Figure Legends
Fig 1 . The workflow of three-dimensional (3D) printing of a three-dimensional transesophageal echocardiography (3D TEE) derived atrial septal defect (ASD)model.
A. After Acquiring the high-quality 3D-TEE image, the data set was exported from the ultrasound system to the EchoPAC workstation anonymously and converted to standard DICOM format.
B. The DICOM format of optimized 3D-TEE ASD image at the isovolumetric diastole stored in the EchoPAC workstation was imported into the Mimics software to label the region of interest and create a 3D digital ASD model.
C. The 3D digital ASD model was converted to a 3D hollow mold by software 3-matic.
D. The soft 3D printed ASD model generated by rubber like material.
Fig 2. Three types of 3D printed ASD models.
A. The round one-hole ASD model, of which the maximal diameter, the minimum diameter, circular index and circumference measured from the 3D printed ASD model was 22.62mm, 20.67mm, 1.09,71.19mm, respectively.
B. The oval one-hole ASD model, of which the maximal diameter, minimum diameter, circular index and circumference measured from the 3D printed ASD model was 26.91mm,17.30mm,1.56, and 73.00mm , respectively.
C. The double-hole ASD model, the size of the two holes are16.09×10.00mm and 6.68×5.17mm. The distance between the two defects is 6mm, and the whole size of the ASD is 21.28×18.47mm.
Fig 3. Simulation exercises
On the basis of comprehensive analysis of the size parameters of ASD models, simulation exercises are performed in the models, the most suitable device finally selected according to the simulation operation is confirmed to be the same as the one selected in actual surgical procedure and the preoperative exercises achieved good results.
A. In the round one-hole ASD model, a 32mm Amplatzer septal occluder (ASO) was selected after two attempts.
B. In the oval one-hole ASD case, a 34mm ASO was applied to occlude the defect successfully.
C. In the biforate ASD model, a 34mm ASO was finally selected to cover all the defects successfully with the bigger defect as the optimal target defect after several experiments in vitro.
Fig 4. Bland-Altman plots showing the agreement of atrial septal defect (ASD)size parameters as the maximal diameter (Dmax)(A), the minimum diameter (Dmin)(B), circular index(C), and circumference(D) between the three-dimensional transesophageal echocardiography(3D-TEE) images and three-dimensional printed models(3DPM). The solid lines represent average differences of the two methods, and dashed lines represent the limitation of agreement.
Fig 5 . Bland-Altman plots showing the agreement of atrial septal defect (ASD)size parameters as the maximal diameter (Dmax)(A), the minimum diameter (Dmin)(B), circular index(C) between the two-dimensional transesophageal echocardiography(2D-TEE) images and three-dimensional printed models(3DPM). The solid lines represent average differences of the two methods, and dashed lines represent the limitation of agreement.