An anthropomorphic phantom for atrial transseptal puncture simulation training

Aya Mutaz Zeidan; Zhouyang Xu; Lisa Leung; Calum Byrne; Sachin Sabu; Yijia Zhou; Christopher Aldo Rinaldi; John Whitaker; Steven E Williams; Jonathan Behar; Aruna Arujuna; R James Housden; Kawal Rhode

doi:10.1186/s41205-024-00241-y

An anthropomorphic phantom for atrial transseptal puncture simulation training

3D Print Med. 2024 Oct 30;10(1):34. doi: 10.1186/s41205-024-00241-y.

Authors

Aya Mutaz Zeidan^#¹, Zhouyang Xu^#², Lisa Leung^{3

4}, Calum Byrne³, Sachin Sabu³, Yijia Zhou², Christopher Aldo Rinaldi^{2

3}, John Whitaker^{2

3}, Steven E Williams^{2

5}, Jonathan Behar^{2

3}, Aruna Arujuna², R James Housden², Kawal Rhode²

Affiliations

¹ Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK. aya.zeidan@kcl.ac.uk.
² Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK.
³ Cardiology Department, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
⁴ St. George's Hospital, NHS Foundation Trust, London, SW17 0QT, UK.
⁵ Center for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.

^# Contributed equally.

Abstract

Background: Transseptal puncture (TSP) is a critical prerequisite for left-sided cardiac interventions, such as atrial fibrillation (AF) ablation and left atrial appendage closure. Despite its routine nature, TSP can be technically demanding and carries a risk of complications. This study presents a novel, patient-specific, anthropomorphic phantom for TSP simulation training that can be used with X-ray fluoroscopy and ultrasound imaging.

Methods: The TSP phantom was developed using additive manufacturing techniques and features a replaceable fossa ovalis (FO) component to allow for multiple punctures without replacing the entire model. Four cardiologists and one cardiology trainee performed TSP on the simulator, and their performance was assessed using four metrics: global isotropy index, distance from the centroid, time taken to perform TSP, and a set of 5-point Likert scale questions to evaluate the clinicians' perception of the phantom's realism and utility.

Results: The results demonstrate the simulator's potential as a training tool for interventional cardiology, providing a realistic and controllable environment for clinicians to refine their TSP skills. Experienced cardiologists tended to cluster their puncture points closer to regions of the FO associated with higher global isotropy index scores, indicating a relationship between experience and optimal puncture localization. The questionnaire analysis revealed that participants generally agreed on the phantom's realistic anatomical representation and ability to accurately visualize the TSP site under fluoroscopic guidance.

Conclusions: The TSP simulator can be incorporated into training programs, offering trainees the opportunity to improve tool handling, spatial coordination, and manual dexterity prior to performing the procedure on patients. Further studies with larger sample sizes and longitudinal assessments are needed to establish the simulator's impact on TSP performance and patient outcomes.

Keywords: 3D printing; Cardiology; Patient-specific; Simulation; Training; Transseptal puncture.

Abstract

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