Vol 24, No 4 (2017)
Review articles — Clinical cardiology
Published online: 2017-05-19

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Three-dimensional printing in cardiology: Current applications and future challenges

Hongxing Luo1, Jarosław Meyer-Szary2, Zhongmin Wang1, Robert Sabiniewicz3, Yuhao Liu1
Pubmed: 28541602
Cardiol J 2017;24(4):436-444.


Three-dimensional (3D) printing has attracted a huge interest in recent years. Broadly speaking, it refers to the technology which converts a predesigned virtual model to a touchable object. In clinical medicine, it usually converts a series of two-dimensional medical images acquired through computed tomography, magnetic resonance imaging or 3D echocardiography into a physical model. Medical 3D printing consists of three main steps: image acquisition, virtual reconstruction and 3D manufacturing. It is a promising tool for preoperative evaluation, medical device design, hemodynamic simulation and medical education, it is also likely to reduce operative risk and increase operative success. However, the most relevant studies are case reports or series which are underpowered in testing its actual effect on patient outcomes. The decision of making a 3D cardiac model may seem arbitrary since it is mostly based on a cardiologist’s perceived difficulty in performing an interventional procedure. A uniform consensus is urgently necessary to standardize the key steps of 3D printing from imaging acquisition to final production. In the future, more clinical trials of rigorous design are possible to further validate the effect of 3D printing on the treatment of cardiovascular diseases. (Cardiol J 2017; 24, 4: 436–444)

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  1. Matsumoto JS, Morris JM, Foley TA, et al. Three-dimensional Physical Modeling: Applications and Experience at Mayo Clinic. Radiographics. 2015; 35(7): 1989–2006.
  2. Giannopoulos AA, Mitsouras D, Yoo SJ, et al. Applications of 3D printing in cardiovascular diseases. Nat Rev Cardiol. 2016; 13(12): 701–718.
  3. Martelli N, Serrano C, van den Brink H, et al. Advantages and disadvantages of 3-dimensional printing in surgery: A systematic review. Surgery. 2016; 159(6): 1485–1500.
  4. Ma XJ, Tao L, Chen X, et al. Clinical application of three-dimensional reconstruction and rapid prototyping technology of multislice spiral computed tomography angiography for the repair of ventricular septal defect of tetralogy of Fallot. Genet Mol Res. 2015; 14(1): 1301–1309.
  5. Wang Z, Luo H, Gao C, et al. Three-dimensional printing model for the postoperative follow-up of atrial septal defect. Int J Cardiol. 2016; 222: 891–892.
  6. Pepper J, Petrou M, Rega F, et al. Implantation of an individually computer-designed and manufactured external support for the Marfan aortic root. Multimed Man Cardiothorac Surg. 2013; 2013: mmt004.
  7. Maragiannis D, Jackson MS, Igo SR, et al. Replicating patient-specific severe aortic valve stenosis with functional 3D modeling. Circ Cardiovasc Imaging. 2015; 8(10): e003626.
  8. Ngan E, Rebeyka I, Ross D, et al. The rapid prototyping of anatomic models in pulmonary atresia. J Thorac Cardiovasc Surg. 2006; 132(2): 264–269.
  9. Noecker AM, Chen JF, Zhou Q, et al. Development of patient-specific three-dimensional pediatric cardiac models. ASAIO J. 2006; 52(3): 349–353.
  10. Schievano S, Migliavacca F, Coats L, et al. Percutaneous pulmonary valve implantation based on rapid prototyping of right ventricular outflow tract and pulmonary trunk from MR data. Radiology. 2007; 242(2): 490–497.
  11. Armillotta A, Bonhoeffer P, Dubini G, et al. Use of rapid prototyping models in the planning of percutaneous pulmonary valved stent implantation. Proc Inst Mech Eng H. 2007; 221(4): 407–416.
