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  <front>
    <journal-meta>
      <journal-id journal-id-type="nlm-ta">Arq Bras Cardiol</journal-id>
      <journal-id journal-id-type="publisher-id">abc</journal-id>
      <journal-title-group>
        <journal-title>Arquivos Brasileiros de Cardiologia</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Arq. Bras. Cardiol.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">0066-782X</issn>
      <issn pub-type="epub">1678-4170</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia - SBC</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v3">mRFD9jMRZLKpbJFYttp6nXm</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v2">S0066-782X2017000500484</article-id>
      <article-id pub-id-type="doi">10.5935/abc.20170051</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Image</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Three-Dimensional Printing Model-Guided Percutaneous Closure of Atrial Septal Defect</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Luo</surname>
            <given-names>Hongxing</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
          <xref ref-type="corresp" rid="c1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Xu</surname>
            <given-names>Yu</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Wang</surname>
            <given-names>Zhongmin</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Liu</surname>
            <given-names>Yuhao</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Gao</surname>
            <given-names>Chuanyu</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <aff id="aff1">
          <institution content-type="orgname">Zhengzhou University</institution>
          <institution content-type="orgdiv1">People's Hospital</institution>
          <addr-line>
            <named-content content-type="city">Zhengzhou</named-content>
            <named-content content-type="state">Henan Province</named-content>
          </addr-line>
          <country country="CN">China</country>
          <institution content-type="original">Zhengzhou University People's Hospital, Zhengzhou, Henan Province - China</institution>
          <institution content-type="normalized">Zhengzhou University</institution>
        </aff>
      </contrib-group>
      <author-notes>
        <corresp id="c1"><bold>Mailing Address: Hongxing Luo</bold>, N&#186;.7 Weiwu Road, 450003, Zhengzhou, Henan Province - China. E-mail: <email>1519782837@qq.com</email>
				</corresp>
        <fn fn-type="con">
          <p>
            <bold>Author contributions</bold>
          </p>
          <p>Conception and design of the research: Luo H; Acquisition of data: Luo H, Xu Y; Analysis and interpretation of the data: Wang Z, Liu Y; Writing of the manuscript: Luo H; Critical revision of the manuscript for intellectual content: Liu Y, Gao C.</p>
        </fn>
        <fn fn-type="conflict">
          <p>
            <bold>Potential Conflict of Interest</bold>
          </p>
          <p>No potential conflict of interest relevant to this article was reported.</p>
        </fn>
      </author-notes>
      <pub-date pub-type="epub-ppub">
        <month>05</month>
        <year>2017</year>
      </pub-date>
      <volume>108</volume>
      <issue>5</issue>
      <fpage>484</fpage>
      <lpage>485</lpage>
      <history>
        <date date-type="received">
          <day>15</day>
          <month>08</month>
          <year>2016</year>
        </date>
        <date date-type="rev-recd">
          <day>31</day>
          <month>10</month>
          <year>2016</year>
        </date>
        <date date-type="accepted">
          <day>31</day>
          <month>10</month>
          <year>2016</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/" xml:lang="en">
          <license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
        </license>
      </permissions>
      <kwd-group xml:lang="en">
        <title>Keywords</title>
        <kwd>Heart Septal Defects, Atrial / surgery</kwd>
        <kwd>Echocardiography / methods</kwd>
