Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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Table of Contents
Year : 2014  |  Volume : 17  |  Issue : 4  |  Page : 283-284
Echocardiography derived three- dimensional printing of normal and abnormal mitral annuli

Department of Non Invasive Cardiology, Indraprastha Apollo Hospital, New Delhi, India

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Date of Web Publication1-Oct-2014

How to cite this article:
Kapur K K, Garg N. Echocardiography derived three- dimensional printing of normal and abnormal mitral annuli. Ann Card Anaesth 2014;17:283-4

How to cite this URL:
Kapur K K, Garg N. Echocardiography derived three- dimensional printing of normal and abnormal mitral annuli. Ann Card Anaesth [serial online] 2014 [cited 2022 Nov 29];17:283-4. Available from:

The study by Feroze Mahmood et al., published by in this issue of Annals of Cardiac Anesthesia, is an attempt to create three dimensional models of normal and abnormal mitral annuli using transesophageal echocardiography (TEE) derived high-resolution three-dimensional ultrasound images in patients undergoing cardiac surgery. This study is the first report of the use of live three-dimensional-TEE images to print replicas of mitral annuli. In an earlier study, Thomas M. Binder et al.; had used reconstruction TEE images to create steriolithographic models of various mitral valve pathologies.

The use of three-dimensional printed replicas for various medical applications is a relatively recent phenomenon. This exciting field is rapidly evolving and has several potential advantages over the conventional methods of prosthetic replacements. Usually, computed tomography (CT) or magnetic resonance imaging (MRI) have been used to provide the basic three-dimensional images for creating accurately sized solid replicas. However, CT/MRI technology is time-consuming and not available in the operation theaters. The use of high-resolution transesophageal (TEE) three-dimensional images is a novel concept. The advantage of the echocardiographic technique lies in its easy availability, portability, cost effectiveness and time effectiveness.

In this elegant study the authors have demonstrated the feasibility of rapidly acquiring full volume three-dimensional-TEE images to track mitral annulus using the TomTec Imaging Systems GmbH, Germany and then quickly printing these images into solid lithographic models; within a short span of 30 min. This printing was performed in 2 patients with normal mitral valve and 3 other patients with mitral valve pathologies (2 with ischemic mitral regurgitation and one with myxomatous mitral valve). The authors have discussed in some depth the potential utility of the three-dimensional printed models of mitral annuli in selection of appropriate selection of the size, type and design of prosthetic mitral rings in surgical repair of mitral valve pathologies. The advantage of printed solid three-dimensional models over the digital three-dimensional images is obvious. The digital images lack the appropriate platform to display the actual three-dimensional structures while the printed models allow a complete visual, as well as tactile appreciation of the three-dimensional anatomy.

Hitherto, the selection of the type and sizing of prosthetic ring was based on the judgement and experience of a cardiac surgeon. This results in substantial variability in the selection of appropriate prosthetic mitral rings from one surgeon to the other. The three-dimensional printed replicas could provide a standardized patient-specific choice of the prosthetic ring. In the future, it may be possible to actually generate the desired design of mitral ring as well as to manufacture the prosthetic ring itself made of appropriate material and within the operation theatre complex.

However, this is only a feasibility study and has several limitations. The printed replicas have not been validated about their size and shape with the actual annuli of the patients. Since the three-dimensional-TEE imaging is operator dependent, the images derived by different operators could show significant variations that could impact the size and shape of the printed replicas. Further studies are required to show that the method of three-dimensional printing would provide superior, cost effective and longer lasting prosthetic mitral rings as compared to the choice and judgment of the experienced cardiac surgeon.

In conclusion, the authors need to be lauded for the commendable, innovative approach about the design and methodology of the study. This has the potential to open up a new field of creation of quick, efficient, precise, patient-specific prosthetic materials including valves, rings, grafts, stents and conduits.

Correspondence Address:
K K Kapur
Department of Non Invasive Cardiology, Indraprastha Apollo Hospital, New Delhi 110 076
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Source of Support: None, Conflict of Interest: None

PMID: 25281625

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