3D打印技术在先天性心脏病诊疗中的应用现状Applications of 3-dimensional printing technology in congenital heart disease
常开丽,张灿,徐云燕,戴海龙
摘要(Abstract):
近年来新兴的3D打印技术(也称为快速成型或增材制造技术),可利用各种材料如金属、塑料,陶瓷等,将数字文件转化为物理模型。3D打印技术高度适用于先天性心脏病的诊疗,根据CT、磁共振成像、超声心动图等影像学数据制造心脏模型,可以直观地重现心脏及大血管的复杂解剖与位置关系,有助于医师更好地理解解剖结构,协助临床诊断、指导制定治疗策略。该技术已广泛应用于多种先天性心脏病的诊断、术前计划和模拟。在医学教育、促进医患沟通、介入操作培训、封堵器测试等方面亦取得良好进展。本文就3D打印技术在先天性心脏病中的应用情况做一综述。
关键词(KeyWords): 3D打印;先天性心脏病;诊疗
基金项目(Foundation): 国家自然科学基金资助项目(82060018、81700438);; 云南省自然科学基金资助项目(202101AS070043、202102AA310003-7)
作者(Author): 常开丽,张灿,徐云燕,戴海龙
参考文献(References):
- [1] Fan Y,Wong RHL,Lee AP. Three-dimensional printing in structural heart disease and intervention[J]. Ann Transl Med,2019,7(20):579. DOI:10.21037/atm.2019.09.73.
- [2]卢涛,王水云. 3D打印在心血管疾病手术中的应用进展[J].中国心血管病研究,2021,19(5):469-475. DOI:10.3969/j.issn.1672-5301.2021.05.017.
- [3] Vukicevic M,Mosadegh B,Min JK,et al. Cardiac 3D printing and its future directions[J]. JACC Cardiovasc Imaging,2017,10(2):171-184. DOI:10.1016/j.jcmg.2016.12.001.
- [4] Wang DD,Qian Z,Vukicevic M,et al. 3D printing,computational modeling,and artifi cial intelligence for structural heart disease[J]. JACC Cardiovasc Imaging,2021,14(1):41-60. DOI:10.1016/j.jcmg.2019.12.022.
- [5] Liang J,Zhao X,Pan G,et al. Comparison of blood pool and myocardial 3D printing in the diagnosis of types of congenital heart disease[J]. Sci Rep,2022,12(1):7136. DOI:10.1038/s41598-022-11294-6.
- [6] Lee S,Squelch A,Sun Z. Quantitative assessment of 3D printed model accuracy in delineating congenital heart disease[J]. Biomolecules,2021,11(2):270. DOI:10.3390/biom11020270.
- [7]许毓楷,张智伟.房间隔缺损合并三尖瓣反流的研究进展[J].中国介入心脏病学杂志,2022,30(2):135-138. DOI:10.3969/j. issn. 1004-8812. 2022. 02. 011.
- [8]徐吉,江尕学,刘天蕊,等.房间隔缺损或卵圆孔未闭合并房间隔瘤介入封堵治疗临床经验[J].中国介入心脏病学杂志,2021,29(6):324-328. DOI:10. 3969/j. issn. 1004-8812. 2021. 06. 006.
- [9] He L,Cheng GS,Du YJ,et al. Feasibility of device closure for multiple atrial septal defects with an inferior sinus venosus defect:procedural planning using three-dimensional printed models[J]. Heart Lung Circ,2020,29(6):914-920.DOI:10.1016/j.hlc.2019.07.004.
- [10] Chaowu Y,Hua L,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[J]. Circulation,2016,133(17):e608-e610.DOI:10.1161/CIRCULATIONAHA.115.020735.
- [11] Yan C,Wang C,Pan X,et al. Three-dimensional printing assisted transcatheter closure of atrial septal defect with defi cient posterior-inferior rim[J]. Catheter Cardiovasc Interv,2018,92(7):1309-1314. DOI:10.1002/ccd.27799.