        <kwd>Imaging, Three-Dimensional</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <p>A 32-year-old female with a 2-year history of chest distress was admitted to our department due to exacerbation for 3 days. On physical examination, we found fixed splitting second heart sounds on the patient's pulmonic area. An echocardiography was performed and showed a 15-mm atrial septal defect of the inferior vena cava type. After obtaining the patient's consent, a three-dimensional printing cardiac model was printed out. We tried various sizes of ASD occluders on the model to completely cover the defect, which indicated that a 28-mm occluder was appropriate. Thus, we placed a 28-mm ASD occluder during the operation and succeeded after only one attempt. The patient was re-assessed by echocardiography, which showed a favorable position of the ASD occluder without any left-to-right shunt.</p>
    <p>Three-dimensional printing (3D printing) is a new technology that converts two-dimensional medical images into a tangible object, allowing not only a comprehensive view of the cardiac anatomical structures but also preoperative simulation to choose the optimal size of ASD occluder. Although it has been applied to orthopedics, general surgery and so on, the use of 3D printing in cardiology is still at its infancy. Our case showed the feasibility of using a 3D printing cardiac model to guide the percutaneous closure of ASD. It is likely to increase the success rate and reduce the operation time for interventional cardiology, especially the complex ASD cases, and more studies should be carried out to extend its fields of application.</p>
    <p>
      <fig id="f1">
        <label>Figure 1</label>
        <caption>
          <title>Echocardiographic apical four-chamber axis view showing a 15-mm ASD with left-to-right shunt (A). Three-dimensional printing cardiac model in whole view (B) or being separated to show the ASD (C). A 28-mm occluder was placed to completely cover the ASD (D). Intraoperative placement of a 28-mm ASD occluder after one trial (E). Postoperative echocardiographic apical four-chamber axis view showing no left-to-right shunt (F).</title>
        </caption>
        <graphic xlink:href="1678-4170-abc-108-05-0484-70051-gf01.jpg"/></fig>
    </p>
  </body>
  <back>
    <fn-group>
      <fn fn-type="supported-by">
        <p>
          <bold>Sources of Funding</bold>
        </p>
        <p>There were no external funding sources for this study.</p>
      </fn>
      <fn fn-type="other">
        <p>
          <bold>Study Association</bold>
        </p>
        <p>This study is not associated with any thesis or dissertation work.</p>
      </fn>
    </fn-group>
  </back>
  <sub-article article-type="translation" id="s1" xml:lang="pt">
    <front-stub>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Imagem</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Fechamento Percut&#226;neo de Comunica&#231;&#227;o Interatrial Guiado por Modelo de Impress&#227;o 3D</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Luo</surname>
            <given-names>Hongxing</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">1</xref>
          <xref ref-type="corresp" rid="c2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Xu</surname>
            <given-names>Yu</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Wang</surname>
            <given-names>Zhongmin</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Liu</surname>
            <given-names>Yuhao</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Gao</surname>
            <given-names>Chuanyu</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">1</xref>
        </contrib>
        <aff id="aff2">
          <label>1</label>
          <institution content-type="original">Zhengzhou University People's Hospital, Zhengzhou, Henan Province - China</institution>
        </aff>
      </contrib-group>
      <author-notes>
        <corresp id="c2"><bold>Correspond&#234;ncia: Hongxing Luo</bold>, N&#186;.7 Weiwu Road, 450003, Zhengzhou, Henan Province - China. E-mail: <email>1519782837@qq.com</email>
				</corresp>
        <fn fn-type="con">
          <p>
