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DOI: 10.1055/s-0038-1641751
Three-Dimensional Heart Printing for Planning of Septal Reduction Therapy in Patients with Hypertrophic Obstructive Cardiomyopathy
Publication History
Publication Date:
19 April 2018 (online)
Since hypertrophic obstructive cardiomyopathy complicated by intractable symptoms has heterogeneous phenotypic expressions, it is extremely important to tailor the therapy specifically for each patient. Therefore, a careful clinical evaluation including magnetic resonance and echocardiography should be performed prior to making decision about possible septal reduction therapy.[1]
Clinical experience suggests that severe left ventricular obstruction might be present not only in the left ventricular outflow tract, but also deeper in the mid-ventricular segment. Currently, we recommend surgical myectomy in all highly symptomatic patients with a mild septal thickness and long mitral leaflets, redundant chordae, significant papillary muscle abnormalities, and/or mid-ventricular cavity obstruction.[1] On the other hand, patients with less complex left ventricular pathology and septal thickness localized optimally only into the basal septum are better suited to alcohol septal ablation.[1]
For better visualization of left ventricular pathology and to improve decision making about a type of septal reduction, a three-dimensional printing of the heart might be performed using data from cardiac computed tomography (CT) examination.[2] [3] [4] ([Figs. 1] and [2]) Additionally, different colors can delineate the area with maximal obstruction done by anterior mitral leaflet and hypertrophied basal septum. Such three-dimensional model might be a new source of information for heart teams in a process of planning the optimal reduction therapy.
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References
- 1 Veselka J, Anavekar NS, Charron P. Hypertrophic obstructive cardiomyopathy. Lancet 2017; 389 (10075): 1253-1267
- 2 Cooper RM, Raphael CE, Liebregts M, Anavekar NS, Veselka J. New developments in hypertrophic cardiomyopathy. Can J Cardiol 2017; 33 (10) 1254-1265
- 3 Bartel T, Rivard A, Jimenez A, Mestres CA, Müller S. Medical three-dimensional printing opens up new opportunities in cardiology and cardiac surgery. Eur Heart J 2017; ; [ Epub ahead of print ] DOI: 10.1093/eurheartj/ehx016.
- 4 Veselka J. How to treat obstruction in patients with hypertrophic cardiomyopathy. Int J Angiol 2015; 24 (02) 121-126