Author + information
- Received November 18, 2015
- Revision received January 13, 2016
- Accepted January 14, 2016
- Published online November 1, 2016.
- Dee Dee Wang, MDa,∗ (, )
- Marvin Eng, MDa,
- Adam Greenbaum, MDa,
- Eric Myers, BFAb,
- Michael Forbes, BFAb,
- Milan Pantelic, MDc,
- Thomas Song, MDc,
- Christina Nelson, RTRCTc,
- George Divine, PhDa,
- Andrew Taylor, MAa,
- Janet Wyman, DNPa,
- Mayra Guerrero, MDa,d,
- Robert J. Lederman, MDe,
- Gaetano Paone, MDa and
- William O’Neill, MDa
- aDivision of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
- bHenry Ford Innovation Institute, Henry Ford Health System, Detroit, Michigan
- cDivision of Radiology, Henry Ford Health System, Detroit, Michigan
- dDivision of Cardiology, Evanston Hospital/NorthShore University Health System, Evanston, Illinois
- eCardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- ↵∗Reprint requests and correspondence:
Dr. Dee Dee Wang, Henry Ford Health System, Institute for Structural Heart Disease, 2799 West Grand Boulevard, K14, Detroit, Michigan 48202-2608.
Evolution of catheter-based structural interventions has given patients less invasive alternatives to surgery; however, the current generation of transcatheter heart valves (THV) are not specifically designed for mitral position implantation and have intrinsic geometry that may make mitral implantation suboptimal. Operators are faced with unique challenges with valve deliverability, embolism, and notably left ventricular outflow tract (LVOT) obstruction. Therefore, understanding the suitability of prosthesis delivery and implantation individualized to each heart is of paramount importance.
Successful transcatheter mitral valve replacement (TMVR) depends on accurate sizing of the mitral annulus (Figure 1) and avoidance of LVOT obstruction. Incorporation of computer-aided design and generation of 3-dimensional-printed heart models allows for ex vivo device bench testing in patient-specific anatomy (Figures 1 and 2). Modeling of proposed THV at different angles/depths of deployment into the LV allows estimation of LVOT obstruction of neo-LVOT/LVOT (Figure 3). We now aim to describe the utility of cardiac computed tomography (Table 1) and ex vivo THV fit testing with 3-dimensional models to predict LVOT obstruction in TMVR.
The authors thank Dr. Scott Dulchavsky, Mark Coticchia, and Lindsay Klee of the Henry Ford Innovation Institute for their support toward clinical 3-dimensional printing.
Drs. Wang, O’Neill, Mr. Myers, and Mr. Forbes are co-inventors on a patent application, assigned to their employer Henry Ford Health System, on software to predict LVOTO. Dr. Greenbaum is a proctor for Edwards Lifesciences and St. Jude Medical. Dr. Guerrero has received a research grant from and is a proctor for Edwards Lifesciences. Dr. Paone is a consultant and proctor for Edwards Lifesciences. Dr. O’Neill is a consultant for Edwards Lifesciences, Medtronic, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 18, 2015.
- Revision received January 13, 2016.
- Accepted January 14, 2016.
- American College of Cardiology Foundation