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Patient-specific Dynamic 3d Mitral Valve Models For Surgical Planning And Simulation
Olivia Ginty1, John Moore1, Yuanwei Xu1, Wenyao Xia1, Satoru Fujii, MD2, Dan Bainbridge, MD2, Terry Peters, PhD1, Bob Kiaii, MD, FRCSC2, Michael W. A. Chu, MD, FRCSC2.
1Robarts Research Institute, London, ON, Canada, 2Western University, London, ON, Canada.
OBJECTIVE: Advances in trans-esophageal echocardiography (TEE) imaging and the advent of easily available 3D printing present an opportunity to accurately model patient-specific mitral valve (MV) anatomy. The goal of this project is to create a workflow for making accurate, patient-specific MV silicone models capable of dynamically simulating pathologies, as well as the respective surgical repairs. These models can be used in both planning complex repairs, and as part of simulated training for trainee surgeons. Since the models attach into a beating heart simulator, they can immediately offer the trainee an indication of the outcome of a given repair.
METHODS: We create geometric models of the patient’s MV and associated tissues based on 3D TEE image data. These models are then integrated into computer-aided design software and 3D printed. The resulting 3D prints are combined with tissue-mimicking silicone to create replicas of the patient MV. The models can then be placed in a beating heart simulator to assess their dynamic behaviour.
RESULTS: Using MV analysis software (QLab) a retrospective study of 9 MV repair cases were replicated and assessed for anatomical equivalence. Measurement differences between a patient valve and sample model include a A2-P2 annulus diameter of 2.2mm, intercommissure annulus diameter of 3mm, anterior leaflet length of 0.9mm, posterior leaflet length of 4.8mm and leaflet thickness 0.9mm. These preliminary results show a close anatomical replication of the patient’s valve in the form of suturable silicone model, which correlated with a realistic simulation of the patient’s valve for pre-operative repair ‘rehearsal’.
CONCLUSIONS: Modern TEE imaging, coupled with inexpensive 3D printing technologies, can be used to replicate patient specific MV pathologies in models that can be employed in simulation training for surgeons, and as a means of assessing repair techniques prior to complex surgery. LEGEND: (left to right) 1st row - Patient 2D Doppler and 3D TEE. 2nd row - QLab models of patient valve and sample valve. 3rd row - Sample silicone valve with/without beating left ventricle simulator. 
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