Application Of 3D Printing Technology In Personalized Diagnosis And Treatment Of Congenital Heart Disease

Objective:To explore the clinical application of 3D printing technology in personalized diagnosis and treatment of congenital heart disease.Methods:1?Form June 2018 to June 2019,eight patients(5 males and 3 females)CTA with subarterial VSD?ten patients(6 males and 4 females)CTA with DORV?three patients with coronary artery abnormalities,including one case of Anomalous left coronary artery from the pulmonary artery(ALCAPA),one case of right coronary artery-left ventricular fistula,and one case of left and right coronary artery all originating from right coronary sinus combined with left coronary artery-pulmonary artery fistula and right coronary artery-pulmonary artery fistula and other congenital heart disease were collected.The patients's CTA image data were modeled by Mimics 19.0 and input into a 3D printer to make 3D printed cardiac models for personalized and accurate guidance of surgery.To guide and assist the preoperative planning and personalized surgical treatment.2?Eight cases of subarterial VSD and ten cases of DORV with 3D solid model to guide the operation were included in the 3D printing model group,while twenty cases of subarterial VSD and twenty-five cases of DORV without 3D solid model to guide the operation were included in the non-3D printing model group3?The consistency of data was compared between3D printing model and CT,and the intraoperative and postoperative data were compared between the 3D printing group and the non-3d printing group.Results:1?The size of VSD diagnosed by CT in 8 cases was(3.50±1.41)mm,and the size of VSD measured by the 3D printing model was(3.25±1.28)mm.There was no statistical difference between the two groups(t=0.370,P=0.717),and the Pearson correlation coefficient was 0.946.The distance between VSD and aortic valve in CT was(1.91±0.59)mm,and the distance between VSD and aortic valve in the 3D printed model was(1.81±0.65)mm,There was no statistical difference between the two groups(t=0.322,P=0.752),and the Pearson correlation coefficient was 0.826.The size of the closure device was(4.50±1.41)mm in the preoperative simulation and(4.25±1.28)mm in the actual operation,with no statistical difference between two groups(t=0.357,P=0.727).There was no statistical difference between the preoperative simulated catheter entering intercostal location and the intraoperative actual catheter entering intercostal location(t=0.386,P=0.705),and the Pearson correlation coefficient between the two groups was 0.898.The operation time of the 3D printing model group was less than that of the non-3D printing model group,there was a significant statistical difference between two groups(t=-2.227,P=0.035).There was no statistical difference between the two groups in length of stay and success rate of plugging(P>0.05).In the 3D printing model group,the plugging device was fixed in place with echocardiography and no residual shunt was found during operation.The aortic valve and pulmonary valve opening and closing were not affected.But in the non-3D printing model group,there were 3 cases failure of plugging operation,and ventricular septal defect was repaired under cardiopulmonary bypass.2?10 DORV patients's McGoon index of was(1.91±0.70).The size of VSD diagnosed by CT in 10 cases was(13.20±4.57)mm,and the size of VSD measured by the 3D printing model was(13.4±5.04)mm.There was no statistical difference between the two groups(t=0.093,P=0.927),and the Pearson correlation coefficient was 0.982.The diameter of the ascending aorta measured by CT was(17.1±2.92)mm,and the diameter of the ascending aorta measured by 3D printing model was(16.9±3.51)mm,there was no statistical difference betveen the two groups(t=0.138,P=0.891),and the Pearson correlation coefficient was 0.943.The diameter of pulmonary trunk measured by CT was(12.5±5.23)mm,and the diameter of the pulmonary trunk measured by 3D printing model was(12.9±4.63)mm,there was no statistical difference between the two groups(t=0.181,P=0.858),and the Pearson correlation coefficient was 0.975.All patients underwent preoperative planning for surgical treatment by 3D printed models and were discharged safely after surgery.In these 10 patients,six of them underwent biventricular repair surgery and four underwent palliative surgery.The operation time,endotracheal intubation time,ICU time and hospital stays in the 3D printing model group were all less than those in the non-3D printing model group,there was a significant statistical difference between two groups(P<0.05).After hospital discharge,the patient was examined by cardiac ultrasound regularly,and the ultrasonic display that no residual leakage was observed in the patients,and the right ventricular outflow tract was patency.3?The 3D printed heart models of the 3 cases can clearly show the spatial relationship between coronary arteries and pulmonary arteries?aorta,as well as the size and location of coronary artery fistula,and the model is consistent with the data model without any significant difference.All patients's operations were completed successfully and recovered well without serious complications.4?Other congenital heart diseases(2 cases single ventricle and 2 cases congenital bicuspid aortic valve)were also successfully printed for personalized diagnosis and treatment,with great results.Conclusion:1?Subarterial VSD position is higher,adjacent to the aortic valve and pulmonary artery,3D printing model can well display the spatial relations betwenn VSD and aortic,the distance betwenn VSD and aortic,the VSD size,etc.,It can evaluate whether it is suitable for ventricular septal defect plugging operation,and to predict and choose accurate size plugging device and the entry of the catheter into the intercostal location to lower operation's failure rate and risk.2?The DORV model printed by 3D printing technology can observe the relationship between VSD and aorta and pulmonary artery from a 3D perspective,and make surgical plans through preoperative precise anatomical relationship,which can assist physicians to make reasonable,science and effective decision.Finally,we can reduce intraoperative exploration time,clarify the details of surgical operation and reduce operative time and risk.3?3D printing technology was applied to coronary artery anomalies and other congenital heart diseases is valuable to diagnosis and formulate appropriate surgical plan.Based on the CT image digital processing,we can get precise 3D heart models,which can help patients to make a clear diagnosis and surgeons to formulate the best personalized operation plan,and guide the smooth and safe treatment.