Cardiac Catheterization Laboratory, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141 USA.
J Invasive Cardiol. 2021 Aug;33(8):E592-E603. doi: 10.25270/jic/20.00586.
Three-dimensional (3D) printing technology has seen tremendous growth in augmenting didactics, research, and preprocedural planning with structural heart procedures. Limited investigative efforts have been made in other areas of the cardiovascular spectrum. 3D-printed models (PMs) of anatomically complex coronary artery bypass graft (CABG) patients from coronary computed tomography angiography (CCTA) have implications for adaptive learning and preprocedural planning.
Five patients with CCTA who underwent subsequent coronary angiography were 3D printed for retrospective comparisons. Standard slicer software was used to create a computer-aided image of the ascending aorta, native coronary arteries, bypass grafts, aortic arch, and great vessels and 3D printed using polylactic acid filament. The models were painted with acrylic paint to highlight anatomical features and comparison was made with coronary angiography and 3D-CTA images.
All occluded vein grafts, left and right internal mammary artery (IMA) grafts, patent saphenous vein grafts, along with distal graft anastomotic sites, were accurately 3D printed. In cases with chronic total occlusions (CTOs), ambiguous ostial caps, mid or distal vessel chronic occlusions, and occlusions seen as CTOs on coronary angiography were 3D printed showing either distal vessel reconstitution via collaterals or complete arterial filling seen in a setting of calcification, microchannels, and collateral flow. Lastly, 3D printing of the aortic root and great vessels allowed for better appreciation of vessel tortuosity to aid in the cannulation of IMA grafts and optimizing engagement with diagnostic and guiding catheters.
3D printing of anatomically complex CABG patients has the potential to assist with preprocedural planning and operator understanding of complex coronary anatomy.
三维（3D）打印技术在结构性心脏手术的教学、研究和术前规划方面取得了巨大的发展。在心血管领域的其他领域，有限的研究工作已经开展。从冠状动脉计算机断层血管造影（CCTA）对解剖复杂的冠状动脉旁路移植术（CABG）患者进行 3D 打印，对适应性学习和术前规划具有重要意义。
对随后进行冠状动脉造影的 5 例 CCTA 患者进行了 3D 打印，用于回顾性比较。使用标准切片软件创建升主动脉、原生冠状动脉、旁路移植、主动脉弓和大血管的计算机辅助图像，并使用聚乳酸长丝进行 3D 打印。模型用丙烯酸漆进行涂装，以突出解剖特征，并与冠状动脉造影和 3D-CTA 图像进行比较。
所有闭塞的静脉移植物、左、右内乳动脉（IMA）移植物、通畅的大隐静脉移植物，以及远端移植物吻合部位，都能准确地 3D 打印。在慢性完全闭塞（CTO）病例中，对于模糊的开口帽、中段或远段血管慢性闭塞以及在冠状动脉造影中看到的 CTO，3D 打印可以显示通过侧支循环的远端血管重建，或者在钙化、微通道和侧支血流的情况下显示完全动脉充盈。最后，主动脉根部和大血管的 3D 打印可以更好地了解血管迂曲，有助于 IMA 移植物的插管，并优化与诊断和引导导管的配合。
对解剖复杂的 CABG 患者进行 3D 打印有可能辅助术前规划和术者对复杂冠状动脉解剖结构的理解。
