Utility of 3D printing of left atrial appendages for closure with Watchman Devices and comparison of computed tomography and transesophageal echocardiography based models

Using imaging comparisons to print three dimensional cardiovascular structures

Abstract

Three dimensional (3D) printed cardiac models are useful for WATCHMAN device procedural planning, sizing, and complication reduction. These models also provide accurate representation of dynamic heart anatomy, helping practitioners determine their procedural approach and select proper device sizing. While the efficacy of 3D models obtained from Computed Tomography and Transesophageal Echocardiography over 2D Transesophageal Echocardiography imaging for WATCHMAN procedural planning has been demonstrated, this project aims to directly compare 3D Computed Tomography versus 3D Transesophageal Echocardiography and determine which is more favorable. Computed Tomography and Transesophageal Echocardiography 2D imaging studies from patients that underwent LAA WATCHMAN closure device implantation we used as templates for 3D cardiac models. These 3D models were scored using a 10-point Likert questionnaire. Scoring was conducted by a diverse team that included cardiologists, research specialists, medical students, and 3D printing technicians.  Three dimensional models developed using Computed Tomography demonstrated favorability over 3D models by all qualitative measures. Scoring indicates that Computed Tomography based 3D models are superior tools for WATCHMAN sizing, multi-level medical education, and physician preparedness. To our knowledge, this is the only study that compares 3D models crafted from each imaging modality, and we hope that it encourages future use of 3D modeling techniques based on Computed Tomography scans.