CH, Binder J, Connolly HM, Scott CG, Freeman WK, et al. Risk of death in long-term follow-up of patients with apical hypertrophic cardiomyopathy. Am J Cardiol 2013;111:1784-1791  https://doi.org/10.1016/j.amjcard.2013.02.040
  3. Towe EC, Bos JM, Ommen SR, Gersh BJ, Ackerman MJ. Genotype-phenotype correlations in apical variant hypertrophic cardiomyopathy. Congenit Heart Dis 2015;10:E139-E145  https://doi.org/10.1111/chd.12242
  4. Kunkala MR, Schaff HV, Nishimura RA, Abel MD, Sorajja P, Dearani JA, et al. Transapical approach to myectomy for midventricular obstruction in hypertrophic cardiomyopathy. Ann Thorac Surg 2013;96:564-570  https://doi.org/10.1016/j.athoracsur.2013.04.073
  5. Kim H, Park JH, Won KB, Yoon HJ, Park HS, Cho YK, et al. Significance of apical cavity obliteration in apical hypertrophic cardiomyopathy. Heart 2016;102:1215-1220  https://doi.org/10.1136/heartjnl-2015-309121
  6. Hang D, Schaff HV, Ommen SR, Dearani JA, Nishimura RA. Combined transaortic and transapical approach to septal myectomy in patients with complex hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 2018;155:2096-2102  https://doi.org/10.1016/j.jtcvs.2017.10.054
  7. Tang Y, Song Y, Duan F, Deng L, Ran J, Gao G, et al. Extended myectomy for hypertrophic obstructive cardiomyopathy patients with midventricular obstruction. Eur J Cardiothorac Surg 2018;54:875-883  https://doi.org/10.1093/ejcts/ezy203
  8. Nguyen A, Schaff HV, Nishimura RA, Geske JB, Dearani JA, King KS, et al. Apical myectomy for patients with hypertrophic cardiomyopathy and advanced heart failure. J Thorac Cardiovasc Surg 2019 Apr [Epub]. https://doi.org/10.1016/j.jtcvs.2019.03.088 
  9. Maron MS, Rowin EJ, Olivotto I, Casey SA, Arretini A, Tomberli B, et al. Contemporary natural history and management of nonobstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2016;67:1399-1409 
  10. Parachuri VR, Adhyapak SM. The case for surgical myectomy in hypertrophic cardiomyopathy: is strategic planning the key to success? J Thorac Cardiovasc Surg 2017;154:1687-1688  https://doi.org/10.1016/j.jtcvs.2017.02.032
  11. Vukicevic M, Mosadegh B, Min JK, Little SH. Cardiac 3D printing and its future directions. JACC Cardiovasc Imaging 2017;10:171-184  https://doi.org/10.1016/j.jcmg.2016.12.001
  12. Sodian R, Weber S, Markert M, Loeff M, Lueth T, Weis FC, et al. Pediatric cardiac transplantation: three-dimensional printing of anatomic models for surgical planning of heart transplantation in patients with univentricular heart. J Thorac Cardiovasc Surg 2008;136:1098-1099  https://doi.org/10.1016/j.jtcvs.2008.03.055
  13. Yang DH, Park SH, Kim N, Choi ES, Kwon BS, Park CS, et al. Incremental value of 3D printing in the preoperative planning of complex congenital heart disease surgery. JACC Cardiovasc Imaging 2020 Aug [Epub]. https://doi.org/10.1016/j.jcmg.2020.06.024 
  14. Kiraly L, Tofeig M, Jha NK, Talo H. Three-dimensional printed prototypes refine the anatomy of post-modified Norwood-1 complex aortic arch obstruction and allow presurgical simulation of the repair. Interact Cardiovasc Thorac Surg 2016;22:238-240  https://doi.org/10.1093/icvts/ivv320
  15. Guo HC, Wang Y, Dai J, Ren CW, Li JH, Lai YQ. Application of 3D printing in the surgical planning of hypertrophic obstructive cardiomyopathy and physician-patient communication: a preliminary study. J Thorac Dis 2018;10:867-873  https://doi.org/10.21037/jtd.2018.01.55