- [12]庞英,梁明亭,杨帆,等.应用3D打印技术实施下腔型房间隔缺损封堵术1例[J].临床心血管病杂志,2016,32(1):97-98. DOI:10.13201/j.issn.1001-1439.2016.01.025.
- [13] Szkutnik M,Masura J,Bialkowski J,et al. Transcatheter closure of double atrial septal defects with a single Amplatzer device[J]. Catheter Cardiovasc Interv,2004,61(2):237-241. DOI:10.1002/ccd.10753.
- [14] Li P,Fang F,Qiu X,et al. Personalized three-dimensional printing and echoguided procedure facilitate single device closure for multiple atrial septal defects[J]. J Interv Cardiol,2020,2020:1751025. DOI:10.1155/2020/1751025.
- [15] Zhao LJ,Han B,Zhang JJ,et al. Transcatheter closure of congenital perimembranous ventricular septal defect using the Amplatzer duct occluder 2[J]. Cardiol Young,2018,28(3):447-453. DOI:10.1017/S1047951117002396.
- [16] Minette MS,Sahn DJ. Ventricular septal defects[J].Circulation,2006,114(20):2190-2197. DOI:10.1161/CIRCULATIONAHA.106.618124.
- [17] Yin S,Zhu D,Lin K,et al. Perventricular device closure of congenital ventricular septal defects[J]. J Card Surg,2014,29(3):390-400. DOI:10.1111/jocs.12334.
- [18] Butera G,Chessa M,Carminati M. Percutaneous closure of ventricular septal defects. State of the art[J]. J Cardiovasc Med(Hagerstown),2007,8(1):39-45. DOI:10.2459/01.JCM.0000247434.59451.d7.
- [19] Gaynor JW,O’Brien JE Jr,Rychik J,et al. Outcome following tricuspid valve detachment for ventricular septal defects closure[J]. Eur J Cardiothorac Surg,2001,19(3):279-282. DOI:10.1016/s1010-7940(01)00577-2.
- [20] Mendez A, Gomez-Ciriza G, Raboisson MJ, et al.Apical muscular ventricular septal defects:surgical strategy using three-dimensional printed model[J]. Semin Thorac Cardiovasc Surg,2018,30(4):450-453. DOI:10.1053/j.semtcvs.2018.07.002.
- [21] Longinotti L,Castaldi B,Bertelli F,et al. Three-dimensional printing for hybrid closure of complex muscular ventricular septal defects[J]. Ann Thorac Surg,2022,113(2):e129-e132.DOI:10.1016/j.athoracsur.2021.04.049.
- [22]张小飞,魏国荣,李保军,等.介入封堵及外科结扎治疗伴有体肺侧支的法洛四联症的疗效对比[J].中国介入心脏病学杂志,2022,30(7):540-544. DOI:10. 3969/j. issn. 1004-8812. 2022. 07. 011.
- [23] Apitz C,Webb GD,Redington AN. Tetralogy of Fallot[J]. Lancet,2009,374(9699):1462-1471. DOI:10.1016/S0140-6736(09)60657-7.
- [24] Geva T. Repaired tetralogy of Fallot:the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support[J]. J Cardiovasc Magn Reson,2011,13(1):9. DOI:10.1186/1532-429X-13-9.
- [25] Nathan M, Marshall A C, Kerstein J, et al. Technical performance score as predictor for post-discharge reintervention in valve-sparing tetralogy of Fallot repair[J]. Semin Thorac Cardiovasc Surg,2014,26(4):297-303. DOI:10.1053/j.semtcvs.2014.12.001.
- [26] Tomov ML, Cetnar A, Do K, et al. Patientspecific 3-dimensional-bioprinted model for in vitro analysis and treatment planning of pulmonary artery atresia in tetralogy of Fallot and major aortopulmonary collateral arteries[J]. J Am Heart Assoc,2019,8(24):e014490. DOI:10.1161/JAHA.119.014490.
- [27] Nam JG,Lee W,Jeong B,et al. Three-dimensional printing of congenital heart disease models for cardiac surgery simulation:evaluation of surgical skill improvement among inexperienced cardiothoracic surgeons[J]. Korean J Radiol,2021,22(5):706-713. DOI:10.3348/kjr.2020.0682.
