Personalized Three-Dimensional Printing and Echoguided Procedure Facilitate Single Device Closure for Multiple Atrial Septal Defects

الملخص EN

Background.

To evaluate the feasibility of using a single device to close multiple atrial septal defects (ASDs) under the guidance of transthoracic echocardiography (TTE) and with the aid of three-dimensional (3D) printing models.

Methods.

Sixty-two patients with multiple ASDs were retrospectively analyzed.

Thirty of these patients underwent TTE-guided closure (3D printing and TTE group) after a simulation of occlusion in 3D printing models.

The remaining 32 patients underwent ASD closure under fluoroscopic guidance (conventional group).

Closure status was assessed immediately and at 6 months after device closure.

Results.

Successful transcatheter closure with a single device was achieved in 26 patients in the 3D printing and TTE group and 27 patients in the conventional group.

Gender, age [18.8 ± 15.9 (3–51) years in the 3D printing and TTE group; 14.0 ± 11.6 (3–50) years in the conventional group], mean maximum distance between defects, prevalence of 3 atrial defects and large defect distance (defined as distance ≥7 mm), and occluder size used were similarly distributed between groups.

However, the 3D printing and TTE group had lower frequency of occluder replacement (3.8% vs 59.3%, p<0.0001), prevalence of mild residual shunts (defined as <5 mm) immediately (19.2% vs 44.4%, p<0.05) and at 6 months (7.7% vs 29.6%, p<0.05) after the procedure, and cost (32960.8 ± 2018.7 CNY vs 41019.9 ± 13758.2 CNY, p<0.01).

Conclusion.

The combination of the 3D printing technology and ultrasound-guided interventional procedure provides a reliable new therapeutic approach for multiple ASDs, especially for challenging cases with large defect distance.