Three-dimensional printing-guided percutaneous transcatheter closure of secundum atrial septal defect with rim deficiency: First-in-human series.

BACKGROUND: This study aimed to prospectively evaluate the use of 3-dimensional printing (3DP) for the percutaneous transcatheter closure of a secundum atrial septal defect (ASD) with rim deficiency less than 5 mm.

METHODS: Patients with ASD were scanned using multi-slice computed tomography to acquire raw data for virtual 3DP reconstruction models. Different ASD occluders were tried on the 3DP models to select the optimal size for intraoperative use. The patients were followed up 1 month postoperatively, and 3DP models were again manufactured to observe the operative effects.

RESULTS: From January to April 2016, 6 patients (5 females and 1 male) were recruited. Their average age was 29.5 ± 17.6 years, and the mean ASD size was 13.4 ± 1.3 mm. ASD occlusion succeeded in 5 of 6 cases. There were 1, 2, and 3 cases with 0-mm distance from the defect rim to the aorta, inferior vena cava, and superior vena cava, respectively. ASD occluder sizes were consistent between preoperative simulation and intraoperative placement in 4 cases. One case had occluder size change from 30 mm to 34 mm.

CONCLUSIONS: A 3DP model presents ASD in a more visible way and allows more direct preoperative simulation to choose the most appropriate size of occluder, as compared with conventional imaging techniques. This technique is likely to extend the current indications for ASD with an insufficient rim.