- [28] Averkin II,Grehov EV,Pervunina TM,et al. 3D-printing in preoperative planning in neonates with complex congenital heart defects[J]. J Matern Fetal Neonatal Med,2022,35(10):2020-2024. DOI:10.1080/14767058.2020.1771691.
- [29] Ryan JR,Moe TG,Richardson R,et al. A novel approach to neonatal management of tetralogy of Fallot,with pulmonary atresia,and multiple aortopulmonary collaterals[J]. JACC Cardiovasc Imaging,2015,8(1):103-104. DOI:10.1016/j.jcmg.2014.04.030.
- [30] Yang DH,Park SH,Kim N,et al. Incremental value of 3D printing in the preoperative planning of complex congenital heart disease surgery[J]. JACC Cardiovasc Imaging,2021,14(6):1265-1270. DOI:10.1016/j.jcmg.2020.06.024.
- [31] Yim D,Dragulescu A,Ide H,et al. Essential modifiers of double outlet right ventricle:revisit with endocardial surface images and 3-dimensional print models[J]. Circ Cardiovasc Imaging, 2018, 11(3):e006891. DOI:10. 1161/CIRCIMAGING.117.006891
- [32] 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[J]. World J Pediatr Congenit Heart Surg,2016,7(3):344-350. DOI:10.1177/2150135116645604.
- [33] Farooqi KM,Nielsen JC,Uppu SC,et al. Use of 3-dimensional printing to demonstrate complex intracardiac relationships in double-outlet right ventricle for surgical planning[J]. Circ Cardiovasc Imaging,2015,8(5):e003043. DOI:10.1161/CIRCIMAGING.114.003043.
- [34] Liang J,Lu B,Zhao X,et al. Feasibility analyses of virtual models and 3D printing for surgical simulation of the doubleoutlet right ventricle[J]. Med Biol Eng Comput,2022,60(10):3029-3040. DOI:10.1007/s11517-022-02660-7.
- [35] Anwar S,Singh GK,Varughese J,et al. 3D printing in complex congenital heart disease:across a spectrum of age,pathology,and imaging techniques[J]. JACC Cardiovasc Imaging,2017,10(8):953-956. DOI:10.1016/j.jcmg.2016.03.013.
- [36] Shearn AIU,Yeong M,Richard M,et al. Use of 3D models in the surgical decision-making process in a case of double-outlet right ventricle with multiple ventricular septal defects[J]. Front Pediatr,2019,7:330. DOI:10.3389/fped.2019.00330.
- [37] Canan A,Ashwath R,Agarwal PP,et al. Multimodality imaging of transposition of the great arteries[J].Radiographics,2021,41(2):338-360. DOI:10.1148/rg.2021200069.
- [38] Gaur L,Cedars A,Diller GP,et al. Management considerations in the adult with surgically modifi ed d-transposition of the great arteries[J]. Heart,2021,107(20):1613-1619. DOI:10.1136/heartjnl-2020-318833.
- [39] Silversides CK,Roche SL. Congenitally corrected transposition of the great arteries:untangling the mechanisms of right ventricular dysfunction[J]. JACC Cardiovasc Imaging,2022,15(4):575-577. DOI:10.1016/j.jcmg.2021.12.002.
- [40] Kutty S,Danford DA,Diller GP,et al. Contemporary management and outcomes in congenitally corrected transposition of the great arteries[J]. Heart,2018,104(14):1148-1155. DOI:10.1136/heartjnl-2016-311032.
- [41] Valverde I,Gomez G,Gonzalez A,et al. Three-dimensional patient-specific cardiac model for surgical planning in Nikaidoh procedure[J]. Cardiol Young,2015,25(4):698-704.DOI:10.1017/S1047951114000742.
- [42] Sahayaraj RA, Ramanan S, Subramanyan R, et al.3D printing to model surgical repair of complex congenitally corrected transposition of the great arteries[J]. World J Pediatr Congenit Heart Surg,2019,10(3):373-375. DOI:10.1177/2150135117704655.