            <bold>Contribui&#231;&#227;o dos autores</bold>
          </p>
          <p>Concep&#231;&#227;o e desenho da pesquisa e Reda&#231;&#227;o do manuscrito: Luo H; Obten&#231;&#227;o de dados: Luo H, Xu Y; An&#225;lise e interpreta&#231;&#227;o dos dados: Wang Z, Liu Y; Revis&#227;o cr&#237;tica do manuscrito quanto ao conte&#250;do intelectual importante: Liu Y, Gao .C.</p>
        </fn>
        <fn fn-type="conflict">
          <p>
            <bold>Potencial conflito de interesses</bold>
          </p>
          <p>Declaro n&#227;o haver conflito de interesses pertinentes.</p>
        </fn>
      </author-notes>
      <kwd-group xml:lang="pt">
        <title>Palavras-chave</title>
        <kwd>Comunica&#231;&#227;o Interatrial / cirurgia</kwd>
        <kwd>Ecocardiografia / m&#233;todos</kwd>
        <kwd>Imagem Tridimensional</kwd>
      </kwd-group>
    </front-stub>
    <body>
      <p>Uma mulher de 32 anos com hist&#243;rico de dois anos de dores no peito foi internada em nosso departamento devido &#224; exacerba&#231;&#227;o ocorrida 3 dias antes. No exame f&#237;sico, encontramos desdobramento fixo da segunda bulha na &#225;rea pulm&#244;nica da paciente. Um ecocardiograma foi realizado e mostrou uma comunica&#231;&#227;o interatrial (CIA) de 15 mm do tipo veia cava inferior. Ap&#243;s a obten&#231;&#227;o do consentimento da paciente, um modelo card&#237;aco de impress&#227;o tridimensional foi impresso. Tentamos v&#225;rios tamanhos de oclusores de CIA no modelo para cobrir completamente o defeito, o que indicou como adequado um oclusor de 28 mm. Assim, colocamos um oclusor de CIA de 28 mm durante a opera&#231;&#227;o e obtivemos sucesso ap&#243;s a primeira tentativa. A paciente foi reexaminada por ecocardiografia, que mostrou uma posi&#231;&#227;o favor&#225;vel do oclusor da CIA sem qualquer <italic>shunt</italic> da esquerda para direita.</p>
      <p>A impress&#227;o tridimensional (impress&#227;o em 3D) &#233; uma nova tecnologia que converte imagens m&#233;dicas bidimensionais em um objeto tang&#237;vel, permitindo n&#227;o s&#243; uma vis&#227;o abrangente das estruturas anat&#244;micas card&#237;acas, mas tamb&#233;m a simula&#231;&#227;o pr&#233;-operat&#243;ria para escolher o tamanho &#243;timo do oclusor de CIA. Embora tenha sido aplicada na ortopedia, cirurgia geral e outras &#225;reas, o uso da impress&#227;o 3D em cardiologia ainda est&#225; em sua inf&#226;ncia. Nosso caso mostrou a viabilidade do uso de um modelo de impress&#227;o card&#237;aca em 3D para guiar o fechamento percut&#226;neo de CIA. &#201; prov&#225;vel que aumente a taxa de sucesso e reduza o tempo de opera&#231;&#227;o na cardiologia intervencionista, especialmente os casos complexos de CIA, e mais estudos devem ser realizados para ampliar seus campos de aplica&#231;&#227;o.</p>
      <p>
        <fig id="f2">
          <label>Figura 1</label>
          <caption>
            <title>Corte apical de quatro c&#226;maras &#224; ecocardiografia mostrando uma CIA de 15 mm com shunt da esquerda para a direita (A). Modelo card&#237;aco de impress&#227;o tridimensional em vista inteira (B) ou sendo separado para mostrar a CIA (C). Um oclusor de 28 mm foi colocado para fechar completamente a CIA (D). Coloca&#231;&#227;o intraoperat&#243;ria de um oclusor de CIA de 28 mm ap&#243;s uma tentativa (E). Ecocardiografia p&#243;s-operat&#243;ria em corte apical de quatro c&#226;maras, mostrando n&#227;o haver shunt da esquerda para direita (F).</title>
          </caption>
          <graphic xlink:href="1678-4170-abc-108-05-0484-70051-gf01-pt.jpg"/></fig>
      </p>
    </body>
    <back>
      <fn-group>
        <fn fn-type="supported-by">
          <p>
            <bold>Fontes de financiamento</bold>
          </p>
          <p>O presente estudo n&#227;o teve fontes de financiamento externas.</p>
        </fn>
        <fn fn-type="other">
          <p>
            <bold>Vincula&#231;&#227;o acad&#234;mica</bold>
          </p>
          <p>N&#227;o h&#225; vincula&#231;&#227;o deste estudo a programas de p&#243;s-gradua&#231;&#227;o.</p>
        </fn>
      </fn-group>
    </back>
  </sub-article>
</article>
