ATLA Techincal editor Dr Rita Seabra offers us a deep dive into a paper published in ATLA by researchers at Chungbuk National University, South Korea.

Minimally Invasive Care for Man’s Best Friend

Just like people, dogs can also suffer from heart diseases. Heart diseases in dogs (and people!) can be divided into two main groups: those that are born with (congenital) and those that develop later in life (acquired). Prognosis and treatment options vary depending on the type and stage of the disease. In human medicine, we have benefited from minimally invasive cardiac procedures for a long time; for example, some heart interventions can be performed through the leg or the arm. Fortunately, the same rationale is being applied to veterinary medicine — for many congenital heart problems, veterinarians can now perform minimally invasive procedures through small catheters rather than open surgery.  

The Ethical Training Tool: Learning from 3D-Printed Models

In human medicine, 3D-printed heart models are widely available for training and planning procedures, reducing or maybe even eliminating the need to practice on cadavers. The same is happening in the field of veterinary medicine, where 3D-printed models are being developed and are increasingly being employed to help professionals improve their skills. Such models can be used to teach advanced techniques, as they help veterinarians visualise difficult anatomy or plan procedures ahead of time. Importantly, they allow veterinarians to practice safely without using cadavers or exposing animals to unnecessary stress, anaesthesia, radiation or invasive procedures.  

Putting the 3D Dog Heart Model to the Test

However, there has been little research on 3D-printed heart models for dogs. To address this, a Korean team created a 3D-printed model of a dog’s heart with particular congenital diseases, so that veterinarians could use it as a simulator to train catheter-based heart procedures.

Laboratory members from left to right: Dongwoo Chang, Changgyu Lim, Namsoon Lee (centre), Hearang Lim, and Songyi Kim

Treatments that involve catheter-based procedures are becoming more popular because they work well and have fewer complications than traditional surgery. However, these procedures are complex, demanding an excellent understanding of the heart’s anatomy and of all the steps involved in the actual procedure. Unfortunately, the technical complexity of these procedures, combined with the lack of accessible training opportunities, has limited their widespread adoption in clinical veterinary practice.

The veterinarians who participated in this study were shown a demonstration of specific cardiac procedures on the 3D model, and then were asked to repeat the same procedures three times. The idea was that they would be able to refine their skills over the three attempts and correct any errors in a low-stress and low-risk environment. As with all teaching and training aids, it is important to know how relevant and effective the model is. Thus, the time the veterinarians took to accurately complete each of the procedures was recorded, and they also completed a before-and-after questionnaire. Training on the 3D model improved the technical proficiency of the veterinarians and reduced the time they took to complete the procedures. Their results suggests that practicing on the 3D model bridged the gap between theoretical knowledge and the acquisition of technical skills. Interestingly, the vets reported an increase in their confidence levels and more motivation to engage in the catheter-based procedures — ‘practice makes perfect’ after all.  

Refining the Model and Planning for the Future

The authors pointed out the limitations of their model so that future designs could be improved. For example, the 3D heart was made of a rigid material and could not be deformed. This mean that, while it permitted the manipulation of catheters in the chambers and vessels, the material did not mimic the elasticity of biological tissue. Also, this was a small study with veterinarians undergoing radiology training. In the future, a study with a larger number of general practitioner veterinarians would generate better results and be able to determine the practical impact of training with this 3D model. Nonetheless, the authors remarked “Thus, 3D-printed models could represent an effective and scalable alternative to traditional animal-based training methods, thereby minimising the need to use live animals and cadavers for these purposes.” 

Both images show the 3D-printed model set up and simulated under fluoroscopic guidance. The arrows in the images indicate the curtain-type radiation protection device.

Secondly, the small sample size, and the inclusion only of veterinarians in radiology training, limited the statistical significance of the findings. A more-diverse participant pool, comprising general practitioners, would yield more universally relevant results. Furthermore, the long-term performance and impact on real-life efficacy in the clinic remain unclear, and these aspects should be investigated in a future follow-up study. 

Future studies should focus on developing a training model that incorporates ultrasound compatibility to enhance the educational utility of the model and support advanced interventional cardiology training. Although cost and infrastructure may limit broader implementation of 3D-printed cardiac models, viable alternatives for interventional training that do not involve the use of live animals or cadavers remain scarce. Therefore, the 3D-printed cardiac model presented in this study may offer meaningful educational value by providing an ethical, reusable and practical training tool. 

The next steps

The 3D-printed canine cardiac model replicated the required cardiac anatomy effectively and demonstrated scalability for use in veterinary interventional cardiology training. The simulator was shown to be a valuable teaching and training tool that could serve to replace animal-use for these purposes. The model enhanced the students’ understanding of cardiovascular structures and improved procedural efficiency in simulations of PDA occlusion, PS balloon valvuloplasty, ASD occlusion and transseptal approaches.  

The model could be further refined by addressing the limitations outlined in this study, thereby ensuring its educational and clinical applications in veterinary interventional cardiology. 

Read the full paper: Development of a 3D-printed canine cardiac disease model for interventional procedure training