- [43] Hoashi T,Ichikawa H,Nakata T,et al. Utility of a superflexible three-dimensional printed heart model in congenital heart surgery[J]. Interact Cardiovasc Thorac Surg,2018,27(5):749-755. DOI:10.1093/icvts/ivy160.
- [44] Biglino G,Capelli C,Wray J,et al. 3D-manufactured patientspecifi c models of congenital heart defects for communication in clinical practice:feasibility and acceptability[J]. BMJ Open,2015,5(4):e007165. DOI:10.1136/bmjopen-2014-007165.
- [45] Kiraly L,Shah NC,Abdullah O,et al. Three-dimensional virtual and printed prototypes in complex congenital and pediatric cardiac surgery-a multidisciplinary team-learning experience[J]. Biomolecules,2021,11(11):1703.DOI:10.3390/biom11111703.
- [46] Olivieri LJ,Su L,Hynes CF,et al.“Just-In-Time” simulation training using 3-D printed cardiac models after congenital cardiac surgery[J]. World J Pediatr Congenit Heart Surg,2016,7(2):164-168. DOI:10.1177/2150135115623961.
- [47] Karsenty C,Guitarte A,Dulac Y,et al. The usefulness of 3D printed heart models for medical student education in congenital heart disease[J]. BMC Med Educ,2021,21(1):480.DOI:10.1186/s12909-021-02917-z.
- [48] Loke YH,Harahsheh AS,Krieger A,et al. Usage of 3D models of tetralogy of Fallot for medical education:impact on learning congenital heart disease[J]. BMC Med Educ,2017,17(1):54. DOI:10.1186/s12909-017-0889-0.
- [49] van der Linde D,Konings EE,Slager MA,et al.Birth prevalence of congenital heart disease worldwide:a systematic review and meta-analysis[J]. J Am Coll Cardiol,2011,58(21):2241-2247. DOI:10.1016/j.jacc.2011.08.025.
- [50] Hussein N,Lim A,Honjo O,et al. Development and validation of a procedure-specific assessment tool for hands-on surgical training in congenital heart surgery[J]. J Thorac Cardiovasc Surg, 2020, 160(1):229-240. e1. DOI:10. 1016/j.jtcvs.2019.11.130.
- [51] Biglino G,Capelli C,Koniordou D,et al. Use of 3D models of congenital heart disease as an education tool for cardiac nurses[J]. Congenit Heart Dis,2017,12(1):113-118.DOI:10.1111/chd.12414.
- [52] Lin C,Liu L,Liu Y,et al. Recent developments in nextgeneration occlusion devices[J]. Acta Biomater,2021,128:100-119. DOI:10.1016/j.actbio.2021.04.050.
- [53] Shi D,Kang Y,Zhang G,et al. Biodegradable atrial septal defect occluders:a current review[J]. Acta Biomater,2019,96:68-80. DOI:10.1016/j.actbio.2019.05.073.
- [54] Wu W,Yip J,Tang YD,et al. A novel biodegradable septal defect occluder:the “Chinese Lantern” design,proof of concept[J]. Innovations(Phila),2011,6(4):221-230.DOI:10.1097/IMI.0b013e31822a2c42.
- [55] Robinson SS,Alaie S,Sidoti H,et al. Patient-specific design of a soft occluder for the left atrial appendage[J]. Nat Biomed Eng,2018,2(1):8-16. DOI:10.1038/s41551-017-0180-z.
- [56] Lau I,Wong YH,Yeong CH,et al. Quantitative and qualitative comparison of low-and high-cost 3D-printed heart models[J]. Quant Imaging Med Surg,2019,9(1):107-114. DOI:10.21037/qims.2019.01.02.
- [57] Vukicevic M,Puperi DS,Jane Grande-Allen K,et al. 3D printed modeling of the mitral valve for catheter-based structural interventions[J]. Ann Biomed Eng,2017,45(2):508-519. DOI:10.1007/s10439-016-1676-5.