  12. Mahmood F, Owais K, Montealegre-Gallegos M, et al. Echocardiography derived three-dimensional printing of normal and abnormal mitral annuli. Ann Card Anaesth. 2014; 17(4): 279–283.
  13. Liu P, Liu R, Zhang Y, et al. The value of 3D printing models of left atrial appendage using real-time 3D transesophageal echocardiographic data in left atrial appendage occlusion: applications toward an era of truly personalized medicine. Cardiology. 2016; 135(4): 255–261.
  14. Fan Y, Kwok KW, Zhang Y, et al. Three-dimensional printing for planning occlusion procedure for a double-lobed left atrial appendage. Circ Cardiovasc Interv. 2016; 9(3): e003561.
  15. Park CY, Chang JK, Jeong DY, et al. Development of a custom designed TAH using rapid prototyping. ASAIO J. 1997; 43(5): M647–M650.
  16. Holmes DR, Califf R, Farb A, et al. Overcoming the challenges of conducting early feasibility studies of medical devices in the United States. J Am Coll Cardiol. 2016; 68(17): 1908–1915.
  17. Schievano S, Taylor AM, Capelli C, et al. First-in-man implantation of a novel percutaneous valve: a new approach to medical device development. EuroIntervention. 2010; 5(6): 745–750.
  18. Kurenov S, Ionita C, Sammons D, et al. Three-dimensional printing to facilitate anatomic study, device development, simulation, and planning in thoracic surgery. J Thorac Cardiovasc Surg. 2015; 149(4): 973–979.e1.
  19. Prima MDi, Coburn J, Hwang D, et al. Additively manufactured medical products – the FDA perspective. 3D Printing in Medicine. 2015; 2(1).
  20. Herrmann TA, Siefert AW, Pressman GS, et al. In vitro comparison of Doppler and catheter-measured pressure gradients in 3D models of mitral valve calcification. J Biomech Eng. 2013; 135(9): 94502.
  21. Costello JP, Olivieri LJ, Krieger A, et al. Utilizing three-dimensional printing technology to assess the feasibility of high-fidelity synthetic ventricular septal defect models for simulation in medical education. World J Pediatr Congenit Heart Surg. 2014; 5(3): 421–426.
  22. Costello JP, Olivieri LJ, Su L, et al. Incorporating three-dimensional printing into a simulation-based congenital heart disease and critical care training curriculum for resident physicians. Congenit Heart Dis. 2015; 10(2): 185–190.
  23. Biglino G, Capelli C, Koniordou D, et al. Use of 3D models of congenital heart disease as an education tool for cardiac nurses. Congenit Heart Dis. 2017; 12(1): 113–118.
  24. Olivieri LJ, Su L, Hynes CF, et al. World J Pediatr Congenit Heart Surg. 2016; 7(2): 164–168.
  25. Estai M, Bunt S. Best teaching practices in anatomy education: A critical review. Ann Anat. 2016; 208: 151–157.
  26. Lim KH, Loo ZY, Goldie SJ, et al. Use of 3D printed models in medical education: A randomized control trial comparing 3D prints versus cadaveric materials for learning external cardiac anatomy. Anat Sci Educ. 2016; 9(3): 213–221.
  27. Ryan J, Gregg C, Frakes D, et al. Three-dimensional printing: changing clinical care or just a passing fad? Curr Opin Cardiol. 2017; 32(1): 86–92.
  28. Anwar S, Singh GK, Varughese J, et al. 3D printing in complex congenital heart disease: across a spectrum of age, pathology, and imaging techniques. JACC Cardiovasc Imaging. 2016 [Epub ahead of print].
  29. Markert M, Weber S, Lueth TC. A beating heart model 3D printed from specific patient data. Conf Proc IEEE Eng Med Biol Soc. 2007; 2007: 4472–4475.
  30. Ogden KM, Aslan C, Ordway N, et al. Factors affecting dimensional accuracy of 3-D printed anatomical structures derived from CT data. J Digit Imaging. 2015; 28(6): 654–663.
