Three-Dimensional Modeling of Surgically Implanted Stent-Based Valves in the Mitral Position in Children.
Three-Dimensional Modeling of Surgically Implanted Stent-Based Valves in the Mitral Position in Children.
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DOI：
10.1016/j.athoracsur.2020.02.020
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发表时间：
2020-08
期刊：
影响因子：
--
通讯作者：
Jolley MA
中科院分区：
文献类型：
--
作者：
Choi PS;Nam HH;Lasso A;Herz C;Drouin S;Harrild DM;Quartermain M;Fichtinger G;Mascio CE;Emani S;Jolley MA
对于二尖瓣环太小而无法容纳传统假体的儿童，手术植入基于支架的瓣膜是一种很有前途的选择。然而，目前还没有可靠的术前方法来指导患者的选择、装置的大小和定位。我们描述了一种新的方法来可视化和量化装置适合三维超声心动图（3DE）衍生的心脏模型。使用定制软件从现有的术前3DE创建心脏模型。将瓣膜模型虚拟植入模型中，量化装置配合度和左心室流出道面积。3例在二尖瓣位置接受梅洛迪瓣膜置入术的患者的3DE回顾性建模- 1例左心室流出道梗阻（LVOTO）， 1例瓣膜周围泄漏，1例无并发症。在所有病例中，2D测量都低估了3D环形尺寸，临床LVOT阻塞患者的LVOT面积/主动脉面积比预测最低（0.5）。基于3DE的二尖瓣支架置入术前建模可以改善二尖瓣尺寸的量化，并为潜在LVOTO的风险分层提供信息。
In children with a mitral annulus too small to accommodate traditional prostheses, surgical implantation of stent-based valves is a promising option. However, no reliable pre-operative methods exist to guide patient selection, device sizing and positioning. We describe a novel methodology to visualize and quantify device fit in three-dimensional echocardiogram (3DE)-derived heart models. Heart models were created from existing pre-operative 3DE using custom software. Valve models were virtually implanted into the models and both device fit and left ventricular outflow tract (LVOT) area were quantified. The 3DE of three patients who underwent Melody valve placement in the mitral position were retrospectively modeled — one with left ventricular outflow tract obstruction(LVOTO), one with perivalvar leak, and one without complications. In all cases 2D measurements underestimated 3D annular dimensions, and the patient with clinical LVOT obstruction had the lowest predicted LVOT area/Aortic area ratio (0.5). 3DE based pre-operative modeling of surgical implantation of stent-based valves in the mitral position may improve quantification of mitral valve dimensions and inform risk stratification for potential LVOTO.
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