title: Hemodynamic Testing of Patient-Specific Mitral Valves Using a Pulse Duplicator: A Clinical Application of Three-Dimensional Printing.
abstract: OBJECTIVE
  To evaluate the feasibility of obtaining hemodynamic metrics of echocardiographically derived 3-dimensional printed mitral valve models deployed in a pulse-duplicator chamber.
  
  
  METHODS
  Exploratory study.
  
  
  METHODS
  Tertiary-care university hospital.
  
  
  METHODS
  Percutaneous MitraClip procedure patient.
  
  
  METHODS
  Three-dimensional R-wave gated, full-volume transesophageal echocardiography images were obtained after deployment of the MitraClip device. A high-quality diastolic frame of the mitral valve was segmented using Mimics Innovation Suite and merged with a flange. The data were exported as a stereolithography (.stl) file, and a rigid 3-dimensional model was printed using a MakerBot Replicator 2 printer. A flexible silicone cast then was created and deployed in the pulse-duplicator chamber filled with a blood-mimicking fluid.
  
  
  RESULTS
  The authors were able to obtain continuous-wave Doppler tracings of the valve inflow with a transesophageal echocardiography transducer. They also were able to generate diastolic ventricular and atrial pressure tracings. Pressure half-time and mitral valve area were computed from these measurements.
  
  
  CONCLUSIONS
  This pulse duplicator shows promising applications in hemodynamic testing of patient-specific anatomy. Future modifications to the system may allow for visualization and data collection of gradients across the aortic valve.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Azad
authors.initials: A
authors.lastname: Mashari
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Knio
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Jelliffe
authors.initials: J
authors.lastname: Jeganathan
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Mario
authors.initials: M
authors.lastname: Montealegre-Gallegos
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesia and Pain Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Lu
authors.initials: L
authors.lastname: Yeh
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Hospital México, Universidad de Costa Rica, San José, Costa Rica.
authors.forename: Yannis
authors.initials: Y
authors.lastname: Amador
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Rabya
authors.initials: R
authors.lastname: Saraf
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Kamal
authors.initials: K
authors.lastname: Khabbaz
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: fmahmood@bidmc.harvard.edu.
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
mesh_terms: D018618:Echocardiography, Doppler, Color / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005240:Feasibility Studies; D006439:Hemodynamics; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D008954:Models, Biological; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods*; D066330:Printing, Three-Dimensional / Q000295:instrumentation*
keywords: 3D printing; hemodynamics; mitral valve; pulse duplicator; transesophageal echocardiography