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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EComputer-based design and modeling and the emerging field of physiomimetics are bringing forth changes to the practice of clinical cardiology, such as personalized prosthetic valves and a virtual fractional flow reserve clinical tool, and to pharmaceutical research and development. The personalized valves are produced by 3D printing using computer-aided design.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003E3D printing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecomputer-aided design\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Efuture of cardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ein silico modeling\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ephysiomimetic microsystems\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eprosthetic valves\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eimaging modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine screening \u0026amp; prevention\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\n\u003Cp id=\u0022p-2\u0022\u003EThe potential of computer-aided design and 3D printing, physiomimetics, and in silico modeling to transform clinical practice and drug discovery were highlighted in this session on the future of cardiovascular (CV) medicine.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EPersonalized Prosthetic Heart Valves\u003C\/h2\u003E\n\u003Cp id=\u0022p-3\u0022\u003EThe success of transcatheter aortic valve replacement and the advent of transcatheter mitral valve replacement are driving the need for strategies to create valves that are perfectly sized for each patient to eliminate postprocedure regurgitation, which currently occurs in about 70% of patients and is known to increase heart failure hospitalization and reduce survival [Hayashida K et al. \u003Cem\u003EJACC Cardiovasc Interv.\u003C\/em\u003E 2012]. Such personalized valves are possible by using computer-aided design and 3D printing, according to work by Dee Dee Wang, MD, and colleagues at the Henry Ford Health System, Detroit, Michigan, USA.\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003EThe limitations with current methodologies to determine the size of the aortic valve include the lack of a gold standard to measure the aortic annulus on computed tomography (CT) imaging and the limited number of sizes of commercially available prosthetic aortic valves. Further, the aortic annulus is a virtual ring as compared with a true physical structure [Piazza N et al. \u003Cem\u003ECirc Cardiovasc Interv.\u003C\/em\u003E 2008]; thus, accurate, reproducible measurement of this asymmetrical area is currently challenging. The presence of calcium will cause a gap because a prosthetic valve cannot conform to this bony structure. For transcatheter mitral valve replacement, determining the height and dimensions of the mitral valve for its correct landing location are required, for which CT is insufficient, in part because the presence of calcium interferes with identifying the correct location to measure.\u003C\/p\u003E\n\u003Cp id=\u0022p-5\u0022\u003EComputer-aided design adds a dimensional analysis of the aortic and mitral valve areas, but its accuracy depends on the accuracy of the CT imaging. Software programs assist with determining the size of the prosthetic valve and provide visualization of the potential fit, but this is unreliable because it does not account for the possible presence of calcium. To address these limitations, Dr Wang and colleagues are developing proprietary methods to evaluate the permanent anterior motion of the mitral leaflet and are combining this with 3D printing to create the prosthetic valve that is sized to the specific mitral anatomy of a patient. It provides the correct sizing to personalize structural heart interventions.\u003C\/p\u003E\n\u003Cp id=\u0022p-6\u0022\u003EThe first transcatheter caval valve implantation combined CT and 3D printing, along with transesophageal echocardiography, to evaluate the caval valve and create the prosthetic valve [O\u2019Neill B et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2015]. The patient was discharged 1 week after the successful procedure and was doing well at 4 months.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EPhysiomimetics: Modernizing Drug Discovery\u003C\/h2\u003E\n\u003Cp id=\u0022p-7\u0022\u003EPhysiomimetics is a new strategy to improve the efficiency of the drug discovery process. Such strategies are being developed to address the declining productivity in the pharmaceutical industry, with a decreasing number of drugs approved annually despite the increasing costs for research and development, according to Ashutosh Agarwal, PhD, University of Miami, Miami, Florida, USA.\u003C\/p\u003E\n\u003Cp id=\u0022p-8\u0022\u003EPhysiomimetic microsystems are intended to be models that mimic native tissue microenvironments, use human (rather than animal) cells, and collect functional outputs, while having a high throughput and being inexpensive. These microsystems will mimic the physiology and hopefully pathophysiology of different organs, and would replace the currently used static cultures and animal models. An \u201corgan on a chip\u201d is a new platform to study disease and screen drugs in healthy and diseased tissue.\u003C\/p\u003E\n\u003Cp id=\u0022p-9\u0022\u003EBorrowing a standard nanotechnology process from the electronic industry called photolithography that creates the chips for phones and computers, Agarwal and colleagues have created a heart on a chip. Scalable, standardized, and reproducible fabrication of such chips is possible with a benchtop CO\u003Csub\u003E2\u003C\/sub\u003E laser engraving system.\u003C\/p\u003E\n\u003Cp id=\u0022p-10\u0022\u003EIn 2 different proof-of-principle studies with a heart chip, this group showed it was possible to measure the dose response to isoproterenol to evaluate cardiac contractility [Agarwal A et al. \u003Cem\u003ELab Chip\u003C\/em\u003E. 2013], to more sensitively detect toxicity to doxorubicin, and to evaluate the impact of doxorubicin on the QT interval and twitch stress. In another study, they created a patient-specific heart chip with patient-derived induced pluripotent stem cells that revealed insights into the mechanisms of a rare genetic disorder, Barth syndrome [Wang G et al. \u003Cem\u003ENat Med.\u003C\/em\u003E 2014].\u003C\/p\u003E\n\u003Cp id=\u0022p-11\u0022\u003EAmong challenges to be addressed are methods to capture organ-organ interactions, determining the cells or culture to use, how to scale organs to one another, and how to scale the drug response for small engineered pieces of tissue to an organism or organ.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EIn Silico Modeling: Modernizing Clinical Cardiology\u003C\/h2\u003E\n\u003Cp id=\u0022p-12\u0022\u003EComputer models and simulation, called in silico modeling, are well known in engineering and are bringing a modern revolution in clinical cardiology, stated Paul Morris, MBChB, University of Sheffield, Sheffield, England, United Kingdom. It has been used for research and development in the medical device industry, for example, to test prosthetic heart valves and coronary stents to analyze mechanical stress to determine their design and safety.\u003C\/p\u003E\n\u003Cp id=\u0022p-13\u0022\u003ECV in silico modeling can be 0-, 1-, or 3D or multiscale (which combines models of different dimensions, times, or lengths); and can use imaging and segmentation. One clinical tool is virtual fractional flow reserve (FFR). FFR is an invasive procedure known to improve outcomes and reduce costs when used to guide therapy, but it is underused. A simulation of the geometry of the vessel and blood flow and pressure gradients across the stenosis can provide for virtual FFR.\u003C\/p\u003E\n\u003Cp id=\u0022p-14\u0022\u003EThe virtual FFR is less invasive, analyzes a large section of the epicardial circulation, and can simulate the physiological impact of a therapy, which allows for planning and optimizing the treatment plan. Reductions in the risk for patients and in health care costs are also advantages of such in silico modeling.\u003C\/p\u003E\n\u003Cp id=\u0022p-15\u0022\u003ESystem models or models that represent the entire human physiome, that is, a Virtual Physiological Human, are possible by integrating models of different lengths and time scales. The Virtual Physiological Human is a major focus of coordinated research in Europe. According to Dr Morris, clinical tools are available now to model virtual FFR and the risk of aneurysm rupture, and within 10 years there will be less-invasive, interactive diagnostic tools, virtual intervention suites, and clinical risk estimators. Beyond 10 years, there will be integrated, multiscale system models and in silico trials.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/5\/25.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlpg1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}