Open Source Left Heart Model: Literature Review

From Appropedia

3D printing is growing into the medical industry. Patient-specific 3D models have been created for various purpose:

  • Teaching Tool
  • Functional Flow Models
  • Procedural Planning

This project focuses on creating an anatomically realistic left heart model by extracting the data from the literature for the primary purpose of functional flow studies but can also be used as a teaching tool.

Modeling Dimensions[edit | edit source]

Aortic Annulus, Aortic Root, and Aorta[edit | edit source]

George Gellert, Aortic annulus anatomy and measurement and its relevance to successful transcatheter aortic valve replacement. [cited 2020 Sep 14].[1]

  • Aortic valve structure and shape (irregular shaped oval or elliptical)
  • Explains aortic root anatomy
  • Basal ring measurement method


Blanke P, Siepe M, Reinöhl J, Zehender M, Beyersdorf F, Schlensak C, et al. Assessment of aortic annulus dimensions for Edwards SAPIEN Transapical Heart Valve implantation by computed tomography: calculating average diameter using a virtual ring method. European Journal of Cardio-Thoracic Surgery. 2010 Dec [cited 2020 Sep 14];38(6):750–8. [2]

  • Study population: 71 patients with severe symptomatic aortic stenosis
  • Aortic annulus dimensions in coronal and sagittal view


Evangelista A, Flachskampf FA, Erbel R, Antonini-Canterin F, Vlachopoulos C, Rocchi G, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. European Journal of Echocardiography. 2010 Sep 1 [cited 2020 Sep 14];11(8):645–58. DOI:10.1093/ejechocard/jeq056 [3]

  • Dimensions of the aortic annulus, ascending aorta, aortic arch, and descending aorta


Suchá D, Tuncay V, Prakken NHJ, Leiner T, van Ooijen PMA, Oudkerk M, et al. Does the aortic annulus undergo conformational change throughout the cardiac cycle? A systematic review. European Heart Journal – Cardiovascular Imaging. 2015 Sep 15 [cited 2020 Sep 14];jev210.[4]

  • Aortic annulus dimension from 29 articles
  • 7 studies of a healthy population, 10 studies comparing healthy population with aortic stenosis, and 12 studies of aortic stenosis population
  • Total of 2021 patients


Zhu D, Zhao Q. Dynamic Normal Aortic Root Diameters: Implications for Aortic Root Reconstruction. The Annals of Thoracic Surgery. 2011 Feb [cited 2020 Sep 14];91(2):485–9. [5]

  • Study population: 314 healthy adults age ranging from 17 to 60 years
  • Dimensions of aortic annulus and aortic root


Son MK, Chang S-A, Kwak JH, Lim HJ, Park S-J, Choi J-O, et al. Comparative measurement of aortic root by transthoracic echocardiography in normal Korean population based on two different guidelines. Cardiovascular Ultrasound [Internet]. 2013 Aug 13 [cited 2020 Sep 14];11(1). [6] ‌*Study population: 112 Korean adults age ranging 20-69 years with no cardiovascular disease

  • Dimensions of aortic annulus and aortic root


Boufi M, Guivier-Curien C, Loundou AD, Deplano V, Boiron O, Chaumoitre K, et al. Morphological Analysis of Healthy Aortic Arch. European Journal of Vascular and Endovascular Surgery [Internet]. 2017 May [cited 2020 Sep 14];53(5):663–70. [7]

  • Study population: 123 healthy population with no history of cardiovascular disease
  • Shows different aortic arch segments and their dimensions

Mitral Valve[edit | edit source]

Naoum C, Leipsic J, Cheung A, Ye J, Bilbey N, Mak G, et al. Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse. JACC: Cardiovascular Imaging. 2016 Mar [cited 2020 Sep 14];9(3):269–80. DOI: 10.1016/j.jcmg.2015.08.022 [8]

  • D-shaped mitral annulus concept
  • A study performed on 88 control group patients, 32 mitral valve prolapse, and 27 functional mitral regurgitation
  • Dimensions of mitral valve annulus (area, perimeter, trigone to trigone, septal to lateral, and intercommissural)


Abdelghani M, Spitzer E, Soliman OII, Beitzke D, Laggner R, Cavalcante R, et al. A simplified and reproducible method to size the mitral annulus: implications for transcatheter mitral valve replacement. European Heart Journal – Cardiovascular Imaging. 2016 Jun 26 [cited 2020 Sep 14];jew132. [9]

  • D shaped and saddle shape mitral annulus model comparison
  • Study conducted on 47 patients who had done CRA for coronary revascularization or transcatheter aortic valve replacement
  • Three mitral annular diameter methods: Dmean, Darea, and Dperimeter
  • Dimensions of mitral annular height

Left Ventricle[edit | edit source]

Ho SY. Anatomy and myoarchitecture of the left ventricular wall in normal and in disease. European Journal of Echocardiography [Internet]. 2009 Nov 4 [cited 2020 Sep 14];10(8):iii3–7. [10]

  • Explains anatomy of the left ventricle


Chetrit M, Roujol S, Picard MH, Timmins L, Manning WJ, Rudski LG, et al. Optimal Technique for Measurement of Linear Left Ventricular Dimensions. Journal of the American Society of Echocardiography [Internet]. 2019 Apr [cited 2020 Sep 14];32(4):476-483.e1.[11]

  • Study population: Derivation study-75 patients, Validation study-100 patients
  • Left ventricular dimensions at the midventricular level

3D Printing and Experimentation[edit | edit source]

