Aged, Aged, 80 and over, Calcinosis diagnostic imaging, Calcinosis physiopathology, Cardiac Catheterization adverse effects, Cardiac Catheterization instrumentation, Feasibility Studies, Female, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation instrumentation, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Models, Anatomic, Models, Cardiovascular, Postoperative Complications etiology, Severity of Illness Index, Tomography, X-Ray Computed, Treatment Outcome, Calcinosis surgery, Cardiac Catheterization methods, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation methods, Mitral Valve surgery, Patient-Specific Modeling, and Printing, Three-Dimensional
Introduction: Three-dimensional (3D) prototyping is a novel technology which can be used to plan and guide complex procedures such as transcatheter mitral valve replacement (TMVR).
Methods: Eight patients with severe mitral annular calcification (MAC) underwent TMVR. 3D digital models with digital balloon expandable valves were created from pre-procedure CT scans using dedicated software. Five models were printed. These models were used to assess prosthesis sizing, anchoring, expansion, paravalvular gaps, left ventricular outflow tract (LVOT) obstruction, and other potential procedure pitfalls. Results of 3D prototyping were then compared to post procedural imaging to determine how closely the achieved procedural result mirrored the 3D modeled result.
Results: 3D prototyping simulated LVOT obstruction in one patient who developed it and in another patient who underwent alcohol septal ablation prior to TMVR. Valve sizing correlated with actual placed valve size in six out of the eight patients and more than mild paravalvular leak (PVL) was simulated in two of the three patients who had it. Patients who had mismatch between their modeled valve size and post-procedural imaging were the ones that had anterior leaflet resection which could have altered valve sizing and PVL simulation. 3D printed model of one of the latter patients allowed modification of anterior leaflet to simulate surgical resection and was able to estimate the size and location of the PVL after inserting a valve stent into the physical model.
Conclusion: 3D prototyping in TMVR for severe MAC is feasible for simulating valve sizing, apposition, expansion, PVL, and LVOT obstruction.
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