Author + information
- Brian O’Neill, MD,
- Dee Dee Wang, MD∗ (, )
- Milan Pantelic, MD,
- Thomas Song, MD,
- Mayra Guerrero, MD,
- Adam Greenbaum, MD and
- William W. O’Neill, MD
- ↵∗Advanced Structural Heart Imaging, Department of Cardiology, 2799 West Grand Boulevard, K-14, Detroit, Michigan 48202
We thank Dr. Mathur and colleagues for their interest in our experience with computer-aided design and 3D printing (CAD3DP) in structural heart disease periprocedural planning (1). We agree that in the eventual technological investment in personalized heart valves, there will need to be standardization of 3D printing for health care delivery. The focus, however, should not be on the 3D print itself, but the integration of advanced multidetector slice computed tomography (CT) image reconstruction with CAD3DP for successful periprocedural planning.
First, CAD3DP application is only as usable as the quality of the CT raw source DICOM data that it is being applied from, as demonstrated by the artifact on the model of Mathur and colleagues. For this to be avoided, there needs to be significant investment in education for scanning technique and scan implementation at the level of the CT technologists. For structural heart interventions, we tailor our CT scans to the specific valve or area of interest (Table 1). We use a contrast-enhanced, retrospectively electrocardiogram-gated CT angiography acquisition on a General Electric Discovery CT750 64-slice scanner (General Electric, Waukesha, Wisconsin). Additionally, targeted cardiac phases are identified for reconstruction, as this affects the size, geometry, and functionality of the area of interest. Our models are printed on the Objet30 (Stratasys Ltd., Minneapolis, Minnesota) using Rigid Opaque photopolymers (Stratasys Ltd.).
Second, there is no current U.S. Food and Drug Administration–approved medical 3D printer for use. The absence of elastic printed materials that mimic human tissue should not preclude the advancement and adjunctive clinical application of this technology to current transcatheter procedures for physical periprocedural information gathering and planning. Technology for the future bioprosthetic 3D printed heart valve does not yet exist, but periprocedural clinical application of CAD3DP in structural heart interventions is the beginning to developing the platform to reach that ultimate goal.
We therefore caution comparing medical 3D printing in its infancy with “aesthetic art.” There is a vast difference in the amount of procedural planning awareness generated between the ability to view an image magnified on a computer monitor compared with handling a to-scale reproduction of a patient’s anatomy with tolerances that do not modify or deform. Moving forward, we will continue to develop and advance CT CAD3DP imaging innovation to enhance the care of our patients requiring high-risk advanced structural heart interventional therapy.
Please note: Drs. Guerrero and Greenbaum are proctors for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. B. O’Neill and Wang contributed equally to this work.
- American College of Cardiology Foundation