Page 267 - IJB-9-1

International Journal of Bioprinting Evaluation of advanced visual computing solutions for the left atrial appendage occlusion

researchers, have made it possible. Biomedical applications it and try a different one , at the expense of increasing
[7]
are not an exception, with an unprecedented availability costs, patient’s risk, and procedural time. Due to the large
to medical datasets at different multi-scale and resolution variability of LA and LAA anatomy in humans, and the
levels. Therefore, some visual computing technologies are wide range of device configurations, LAAO interventions
already disrupting traditional concepts of medical image can clearly benefit from pre-operative planning to reduce
exploration. Complex medical interventions are usually the need of device implantation attempts, thus maximizing
planned by exploring pre-operative medical images, where intervention efficiency and minimizing costs.
advanced visual computing solutions, in combination During LAAO interventions, multimodal 2D images
with technologies such as 3D printing, could contribute to such as echocardiography and X-ray are mainly used.
reduce potential complications.
Nevertheless, the complexity and interpatient variability
Until recently, the visualization and analysis of medical of the LAA 3D anatomy are unnoticeable under 2D
imaging data were always performed with visualization imaging modalities. 3D echocardiography and, more
tools, usually as two-dimensional (2D) images and recently, high-resolution computerized tomography (CT)
standard multiplanar reconstruction (MPR) visualization images are increasingly becoming available, providing
viewed in 2D monitors. Commonly, these are the only better spatial information of the LAA and reproducibility
tools available during the intervention since they are fully than 2D-based techniques to optimize the implantation
[8]
integrated with the acquisition systems in the operating strategy and device selection before the intervention.
room, with clinicians mentally integrating the 3D structure However, there is still a debate on which is the most
and functional information provided by multiple sources. adequate imaging technique since there are discrepancies
Offline image analysis can be performed with numerous on the measurements from different modalities .
[9]
tools, including open-source software such as 3D Slicer
[1]
or commercial solutions, which are usually used as the At present, commercial solutions are available with
stand-alone software tools tailored to specific imaging standard MPR visualization of the 3D imaging modalities
modalities and type of pathologies. (e.g., CT images) such as the 3mensio Structural
Heart software (Pie Medical Imaging, Bilthoven, the
In cardiology, patient-specific detailed information about Netherlands) , which also includes advanced 3D
[10]
the structure and function of the heart is a key for medical photorealistic rendering of the heart for an advanced
training, and for optimizing and personalizing clinical exploration of the LAA, or Mimics (Materialise NV, Leuven,
decisions involving diagnosis, treatment planning, and post- Belgium). Karagodin et al. recently demonstrated an
[11]
therapeutic monitoring of patients, specifically in structural improved delineation of cardiac structures, including the
heart disease, where transcatheter interventions are becoming LAA, with a new tissue transparency transillumination tool
a less invasive alternative to open surgery. However, the field when visualizing 3D echocardiographic images, compared
of view in transcatheter interventions is limited, with the to standard 3D rendering in a system developed by Philips
absence of a gold standard open cavity surgical field depriving (Andover, MA). Most of these imaging tools to explore
physicians of the opportunity for tactile feedback and visual 3D LAA anatomies are based on stand-alone software
[2]
confirmation of cardiac anatomy . At this juncture, there but web-based frameworks with cloud-based engines
is a significant gap in understanding the 3D (plus time) are becoming modern and more flexible alternatives for
anatomical and physiological relationships in the heart that medical image visualization and analysis. The Virtual
[3]
visual computing solutions can help to bridge. Recent studies Implantation and Device selection in the left Atrial
have reviewed the added value of advanced visualization Appendages (VIDAA) platform was recently developed,
of cardiac data, including applications in conditions such providing a clinician-friendly web-based tool to support
[2]
as congenital heart disease [4,5] , structural heart disease , or the pre-operative planning of LAAO interventions . It
[12]
transcatheter mitral valve replacement . allows clinicians to interactively explore the LA geometry
[6]
The left atrial appendage occlusion (LAAO), along as a 3D mesh with different computer-aided design (CAD)
with a device inserted into the heart in a transcatheter LAAO models, together with some morphological indices
intervention, has recently been proposed as an efficient and the original CT images in MPR format. However, these
alternative for patients in atrial fibrillation (AF) with software tools are still limited in visualizing and analyzing
contraindications to drug therapy. The interventional imaging data with the standard MPR, volume rendering,
cardiologists need to decide the optimal type and size of and surface mesh views in 2D monitors; therefore, these
the device, as well as the position where to implant it in tools have limited degrees of freedom interaction and
each heart. During a LAAO procedure, if an implanted could prevent a correct perception of the 3D nature of the
device seems inappropriate, the operator can recapture studied anatomy (e.g., depth and scaling).

Volume 9 Issue 1 (2023) 259 https://doi.org/10.18063/ijb.v9i1.640