Mitral paravalvular leak 3D printing from 3D- transesophageal echocardiography – proof of concept and preparation flowchart

Paravalvular leaks (PVLs) can be detected in almost 15% of patients after mitral valve prosthesis implantation. This complication can result in congestive heart failure and hemolysis. Despite advancements in non-invasive imaging, percutaneous closure of PVLs is not always successful. Therefore, efforts are made to improve treatment outcomes by using 3D-printed models of defects as pre-procedural support for interventional cardiologists. Retrospectively, 3D-TEE recordings of 8 patients with clinically significant mitral PVLs were analysed. Qlab Software was used to export DICOM images of each PVL channel, including surrounding tissue. Image segmentation was performed in 3D Slicer, a free, open-source software package used for imaging research. Models were printed to actual size with the polyjet Stratasys Objet 30 printer with a transparent, rigid material. Duration of model preparation and printing, as well as total cost were calculated. Mean total time of model preparation was 430,5 ± 196 min. 3D-printing from 3D-TEE is technically feasible. Both shape and location of PVLs are preserved during model preparation and printing. It remains to be tested if 3D-printing would improve outcomes of percutaneous PVL closure.