  31. Mathur M, Patil P, Bove A. The role of 3D printing in structural heart disease: all that glitters is not gold. JACC Cardiovasc Imaging. 2015; 8(8): 987–988.
  32. Farooqi KM, Lengua CG, Weinberg AD, et al. Blood pool segmentation results in superior virtual cardiac models than myocardial segmentation for 3D printing. Pediatr Cardiol. 2016; 37(6): 1028–1036.
  33. Gosnell J, Pietila T, Samuel BP, et al. Integration of computed tomography and three-dimensional echocardiography for hybrid three-dimensional printing in congenital heart disease. J Digit Imaging. 2016; 29(6): 665–669.
  34. Vukicevic M, Puperi D, Grande-Allen KJ, et al. 3D Printed Modeling of the Mitral Valve for Catheter-Based Structural Interventions. Ann Biomed Eng. 2016; 45(2): 508–519.
  35. Fujita B, Kütting M, Scholtz S, et al. Development of an algorithm to plan and simulate a new interventional procedure. Interact Cardiovasc Thorac Surg. 2015; 21(1): 87–95.
  36. Rajani R, Khattar R, Chiribiri A, et al. Multimodality imaging of heart valve disease. Arq Bras Cardiol. 2014; 103(3): 251–263.
  37. Schmauss D, Haeberle S, Hagl C, et al. Three-dimensional printing in cardiac surgery and interventional cardiology: a single-centre experience. Eur J Cardiothorac Surg. 2015; 47(6): 1044–1052.
  38. Koleilat I, Jaeggli M, Ewing JA, et al. Interobserver variability in physician-modified endograft planning by comparison with a three-dimensional printed aortic model. J Vasc Surg. 2016; 64(6): 1789–1796.
  39. Garekar S, Bharati A, Chokhandre M, et al. Clinical application and multidisciplinary assessment of three dimensional printing in double outlet right ventricle with remote ventricular septal defect. World J Pediatr Congenit Heart Surg. 2016; 7(3): 344–350.
  40. Ripley B, Kelil T, Cheezum MK, et al. 3D printing based on cardiac CT assists anatomic visualization prior to transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr. 2016; 10(1): 28–36.
  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. Valverde I, Gomez G, Gonzalez A, et al. Three-dimensional patient-specific cardiac model for surgical planning in Nikaidoh procedure. Cardiol Young. 2015; 25(4): 698–704.
  43. Farooqi KM, Gonzalez-Lengua C, Shenoy R, et al. Use of a three dimensional printed cardiac model to assess suitability for biventricular repair. World J Pediatr Congenit Heart Surg. 2016; 7(3): 414–416.
  44. Valverde I, Gomez G, Coserria JF, et al. 3D printed models for planning endovascular stenting in transverse aortic arch hypoplasia. Catheter Cardiovasc Interv. 2015; 85(6): 1006–1012.
  45. Sulaiman A, Boussel L, Taconnet F, et al. In vitro non-rigid life-size model of aortic arch aneurysm for endovascular prosthesis assessment. Eur J Cardiothorac Surg. 2008; 33(1): 53–57.
  46. Mottl-Link S, Hübler M, Kühne T, et al. Physical models aiding in complex congenital heart surgery. Ann Thorac Surg. 2008; 86(1): 273–277.
  47. Sodian R, Weber S, Markert M, et al. Stereolithographic models for surgical planning in congenital heart surgery. Ann Thorac Surg. 2007; 83(5): 1854–1857.
  48. Chaowu Y, Hua Li, Xin S. Three-Dimensional printing as an aid in transcatheter closure of secundum atrial septal defect with rim deficiency: in vitro trial occlusion based on a personalized heart model. Circulation. 2016; 133(17): e608–e610.