Cohrs NH, Petrou A, Loepfe M, Yliruka M, Schumacher CM, Kohll AX, et al. A Soft Total Artificial Heart-First Concept Evaluation on a Hybrid Mock Circulation. Artificial Organs [Internet]. 2017 Jul 10 [cited 2020 Sep 14];41(10):948–58. [12]

  • 3D printed silicone ventricles which could provide circulation of blood
  • Provided ideas for designing and 3D printing


Ali SM, Ali ZJ, Abd MM. Design and Modeling of a Soft Artificial Heart by Using the SolidWorks and ANSYS. IOP Conference Series: Materials Science and Engineering [Internet]. 2020 Jan 17 [cited 2020 Sep 14];671:012062.[13]

  • CAD modeling of ventricles in Solidworks and analysis is done in ANSYS
  • Provided ideas for designing


Saaid H, Voorneveld J, Schinkel C, Westenberg J, Gijsen F, Segers P, et al. Tomographic PIV in a model of the left ventricle: 3D flow past biological and mechanical heart valves. Journal of Biomechanics [Internet]. 2019 Jun [cited 2020 Sep 14];90:40–9. [14]

  • 3D printed left ventricle with silicone and performed PIV experiments
  • Provided CAD modeling and 3D printing ideas
  • Conducted silicone refractive index test
  • Ideas for experimental setup


Vukicevic M, Filippini S, Little SH. Patient-Specific Modeling for Structural Heart Intervention: Role of 3D Printing Today and Tomorrow CME. Methodist DeBakey cardiovascular journal. 2020 [cited 2020 Sep 22];16(2):130–7.[15]

  • Types of imaging and segmentation techniques available and what is the best for STL file generation
  • Talk about different 3D printing technology and material selection
  • Application of 3D printing in medical field and future development

Material Selection[edit | edit source]

This project focuses on using flexible material for 3D printing which is transparent or translucent.

The following all papers used TangoPlus (Stratasys) material for in vitro study. This material is flexible and translucent and also best represents the tissue properties. For rigid printing, they used VeroWhite Clear (Stratasys).

  1. Vukicevic M, Mosadegh B, Min JK, Little SH. Cardiac 3D Printing and its Future Directions. JACC: Cardiovascular Imaging. 2017 Feb [cited 2020 Sep 22];10(2):171–84. [16]
  2. Hatoum H, Dasi LP. Sinus Hemodynamics in Representative Stenotic Native Bicuspid and Tricuspid Aortic Valves: An In-Vitro Study. Fluids. 2018 Aug 6 [cited 2020 Sep 22];3(3):56. [17]
  3. Hatoum H, Yousefi A, Lilly S, Maureira P, Crestanello J, Dasi LP. An in vitro evaluation of turbulence after transcatheter aortic valve implantation. The Journal of Thoracic and Cardiovascular Surgery [Internet]. 2018 Nov [cited 2020 Sep 22];156(5):1837–48.[18]
  4. Patient-specific 3D Valve Modeling for Structural Intervention [Internet]. Structural Heart. 2017 [cited 2020 Sep 22]. [19]
  5. Maragiannis D, Jackson M, Igo S, Schutt R, Connell P, Grande-Allen J et al. Replicating Patient-Specific Severe Aortic Valve Stenosis With Functional 3D Modeling. Circulation: Cardiovascular Imaging. 2015;8(10).[20]
  6. Yoo S-J, Spray T, Austin EH, Yun T-J, van Arsdell GS. Hands-on surgical training of congenital heart surgery using 3-dimensional print models. The Journal of Thoracic and Cardiovascular Surgery. 2017 Jun [cited 2020 Sep 22];153(6):1530–40.[21]
  7. So KC-Y, Fan Y, Sze L, Kwok K, Chan AK, Cheung GS-H, et al. Using Multimaterial 3-Dimensional Printing for Personalized Planning of Complex Structural Heart Disease Intervention. JACC: Cardiovascular Interventions [Internet]. 2017 Jun [cited 2020 Sep 22];10(11):e97–8.[22]

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A Review on the 3D Printing of Functional Structures for Medical Phantoms and Regenerated Tissue and Organ Applications. Engineering. 2017 [cited 2020 Sep 22];3(5):653–62.[23]

3D-Printed Tissue-Mimicking Phantoms for Medical Imaging and Computational Validation Applications | 3D Printing and Additive Manufacturing [Internet]. 3D Printing and Additive Manufacturing. 2014 [cited 2020 Sep 22].[24]

  • Different 3D printing materials for bio-parts printing
  • Shows Tangoplus material is suitable for 3D printing

Saaid H, Voorneveld J, Schinkel C, Westenberg J, Gijsen F, Segers P, et al. Tomographic PIV in a model of the left ventricle: 3D flow past biological and mechanical heart valves. Journal of Biomechanics [Internet]. 2019 Jun [cited 2020 Sep 22];90:40–9. [25]

  • 3D printed the left ventricle using rigid material and used it as a mold
  • Painted Silicone on the mold to get a flexible part


Cohrs NH, Petrou A, Loepfe M, Yliruka M, Schumacher CM, Kohll AX, et al. A Soft Total Artificial Heart-First Concept Evaluation on a Hybrid Mock Circulation. Artificial Organs [Internet]. 2017 Jul 10 [cited 2020 Sep 22];41(10):948–58. [26]

  • Created the rigid model with 3D printing using ABS
  • Manufactured the soft heart using lost-wax casting using silicone material