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Application prospects and challenges of 3D printing technology in the heart field

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  In the past 30 years, 3D printing technology has promoted the development of construction, machinery manufacturing and other fields with tremendous advantages. With the development of materials science and medical imaging, 3D printing technology has been gradually applied in medical field, especially in orthopedics and maxillofacial surgery.
In recent years, 3D printed cardiac models have played a unique role in the teaching of cardiovascular science, technical training, treatment planning and other aspects. This article focuses on the application of 3D printing technology in the field of cardiovascular diseases and explores the potential value of this technology.
  The anatomical structure of the heart is exquisite and complex. It requires a strong spatial thinking ability to understand the structure of the heart, but it is more difficult to construct the spatial structure of congenital heart disease. 3D printing technology can visually display the heart, and has obvious advantages in showing the spatial structure.
  Studies have shown that the application of 3D printing technology to the training of cardiovascular specialists has achieved good results, deepening their understanding of the anatomy and pathophysiology of heart diseases. The long training cycle of cardiac surgeons has been the consensus of the industry. The major factor is the unique physiological characteristics of the heart and the difficulty of surgical operation. The lack of a satisfactory training mold in reality is also an unavoidable problem.
  Printing technology provides the possibility of producing a heart model for specific diseases. Hermsen et al. used three-dimensional model of hypertrophic obstructive cardiomyopathy to simulate surgery compared with real surgery, good consistency is not only the success of modeling methods, but also provides a new way of thinking for surgical training.
  On the other hand, because 3D printing technology can accurately restore the structure of the heart, the use of 3D models in preoperative planning and planning of surgery has been widely used in the field of cardiovascular treatment. Taking the complex congenital heart disease represented by double outlet of right ventricle as an example, because different anatomical types need different surgical methods and treatment strategies, 3D printed cardiac disease model improves the understanding of complex anatomical spatial relationship and provides help for making reasonable surgical plan before operation.
  Complex congenital heart disease is not only manifested in the anatomical structure of the abnormalities in the heart, but also includes the location of extracardiac vascular variation, increasing the difficulty of surgery. 3D cardiac model has the advantage of clearly displaying the location of large vessels, which can help to formulate complex surgical procedures such as heart transplantation and ventricular assist device implantation for congenital heart disease. In addition, in the surgical treatment of rare diseases such as cardiac tumors, 3D models can accurately display the size, location and adjacent relationship with the surrounding structures, providing help for planning surgical strategies.
  For patients with ASDs with short defect margins, occlusion tests on a 3D print model can be used to screen suitable cases for more potential patients to benefit from minimally invasive treatment. In the case of left atrial appendage occlusion, 3D model can be used to measure the diameters more accurately before operation, select the type of occluder in advance, accurately predict the occlusion effect and significantly reduce the operation time. Using 3D model to simulate percutaneous mitral annuloplasty and percutaneous aortic valve implantation can plan the operation plan, route and special equipment in more detail and reduce the risk of operation.
  Printing model plays a unique role in the diagnosis and treatment of cardiovascular diseases, but it also has its own shortcomings that need to be improved. First, the fineness of the model needs to be strengthened. At present, 3D modeling data come from clinical ultrasound, CT, magnetic resonance imaging (MRI) examinations, but these examinations have their own limitations. The spatial resolution of ultrasound is insufficient and the fine structure is not clearly displayed; the radiation of CT examination is large, some patients with iodine allergy can not be enhanced CT scanning, and CT examination can not clearly display the valve, soft tissue and other structures; MRI examination time is too long, patients with metal implants in the body can not be carried out.
  In most studies, the cardiac model is based on CT data, which can not well reflect the structure of valve, soft margin of atrial septal defect and sac of ventricular septal defect. Secondly, printing materials need to be improved. Due to the limitation of technical conditions and the periodic changes of heart structure, there is still a big gap between the 3D model and the real heart, and the time of making the model is longer and the cost is higher.
  Most importantly, 3D printing technology has not yet revolutionized the cardiovascular field. Twenty years ago, image reconstruction technology had enabled us to see three-dimensional images on the screen, and to view the heart from different angles by rotating them.
  In recent years, the rapid development of computer technology, so that we can arbitrarily cut the heart in the computer screen, and observe different sections of the three-dimensional images. By contrast, a 3D print model is nothing more than a model that turns the image on the screen into something that can be played at hand.
  Some experts believe that 3D printing is a "gimmick" because 3D printing does not really change the treatment and treatment effect, in the absence of 3D printing, through the computer screen three-dimensional images, the same treatment program and effect can be achieved. For example, in patients with double outlets of the right ventricle, patients who could not establish an internal tunnel based on three-dimensional images could not be overturned by a 3D-printed model simulating surgery, thereby changing the surgical approach.
  It is obvious that the advantages of 3D printing display space structure do not surprise cardiologists, so 3D printing in the field of cardiovascular applications is focused on in vitro testing function, that is, the printed model simulated treatment, to develop different treatment options, and the above model refined

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