  16. Hermsen JL, Burke TM, Seslar SP, Owens DS, Ripley BA, Mokadam NA, et al. Scan, plan, print, practice, perform: development and use of a patient-specific 3-dimensional printed model in adult cardiac surgery. J Thorac Cardiovasc Surg 2017;153:132-140  https://doi.org/10.1016/j.jtcvs.2016.08.007
  17. Shiraishi I, Yamagishi M, Hamaoka K, Fukuzawa M, Yagihara T. Simulative operation on congenital heart disease using rubber-like urethane stereolithographic biomodels based on 3D datasets of multislice computed tomography. Eur J Cardiothorac Surg 2010;37:302-306 
  18. Yang DH, Kang JW, Kim N, Song JK, Lee JW, Lim TH. Myocardial 3-dimensional printing for septal myectomy guidance in a patient with obstructive hypertrophic cardiomyopathy. Circulation 2015;132:300-301  https://doi.org/10.1161/CIRCULATIONAHA.115.015842
  19. Gregory S, Timms D, Pearcy MJ, Tansley G. A naturally shaped silicone ventricle evaluated in a mock circulation loop: a preliminary study. J Med Eng Technol 2009;33:185-191  https://doi.org/10.1080/03091900802184072
  20. Russo M, Koenigshofer M, Stoiber M, Werner P, Gross C, Kocher A, et al. Advanced three-dimensionally engineered simulation model for aortic valve and proximal aorta procedures. Interact Cardiovasc Thorac Surg 2020;30:887-895  https://doi.org/10.1093/icvts/ivaa026
  21. Lezhnev AA, Ryabtsev DV, Hamanturov DB, Barskiy VI, Yatsyk SP. Silicone models of the aortic root to plan and simulate interventions. Interact Cardiovasc Thorac Surg 2020;31:204-209  https://doi.org/10.1093/icvts/ivaa068
  22. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-542  https://doi.org/10.1161/hc0402.102975
  23. Smooth-On, Inc. EcoflexTM 00-10. Smooth-on Web site. https://www.smooth-on.com/products/ecoflex-00-10/. Accessed September 22, 2020 
  24. Gheorghe AG, Fuchs A, Jacobsen C, Kofoed KF, Mogelvang R, Lynnerup N, et al. Cardiac left ventricular myocardial tissue density, evaluated by computed tomography and autopsy. BMC Med Imaging 2019;19:29 
  25. Farooqi KM, Saeed O, Zaidi A, Sanz J, Nielsen JC, Hsu DT, et al. 3D printing to guide ventricular assist device placement in adults with congenital heart disease and heart failure. JACC Heart Fail 2016;4:301-311  https://doi.org/10.1016/j.jchf.2016.01.012
  26. Jacobs S, Grunert R, Mohr FW, Falk V. 3D-imaging of cardiac structures using 3D heart models for planning in heart surgery: a preliminary study. Interact Cardiovasc Thorac Surg 2008;7:6-9  https://doi.org/10.1510/icvts.2007.156588
  27. Chung P, Heller JA, Etemadi M, Ottoson PE, Liu JA, Rand L, et al. Rapid and low-cost prototyping of medical devices using 3D printed molds for liquid injection molding. J Vis Exp 2014;88:e51745 
  28. Thompson AJ, Dearani JA, Johnson JN, Schaff HV, Towe EC, Palfreeman J, et al. What is the role of apical ventriculotomy in children and young adults with hypertrophic cardiomyopathy? Congenit Heart Dis 2018;13:617-623  https://doi.org/10.1111/chd.12618
  29. Kotkar KD, Said SM, Dearani JA, Schaff HV. Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience. Ann Cardiothorac Surg 2017;6:329-336  https://doi.org/10.21037/acs.2017.07.03
  30. Said SM, Schaff HV, Abel MD, Dearani JA. Transapical approach for apical myectomy and relief of midventricular obstruction in hypertrophic cardiomyopathy. J Card Surg 2012;27:443-448 https://doi.org/10.1111/j.1540-8191.2012.01475.x