  49. Yang F, Zheng H, Lyu J, et al. [A case of transcatheter closure of inferior vena cava type atrial septal defect with patent ductus arteriosus occlusion device guided by 3D printing technology]. Zhonghua Xin Xue Guan Bing Za Zhi, 2015. Zhonghua Xin Xue Guan Bing Za Zhi. 2015; 43(7): 631–633.
  50. Lazkani M, Bashir F, Brady K, et al. Postinfarct VSD management using 3D computer printing assisted percutaneous closure. Indian Heart J. 2015; 67(6): 581–585.
  51. Otton J, Spina R, Sulas R, et al. Left atrial appendage closure guided by personalized 3d-printed cardiac reconstruction. JACC Cardiovasc Interv. 2015; 8(7): 1004–1006.
  52. Liu K, Lyu B, Ren X, et al. [Prior transcatheter aortic valve implantation evaluation with 3D printing technology: a case report]. Zhonghua Xin Xue Guan Bing Za Zhi. 2015; 43(7): 634–635.
  53. Schmauss D, Juchem G, Weber S, et al. Three-dimensional printing for perioperative planning of complex aortic arch surgery. Ann Thorac Surg. 2014; 97(6): 2160–2163.
  54. O’Neill B, Wang D, Pantelic M, et al. Transcatheter caval valve implantation using multimodality imaging: roles of TEE, CT, and 3D printing. JACC Cardiovascular Imaging. 2015; 8(2): 221–225.
  55. Poterucha JT, Foley TA, Taggart NW. Percutaneous pulmonary valve implantation in a native outflow tract: 3-dimensional DynaCT rotational angiographic reconstruction and 3-dimensional printed model. JACC Cardiovasc Interv. 2014; 7(10): e151–e152.
  56. Dankowski R, Baszko A, Sutherland M, et al. 3D heart model printing for preparation of percutaneous structural interventions: description of the technology and case report. Kardiol Pol. 2014; 72(6): 546–551.
  57. Son KH, Kim KW, Ahn CB, et al. Surgical planning by 3D printing for primary cardiac schwannoma resection. Yonsei Med J. 2015; 56(6): 1735–1737.
  58. Shirakawa T, Koyama Y, Mizoguchi H, et al. Morphological analysis and preoperative simulation of a double-chambered right ventricle using 3-dimensional printing technology. Interact Cardiovasc Thorac Surg. 2016; 22(5): 688–690.
  59. Olivieri L, Krieger A, Chen MY, et al. 3D heart model guides complex stent angioplasty of pulmonary venous baffle obstruction in a Mustard repair of D-TGA. Int J Cardiol. 2014; 172(2): e297–e298.
  60. Kiraly L, Tofeig M, Jha NK, et al. 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(2): 238–240.
  61. Leotta DF, Starnes BW. Custom fenestration templates for endovascular repair of juxtarenal aortic aneurysms. J Vasc Surg. 2015; 61(6): 1637–1641.
  62. Hadeed K, Dulac Y, Acar P. Three-dimensional printing of a complex CHD to plan surgical repair. Cardiol Young. 2016; 26(7): 1432–1434.
  63. Jabbari OAl, Saleh WA, Patel A, et al. Use of three-dimensional models to assist in the resection of malignant cardiac tumors. J Cardiac Surg. 2016; 31(9): 581–583.
  64. Hermsen JL, Burke TM, Seslar SP, 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(1): 132–140.
  65. 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.
  66. Jacobs S, Grunert R, Mohr FW, et al. 3D-Imaging of cardiac structures using 3D heart models for planning in heart surgery: a preliminary study. Interact Cardiovasc Thorac Surg. 2008; 7(1): 6–9.
  67. Farooqi KM, Saeed O, Zaidi A, et al. 3D printing to guide ventricular assist device placement in adults with congenital heart disease and heart failure. JACC Heart Fail. 2016; 4(4): 301–311.
  68. Bauch T, Vijayaraman P, Dandamudi G, et al. Three-Dimensional printing for in vivo visualization of his bundle pacing leads. Am J Cardiol. 2015; 116(3): 485–486.