CUSTOM-SIZED AORTIC VALVE: 3-DIMENSIONAL PRINTING USING GEOMETRIC MODELING OF AORTIC ROOT MORPHOLOGY

Yıl 2022, , 1 - 5, 10.02.2022

Nilgün Bozbuğa , Ferhat Taş

https://doi.org/10.26650/JARHS2022-1041198

Öz

Objective: The aortic valve complex is an anatomical and a physiological junctional structure. Its root morphology presents a complex junctional structure extending from the ventriculoarterial to sinotubular junction and consisting of three Valsalva sinuses and cusps to achieve an optimal physiological pump function of the left ventricle. In this research study, a geometric model of the aortic complex was created allowing input to make it applicable in cardiac surgery. Material and Methods: The aortic valve has a consistent shape that can be described mathematically, dependent on the root diameter. The geometric model of the mathematical structures was developed with the Bézier technique, that is, by obtaining a curve or surface that can be controlled by the designer. Primarily, the boundary Bézier curves of the aortic valve tissue to be modeled were determined, which then revealed a frame of the surface. In the next step, within this frame, aortic leaflets were obtained by interpolations. Results: After the threedimensional (3-D) computer-aided design display was finished in Blender, the aortic valve complex was exported as a stereolithographic document and a model of the aortic root was printed using polylactic corrosive fibers. Conclusion: Geometric modeling of heart valves obtained by threedimensional imaging can be used in the production of customized prosthetic valves. Evaluation of the anatomical structure features of the heart valves using geometrical modeling could be developed and adapted for other heart valves.

Anahtar Kelimeler

Aortic valve, aortic root, geometric modeling, threedimensional printing

ÖZEL BOYUTLU AORT KAPAK: AORT KÖKÜ MORFOLOJİSİNİN GEOMETRİK MODELLEMESİ KULLANARAK ÜÇ BOYUTLU BASKI

Öz

Amaç: Aort kök morfolojisi, Valsalva sinüsleriyle aortik küspisler olmak üzere ventriküloarteriyel bileşkeden sinotubüler bileşkeye uzanarak sol ventrikül fizyolojik pompa işlevi için optimal yapıyı oluşturur. Aort kapak kompleksi, anatomik ve fizyolojik bir kavşak yapı şeklindedir. Bu araştırmada, aort kapak kompleksinin görüntüleme verileri kullanılarak, kardiyak cerrahiye uyarlanabilir geometrik aort kapak modeli oluşturulmaktadır. Gereç ve Yöntem: Aort kapağı, kök çapına bağlı olarak matematiksel olarak tanımlanabilen tutarlı bir forma sahiptir. Matematiksel yapıların geometrik modeli Bézier tekniği ile yani kurgulayıcı tarafından kontrol edilebilen bir eğri veya yüzey elde edilerek geliştirilmiştir. Öncelikle, modellenecek aort kapak dokusunun sınır Bézier eğrileri belirlenmiş, daha sonra yüzeyin bir çerçevesi ortaya çıkartılmıştır. Bir sonraki aşamada bu çerçevede, interpolasyonlarla aort yaprakçıklarınnın modellenmesi gerçekleştirilmiştir. Bulgular: Üç boyutlu (3-B) bilgisayar destekli tasarım gösterimi Blender’da tamamlandıktan sonra, aort kapak kompleksi stereolitografik bir dokümana dönüştürülerek, aort kökü modeli polilaktik aşındırıcı lifler kullanılarak basıldı. Sonuç: Üç boyutlu görüntüleme ile elde edilen kalp kapakçıklarının geometrik modellemesi, özel boyutlu protez kapakların üretiminde kullanılabilir. Kalp kapakçıklarının anatomik yapı özelliklerinin geometrik modelleme kullanılarak değerlendirilmesi geliştirilebilir ve diğer kalp kapakçıkları için de uyarlanabilir.

