A 3D Printable model of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVMs) are vascular anomalies in which there is a direct connection between pulmonary arteries and veins, bypassing the lung capillary bed (1). The most common cause of PAVMs are congenital, resulting from an autosomal dominant disorder, hereditary hemorrhagic telangiectasia (HHT), causing mutations in proteins important in the vascular signaling pathway (2). Complications of untreated PAVM include stroke, hypoxemia, dyspnea, platypnea, infections, and anemia (1, 3). Treatment of PAVMs is most commonly done so via endovascular embolization (1). When HHT patients develop PAVMs and come to the IR clinic to obtain treatment, they are often anxious about their diagnosis and explaining the anatomy, pathology, and treatment of their disease can present challenges to the physician. The current method of patient education uses the patient’s 2D CT scans along with the physician’s narrative, which the patient may find difficult to follow because they are not trained in reading such medical datasets. We hypothesized that having a patient interact with a 3D‐printed model of PAVM would improve their understanding of the disease and anatomy involved, and decrease their anxiety regarding their diagnosis and treatment. To test this hypothesis, we first created a 3D model using the software 3D Slicer ( www.slicer.org ) to segment CT scans from a single patient with multiple, untreated PAVMs. One PAVM was chosen to be segmented for its distinctive feeding artery exiting the pulmonary trunk into these fistula and distinctive vein exiting the fistula and entering the left atrium. The 3D model was then imported into Maya where it was sculpted, artistically adjusted, and enhanced to provide anatomically accurate representation of the chest anatomy applicable to this disease, to then be printed. This novel model of a disease has the potential to decrease patient anxiety prior to the treatment of their PAVM and improve their knowledge on the anatomy and pathology. The effects of HHT patient interaction with the model on the patient’s anxiety levels and understanding of the disease remains to be investigated.CT axial section of PAVM used for segmentation3D model produced in 3D SlicerCited Sources 1 Contegiacomo , A. , et. al. ( 2019 ). Pulmonary Arteriovenous malformations: What the interventional Radiologist Needs to Know . La Radiologia Medica . doi: 10.1007/s11547-019-01051-7 . 2 Riera-Mestre , A. , et. al. ( 2019 ). Natural history of patients with venous thromboembolism and hereditary hemorrhagic telangiectasia. Findings from the RIETE registry . Orphanet Journal of Rare Diseases , 14 ( 196 ), 1 – 8 . doi: 10.1186/s13023-019-1172-8 . 3 Salibe-Filho , W. , et. al. ( 2019 ). Pulmonary arteriovenous malformations diagnostic and treatment characteristics . Journal Brasilerio de Pneumologia , 45 ( 4 ), 1 – 7 . Doi: 10.1590/1806-3713/e20180137