July 21, 2015 | By Simon

It’s no secret that 3D printing has helped revolutionize the medical and healthcare industry thanks to the ability to create customized manufacturable solutions for a wide variety of ailments - yet it seems like each week we’re presented with entirely new ways of harnessing the technology - which leads us to believe that we’re only barely scratching the surface of what’s possible.  

More recently, a team of Australian physicians have used 3D printing to create an exact replica of a patient's heart leading up to a left atrial appendage (LAA) closure procedure with a Watchman device.  According to researchers on the team, the use of 3D printing makes perfect sense for the procedure because "the anatomy is complex and the interaction between the device and the appendage is difficult to quantify, even using advanced imaging methods."

Dr. James Otton of the Victor Chang Cardiac Research Institute in Sydney, Australia, who is helping lead the team, explains that percutaneous LAA-occlusion procedures with the Watchman are traditionally performed under fluoroscopy and transesophageal echocardiography (TEE) while multidetector computed tomography (CT) helps provide a 3D image of the heart.

In a recent letter to the editor in the June 2015 Journal of the American College of Cardiology: Cardiovascular Interventions, Otton and his colleagues published data based on their experience with 3D printing of the LAA in a 74-year-old man who has a history of paroxysmal atrial fibrillation and who was intolerant to traditional oral anticoagulation.

To create their physical model of the patient’s heart, the team utilized data from an existing CT scan to create a digital 3D model which was subsequently 3D printing using a flexible material to simulate the atrial mechanical properties of the left atrium and LAA.  

"The issue is that the structure of the left atrial appendage (LAA) is very complex, and even if you have a great-quality data set, it's very difficult to know where the device will fit within the left atrial appendage," explained Otton. "The sizing is not straightforward. Within the orifice of the left atrial appendage, it can be hard to decide exactly where the device should go."

In order to help "identify the areas and extent of engagement of the device on the flexible atrial model," the team placed 21-mm, 24-mm, and 27-mm Watchman devices into the 3D printed model before performing another round of CT scans.  With these new scans, the team was able to further analyze the anatomic deformation for each of the different device sizes.  

Based on their research, the team reported that, based on the TEE, 21-mm device would have been selected but the resulting data from the reimaged CT scan of the 3D printed model suggested that the 21-mm device would have been too small.  Alternatively, it was determined that the 24-mm Watchman device would be the ideal size based on their investigation, which was ultimately implanted soon after by Dr. Brendan Gundalingam, also of the Victor Chang Cardiac Research Institute.  

According to Otton, the use of 3D printing to help is not only cheap but can also be done in just 30 minutes.  Although the use of the technology may not become a regular procedure in patients whose anatomy is straightforward and easy to measure, Otton believes that the technique could be useful on a case-by-case basis during the planning stages.      

"I don't want to overstate the utility of [3D printing], because this is really just proof of concept, showing that it can be done," explained Otton.

"I think 3D printing will be used more—even in our own work it's been used in other procedures—and I think it will be useful in a subset of complex procedures. And it'll definitely be useful in education and planning, but I wouldn't go so far as to say it'll be routinely done. I think we'll have to wait a year or two to see how it goes."


Posted in 3D Printing Applications



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