3D printed roadmap provides simulation for aortic arch stenting

Chalk another one up to 3D modeling: In a case study, a 15-year old boy had a successful endovascular stent implantation for an aortic arch hypoplasia. Physicians guided their actions and decisions based on printed 3D models of his heart.

Models were created using MRI results. Israel Valverde, MD, of the pediatric cardiology unit at the Hospital Virgen Del Rocio in Seville, Spain, and colleagues printed two versions of the model, one rigid and one flexible version. Both models were radio-opaque and allowed for an interventional simulation, preparing the team by mimicking the conditions they would find without prolonging the ultimate surgery with unexpected surprises.

Stenting a hypoplastic transverse aortic arch is a challenging procedure rife with potential complications including stent migration, stroke and neuropraxia. Use of the 3D model provided the physicians with enough understanding of the conditions of the arch to be able to place the stent more effectively, understand the approach better and determine accurately the full extension diameter of the stent.

Stent delivery was successful. Physicians confirmed adequate stent position with aortography. They successfully expanded the aortic arch diameter from 9.5 mm to 13.7 mm with no major obstruction of flow of the supra-aortic branches. Systolic peak pressure gradient reduced from 35 mm Hg to 7 mm Hg.

Valverde et al confirmed that there were no statistically significant differences in diameter measurements and accurately reflected the MRI and X-rays taken. Marginal over-estimation of measurements from MRI and X-ray were seen (approximately 0.36 mm). The team wrote that interventional cardiology, particularly in the area of congenital heart disease, is the perfect place for 3D cardiovascular model simulation, citing regular anatomic variability among patients.

“3D printed models accurately recreate patients’ anatomy and are helpful in planning endovascular stenting in transverse arch hyperplasia,” Valverde et al wrote. Improvements to materials and technology, however, should continue to improve the utility of 3D modeling as a tool for understanding complex hearts.

This proof-of-concept was published online Feb. 12 in Catheterization and Cardiovascular Interventions.

For more on 3D models as a tool in cardiovascular care, read "Tiny 3D Hearts Make a Huge Impact."