Three-Dimensional Heart Printing for Planning of Septal Reduction Therapy in Patients with Hypertrophic Obstructive Cardiomyopathy

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.

Fig. 1 Three-dimensional model of the heart with colored both the anterior mitral leaflet (pink) and hypertrophied basal septum (blue).

Fig. 2 The anterior mitral leaflet (pink) is lifted up; the basal septum (blue) narrows the left ventricular outflow tract with aortic valve in the background (asterix).

• 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 ]
• 4 Veselka J. How to treat obstruction in patients with hypertrophic cardiomyopathy. Int J Angiol 2015; 24 (02) 121-126