Three-Dimensional Printing of Cardiac Reconstruction, Facilitating Customized Closure Device of Gigantic Left Atrial Appendage: Case Report

Three-Dimensional Printing of Cardiac Reconstruction, Facilitating Customized Closure Device of Gigantic Left Atrial Appendage: Case ReportAuthors : 1Mann Chandavimol MD,1Tawai Ngernsritrakul MD, 1Krissada Meemook MD, 2Kakanand Srungboonmee PhD,1Thinnakrit Sasiprapha MD,3Thanakhom Hoontrakul1Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand2Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand3Thammasat University Hospital, Thammasat University, Pathum Thani, ThailandCorresponding authors : 1Mann Chandavimol MD1Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandEmail: MChandavimol@gmail.comKey Clinical Message :We present the first successful case of 3D printed cardiac reconstruction for custom LAAO device of gigantic LAA in Asia. We demonstrated custom LAAO device with 3D CT and 3D printed cardiac reconstruction is feasible and effective for anatomically complex LAA.Key words : Customized Left Atrial Appendage Occlusion Device, Three-Dimensional Printing, Cardiac Reconstruction Modelling, Case Report, Giant Left Atrial AppendageData availability statement: Data on any details of the case is available upon request and is subjected to the institution approval.Conflict of Interest : Mann Chandavimol, MD was a proctor for LAmbre™ device.Funding : NONEEthical Approval Statements: The Internal Review Board had approved this case report (COA. No. MURA2024/472). The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013).Patient consent statement: Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.Introduction :Atrial Fibrillation (AF) is the most common arrhythmia that often cause ischemic stroke (IS) from thrombo-embolism. Left atrial appendage (LAA) is a common source of the thrombus, and the standard treatment is oral anticoagulant (OAC) but it exposes patients to haemorrhage risk1. Both Watchman (Boston Scientific)2 and Amulet (Abbott) 3 trials showed that Left Atrial Appendage Occlusion (LAAO) is safe and effective in preventing IS in high bleeding risk population. Moreover, Osmancik et al found that LAAO is noninferior to OAC in preventing cardiovascular, neurologic, and bleeding events 4. Thus, in patient with absolute or relative contraindication for OAC, LAAO allows patients to benefit from stroke prevention as shown by Maarse et al5.A giant LAA with complex anatomy may impedes the implantation of a conventional LAAO device, resulting in leakage. Peridevice leakage has been associated with thromboembolic event, necessitating a complete closure 6. Consequently, routine incorporation of CT was associated with excellent outcomes for procedural safety and absence of major residual leak 7 and Hell et al demonstrated that CT-based 3D printing models may assist device selection and prediction of device compression 8. Besides, Inohara et al reported using custom-made LAAO device on gigantic LAA in Canada. We demonstrated the first successful transcatheter custom-made LAAO device with 3D printing cardiac reconstruction modelling in Asia.

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