Nat. Rev. Cardiol. doi: /nrcardio

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Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.170 Figure 2 3D printing-assisted intervention and surgery planning of structural heart diseases Figure 2 | 3D printing-assisted intervention and surgery planning of structural heart diseases. a–e | Sizing of a Watchman device (Boston Scientific, USA) for left atrial appendage closure with a patient-specific 3D-printed model. Devices in sizes 21 mm (panel a), 24 mm (panel b), and 27 mm (panel c) were deployed in a flexible atrial model derived from CT images. Anatomical distortion was calculated for each device, creating a 3D map colour-coded according to the degree of deformation produced. The 21-mm device applies minimal radial force at the appendage orifice (blue arrow), whereas the barbs of the 27-mm device apply localized stress to the appendage wall (yellow arrow). Panel d shows the Watchman device placed within the flexible 3D-printed model. Transoesophageal echocardiography after the procedure demonstrates complete closure with a 24-mm device (panel e, red arrow). f–i | 3D printing-assisted septal myectomy in a patient with obstructive hypertrophic cardiomyopathy. A 3D porous scaffold of the anatomy of interest was fabricated and infused with a mixture of silicone and a blend of two hydrogels approximating the consistency of the cardiac muscle (panel f). The model was used for preoperative simulation of a transaortic septal myectomy, revealing an abnormality involving the subvalvular mitral apparatus — one papillary muscle inserted directly onto the leaflet (panel g, black arrow; view from ventricular side looking out of the left ventricular outflow tract) — that was confirmed during the operation (panel h, white arrow; view from aortic side looking into left ventricle). Panel i shows the 3D-printed model with resection specimens from the simulated myectomy alongside the actual myectomy specimens from the same patient for comparison. Panels a–e are reprinted from Otton, J. M. et al. Left atrial appendage closure guided by personalized 3D-printed cardiac reconstruction. JACC Cardiovasc. Interv. 8, 1004–1006 (2015) with permission from Elsevier. Panels f–i are reprinted from Hermsen, J. L. et al. Scan, plan, print, practice, perform: development and use of a patient-specific 3D printed model in adult cardiac surgery. J. Thorac. Cardiovasc. Surg. http://dx.doi.org/10.1016/j.jtcvs.2016.08.007 (2016) with permission from Elsevier. Panels a–e are reprinted from Otton, J. M. et al. Left atrial appendage closure guided by personalized 3D‑printed cardiac reconstruction. JACC Cardiovasc. Interv. 8, 1004–1006 (2015) with permission from Elsevier. Panels f–i are reprinted from Hermsen, J. L. et al. Scan, plan, print, practice, perform: development and use of a patient-specific 3D printed model in adult cardiac surgery. J. Thorac. Cardiovasc. Surg. http://dx.doi.org/10.1016/j.jtcvs.2016.08.007 (2016) with permission from Elsevier Giannopoulos, A. A. et al. (2016) Applications of 3D printing in cardiovascular diseases Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.170