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Correct device selection for left atrial appendage (LAA) closure remains challenging due to the variable shapes of the LAA. We investigated the use of personalized 3D print models to guide the device size selection.
Fifteen patients underwent cardiac CT with contrast media injection (SIemens Somaton Flash) pre LAA closure. The LAA was segmented by semiautomatic algorithms using Vitrea software (Vital Images, Inc.; MN,USA) and a 1.5 mm thick shell of the LAA was exported in STL format and printed on an object 260 connex3 printer (Stratasys Ltd. Rheinmünster, Germany) using tangoblackplus flexible material. Based on the CT and transeosophageal echocardiography (TEE) measurements we then tried different Amplatzer Amulet (St Jude Medical, USA) device sizes on the printed model. The sizes predicted by TEE and CT scan were then compared with the device size implanted in the model as well as in the patient.
The mean age of our patient population was 75.4±8.5 years, 60% were male. The device size predicted by TEE and cardiac CT corresponded to the implanted device size in 8/15 (53%) and 10/15 (67%), respectively. The predicted device size based on the 3D heart model was accurate in all patients. The segmentation process lasted less than 15 min. On the CT, the proximal disc sealing the LAA ostium and the close contact of the distal lobe with the LAA wall could be seen well. In cases of incorrect sizing, the absence of contact with the LAA wall or device deformation was easily identified.
Personalized 3D printed LAA model helps to select the correct size of the LAA occluder device.
STRUCTURAL: Left Atrial Appendage Exclusion