Implantation of 3D-Printed Patient-Specific Aneurysm Models into Cadaveric Specimens: A New Training Paradigm to Allow for Improvements in Cerebrovascular Surgery and Research.

AimTo evaluate the feasibility of implanting 3D-printed brain aneurysm model in human cadavers and to assess their utility in neurosurgical research, complex case management/planning, and operative training.MethodsTwo 3D-printed aneurysm models, basilar apex and middle cerebral artery, were generated and implanted in four cadaveric specimens. The aneurysms were implanted at the same anatomical region as the modeled patient. Pterional and orbitozygomatic approaches were done on each specimen. The aneurysm implant, manipulation capabilities, and surgical clipping were evaluated.ResultsThe 3D aneurysm models were successfully implanted to the cadaveric specimens' arterial circulation in all cases. The features of the neck in terms of flexibility and its relationship with other arterial branches allowed for the practice of surgical maneuvering characteristic to aneurysm clipping. Furthermore, the relationship of the aneurysm dome with the surrounding structures allowed for better understanding of the aneurysmal local mass effect. Noticeably, all of these observations were done in a realistic environment provided by our customized embalming model for neurosurgical simulation.Conclusion3D aneurysms models implanted in cadaveric specimens may represent an untapped training method for replicating clip technique; for practicing certain approaches to aneurysms specific to a particular patient; and for improving neurosurgical research

Implantation of 3D-Printed Patient-Specific Aneurysm Models into Cadaveric Specimens: A New Training Paradigm to Allow for Improvements in Cerebrovascular Surgery and Research

Aim. To evaluate the feasibility of implanting 3D-printed brain aneurysm model in human cadavers and to assess their utility in neurosurgical research, complex case management/planning, and operative training. Methods. Two 3D-printed aneurysm models, basilar apex and middle cerebral artery, were generated and implanted in four cadaveric specimens. The aneurysms were implanted at the same anatomical region as the modeled patient. Pterional and orbitozygomatic approaches were done on each specimen. The aneurysm implant, manipulation capabilities, and surgical clipping were evaluated. Results. The 3D aneurysm models were successfully implanted to the cadaveric specimens’ arterial circulation in all cases. The features of the neck in terms of flexibility and its relationship with other arterial branches allowed for the practice of surgical maneuvering characteristic to aneurysm clipping. Furthermore, the relationship of the aneurysm dome with the surrounding structures allowed for better understanding of the aneurysmal local mass effect. Noticeably, all of these observations were done in a realistic environment provided by our customized embalming model for neurosurgical simulation. Conclusion. 3D aneurysms models implanted in cadaveric specimens may represent an untapped training method for replicating clip technique; for practicing certain approaches to aneurysms specific to a particular patient; and for improving neurosurgical research

Quantitative mapping of intracardiac blood flow in embryonic zebrafish

Using real-time in vivo imaging and digital particle image velocimetry (DPIV) we quantitatively described the intracardiac flow environment of early zebrafish (Danio rerio) embryos. Gross cardiac dynamics were defined for two embryonic stages: 4.5 days post fertilization (dpf) and 37 hours post fertilization (hpf) using high-speed transmitted light microscopy with valve dynamics visualized through high-speed laser-scanning microscopy on transgenic embryos expressing GFP

Endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm increases systolic circumferential shortening in sheep

ObjectiveEndoventricular patch plasty (Dor procedure) has gained favor as a surgical treatment for heart failure associated with large anteroapical myocardial infarction. We tested the hypotheses that the Dor procedure increases systolic circumferential shortening and longitudinal shortening in noninfarcted left ventricular regions in sheep.MethodsIn 6 male Dorsett sheep, the left anterior descending coronary artery and its second diagonal branch were ligated 40% of the distance from the apex to the base. Sixteen weeks after myocardial infarction, a Dor procedure was performed with a Dacron patch that was 50% of the infarct neck dimension. Two weeks before and 2 and 6 weeks after the Dor procedure, animals underwent magnetic resonance imaging with tissue tagging in multiple short-axis and long-axis slices. Fully three-dimensional strain analyses were performed. All 6 end-systolic strain components were compared in regions 1 cm, 2 cm, 3 cm, and 4 cm below the valves, as well as in the anterior, posterior, and lateral left ventricular walls and the interventricular septum.ResultsCircumferential shortening increased from before the Dor procedure to 6 weeks after repair in nearly every left ventricular region (13/16). The greatest regional change in circumferential shortening was found in the equatorial region or 2 cm below the base and in the posterior wall (from 9.0% to 18.4%; P < .0001). Longitudinal shortening increased 2 weeks after the Dor procedure but then returned near baseline by 6 weeks after the Dor procedure.ConclusionThe Dor procedure significantly increases systolic circumferential shortening in nearly all noninfarcted left ventricular regions in sheep

Blood Flow Effects on Heart Development and a Minimally Invasive Technique for in vivo Flow Alterations

A series of experiments were conducted on zebrafish (Danio rerio) in order to gain a better understanding of how blood flow and blood flow related forces, such as shear stress, affect vertebrate heart development. Zebrafish were used as a model due to their external fertilization and optical accessibility to the heart and vasculature. The flow field inside the 4.5 day post fertilization (dpf) embryo was analyzed using a combination of manual particle tracking and digital particle image velocimetry (DPIV) software. Our results present the first case of intracardiac microscale DPIV. Additionally, a minimally invasive and reversible technique of delivering and localizing magnetic microspheres inside the vasculature of the embryo was developed. The results of blocked flow induced with this method were compared with previous experiments and controls. The results of the flow field analysis showed the existence of an extremely dynamic flow environment containing jets with a velocity of 5 mm/s and regions of vorticity in a low Reynolds number environment. Calculations of the flow at the 4.5 dpf A-V resulted in wall shear stress levels of 70 dynes/cm2, levels much higher than needed for endothelial cell response. We also showed that injected magnetic microspheres can be delivered and localized within the embryonic vasculature to reversibly block blood flow in the dorsal artery and at the inflow to the heart. Blocked blood flow of 12 hours and longer resulted in lower blood velocity and a less developed heart, exhibiting edema, regurgitance, decreased contractile function, and delayed development. These findings are consistent with previous studies showing that blood flow is a necessary factor for heart development. Furthermore an unexpected result was observed. Exposure to a localized magnetic field eventually caused the absorption of magnetic microspheres into the surrounding tissue. It is theorized that this could be utilized in future studies modeling the effects of reduced cardiac contractility.</p