Anahtar Kelimeler

Aort kapak, aort kökü, geometrik modelleme, üç boyutlu baskı

Kaynakça

• 1. Bozbuğa N, Erentuğ V, Kırali K, Akıncı E, Işık Ö, Yakut C. Midterm results of aortic valve repair with the pericardial cusp extension technique in rheumatic valve disease. Ann Thorac Surg 2004;77(4):1272-6.
• 2. Uğurlucan M, Beyaz MO, Öztaş MD, Özturk A, Şahinoğlu K, Alpagut U, Bozbuğa N. The geometrical modeling of aortic root complex. Heart Views 2019;20(1):6-10.
• 3. Flamini V, DeAnda A, Griffith BE. Immersed boundary-finite element model of fluid-structure interaction in the aortic root. Theor Comput Fluid Dyn 2016;30(1):139-64.
• 4. Qiao A, Pan Y, Dong N. Modeling study of aortic root for Ross procedure: a structural finite element analysis. J Heart Valve Dis 2014;23(6):683-7.
• 5. Bozbuğa N, Erentuğ V, Erdoğan HB, Kırali K, Ardal H, Taş S, Akıncı E, Yakut C. Surgical treatment of aortic abscess and fistula: Reconstruction of the aortic annulus with pericardium in complex aortic root infection. Tex Heart Inst J 2004;31(4):382-6.
• 6. Bozbuğa N, Güler M, Kırali K, Akıncı E, Işık Ö, Yakut C. The durability of valve reconstruction in rheumatic mitral and aortic valves: controvertial in the best treatment for double valve disease. Journal of Cardiovascular Forum on Line 2003;1(2):0037-46.
• 7. Bozbuğa N, Mansuroğlu D, Işık Ö, İpek G, Eren E, Gürbüz A, Balkanay M, Dağlar B, Yakut C. Aortic reconstructions. European Journal for Cardiac Interventions (Cor Europeum) 1996;5(4):143-5.
• 8. Al-Atassi T, Toeg HD, Jafar R, Sohmer B, Labrosse M, Boodhwani M. Impact of aortic annular geometry on aortic valve insufficiency: Insights from a preclinical, ex vivo, porcine model. The Journal of Thoracic and Cardiovascular Surgery 2015;150(3):656-64. e1. doi: 10.1016/j.jtcvs.2015.06.060.
• 9. Coyan GN, D’Amore A, Matsumura Y, Pedersen DD, Samul K. Luketich SK, Shanov V, Katz WE, David TE, Wagner WR, Badhwar V. In vivo functional assessment of a novel degradable metal and elastomeric scaffold-based tissue engineered heart valve. The JTCVS 2018;157(5):1809-16.
• 10. Driessen, NJ, Boerboom RA, Huyghe JM, Bouten CV, Baaijens F. Computational analyses of mechanically induced collagen fiber remodeling in the aortic heart valve. J Biomech Eng 2003;125(4):549-57.
• 11. Ovcharenko EA, Klyshnikov KU, Vlad AR, Sizova IN, Kokov AN, Nushtaev DV, Yuzhalin AE, Zhuravleva IU. Computer-aided design of the human aortic root. Comput Biol Med 2014;54:109- 15.
• 12. Weber M, Heta E, Moreira R, Gesche VN, Schermer T, Frese J, Jockenhoevel S, Mela P.Tissue-engineered fibrin-based heart valve with a tubular leaflet design. Tissue Eng Part C Methods. 2014;20(4):265-75. doi: 10.1089/ten.TEC.2013.0258.
• 13. Farin, G. Curves and surfaces for computer-aided geometric design: a practical guide. Elsevier, 2014.
• 14. Pan Y, Qiao A, Dong N. Fluid-structure interaction simulation of aortic valve closure with various sinotubular junction and sinus diameters. Ann Biomed Eng 2015;43(6):1363-9
• 15. Crooke PS, Beavan LA, Griffin CD, Mazzitelli D, Rankin JS. A geometric model of the normal human aortic root and design of a fully anatomic aortic root graft. Innovations (Phila). 2015;10(1):57- 62.
• 16. Kuana YH, Kabinejadiana F, Nguyenb VT, Yoganathanc AP, Leoa HL. Comparison of hinge microflow fields of bileaflet mechanical heart valves implanted in different sinus shape and downstream geometry. COMPUT metod biome engin 18(16):1785-96, 2015