Three-dimensional printing creates models for surgical planning of aortic valve replacement after previous coronary bypass grafting.

PURPOSE Resternotomy for aortic valve replacement in patients with previous coronary artery bypass grafting and an internal mammary artery graft may be a surgical problem. Thus, we are exploring the effect of using rapid prototyping techniques for surgical planning and intraoperative orientation during aortic valve replacement after previous coronary artery bypass grafting (CABG). DESCRIPTION As a proof of concept, we studied a patient who had undergone CABG 5 years earlier. At that time the patient received a left internal mammary artery graft to the left anterior descending artery and a venous graft to the right coronary artery. Now the patient required aortic valve replacement due to symptomatic aortic valve stenosis. The left internal mammary artery bypass and the right coronary artery bypass were patent and showed good flow in the angiography. The patient was examined by 128-slice computed tomography. The image data were visualized and reconstructed. Afterwards, a replica showing the anatomic structures was fabricated using a rapid prototyping machine. EVALUATION Using data derived from 128-slice computed tomography angiography linked to proprietary software, we were able to create three-dimensional reconstructions of the vascular anatomy after the previous CABG. The models were sterilized and taken to the operating theatre for orientation during the surgical procedure. CONCLUSIONS Stereolithographic replicas are helpful for choosing treatment strategies in surgical planning and for intraoperative orientation during reoperations of patients with previous CABG.

Three-Dimensional Mechanics of Yakutat Convergence in the Southern Alaskan Plate Corner

Three-dimensional numerical models are used to investigate the mechanical evolution of the southern Alaskan plate corner where the Yakutat and the Pacific plates converge on the North American plate. The evolving model plate boundary consists of Convergent, Lateral, and Subduction subboundaries with flow separation of incoming material into upward or downward trajectories forming dual, nonlinear advective thermal/mechanical anomalies that fix the position of major subaerial mountain belts. The model convergent subboundary evolves into two teleconnected orogens: Inlet and Outlet orogens form at locations that correspond with the St. Elias and the Central Alaska Range, respectively, linked to the East by the Lateral boundary. Basins form parallel to the orogens in response to the downward component of velocity associated with subduction. Strain along the Lateral subboundary varies as a function of orogen rheology and magnitude and distribution of erosion. Strain-dependent shear resistance of the plate boundary associated with the shallow subduction zone controls the position of the Inlet orogen. The linkages among these plate boundaries display maximum shear strain rates in the horizontal and vertical planes where the Lateral subboundary joins the Inlet and Outlet orogens. The location of the strain maxima shifts with time as the separation of the Inlet and Outlet orogens increases. The spatiotemporal predictions of the model are consistent with observed exhumation histories deduced from thermochronology, as well as stratigraphic studies of synorogenic deposits. In addition, the complex structural evolution of the St Elias region is broadly consistent with the predicted strain field evolution. Citation: Koons, P. O., B. P. Hooks, T. Pavlis, P. Upton, and A. D. Barker (2010), Three-dimensional mechanics of Yakutat convergence in the southern Alaskan plate corner, Tectonics, 29, TC4008, doi: 10.1029/2009TC002463.

Three-dimensional printing for perioperative planning of complex aortic arch surgery

Purpose In this study, we show the use of three-dimensional printing models for preoperative planning of surgery for patients with complex aortic arch anomalies. Description A 70-year-old man with an extensively arteriosclerotic aneurysm reaching from the ascending aorta to the descending aorta was referred to our center for complete aortic arch replacement. We visualized and reconstructed computed tomography data of the patient and fabricated a flexible three-dimensional model of the aortic arch including the aneurysm. Evaluation This model was very helpful for the preoperative decision making and planning of the frozen elephant trunk procedure owing to the exact and lifelike illustration of the native aortic arch. Conclusions Three-dimensional models are helpful in preoperative planning and postoperative evaluation of frozen elephant trunk procedures in patients with complex aortic anatomy.

A gazetteer of Hebrew printing

by Elkan Nathan Adler