3D printing based on cardiac CT assists anatomic visualization prior to transcatheter aortic valve replacement.
3D printing based on cardiac CT assists anatomic visualization prior to transcatheter aortic valve replacement.
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基于心脏CT的3D打印有助于在经导管主动脉瓣更换之前解剖可视化。
DOI：
10.1016/j.jcct.2015.12.004
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发表时间：
2016-01
影响因子：
5.4
通讯作者：
Blankstein R
中科院分区：
文献类型：
--
作者：
Ripley B;Kelil T;Cheezum MK;Goncalves A;Di Carli MF;Rybicki FJ;Steigner M;Mitsouras D;Blankstein R
3D打印是一种很有前途的技术，可能在医学中有应用，并且人们对使用患者特定的3D模型来指导手术干预的兴趣越来越大。确定使用心脏CT打印主动脉根复合体个体模型用于经导管主动脉瓣置换术（TAVR）计划的可行性，以及确定预测瓣周主动脉瓣返流（PAR）的能力。这项回顾性研究包括16例患者（9例患者在术后经胸超声心动图的盲态解读中发现PAR，7例年龄、性别和瓣膜尺寸匹配的对照患者无PAR）。主动脉根部的3D打印模型是根据TAVR前心脏计算机断层扫描数据创建的。这些模型配有打印的瓣膜，并使用透光试验预测植入后PAR。主动脉根部3D模型高度准确，在3D模型上进行的瓣环测量与在相应的2D数据上进行的瓣环测量之间具有极好的一致性（平均差异为−0.34 mm，95%一致性限值：± 1.3 mm）。3D打印的瓣膜模型在其设计尺寸的0.1 mm范围内。检查患者特定主动脉根模型中瓣膜的拟合，正确预测了9例患者中的6例（6例真阳性，3例假阴性）的PAR，7例患者中的5例（5例真阴性，2例假阳性）没有PAR。基于心脏CT的TAVR前3D打印提供了一种独特的患者特异性方法来评估主动脉根部和植入瓣膜的物理相互作用。通过额外的优化，3D模型可以补充用于预测哪些患者更有可能发生PAR的传统技术。
3D printing is a promising technique that may have applications in medicine, and there is expanding interest in the use of patient-specific 3D models to guide surgical interventions. To determine the feasibility of using cardiac CT to print individual models of the aortic root complex for transcatheter aortic valve replacement (TAVR) planning as well as to determine the ability to predict paravalvular aortic regurgitation (PAR). This retrospective study included 16 patients (9 with PAR identified on blinded interpretation of post-procedure trans-thoracic echocardiography and 7 age, sex, and valve size-matched controls with no PAR). 3D printed models of the aortic root were created from pre-TAVR cardiac computed tomography data. These models were fitted with printed valves and predictions regarding post-implant PAR were made using a light transmission test. Aortic root 3D models were highly accurate, with excellent agreement between annulus measurements made on 3D models and those made on corresponding 2D data (mean difference of −0.34 mm, 95% limits of agreement: ± 1.3 mm). The 3D printed valve models were within 0.1 mm of their designed dimensions. Examination of the fit of valves within patient-specific aortic root models correctly predicted PAR in 6 of 9 patients (6 true positive, 3 false negative) and absence of PAR in 5 of 7 patients (5 true negative, 2 false positive). Pre-TAVR 3D-printing based on cardiac CT provides a unique patient-specific method to assess the physical interplay of the aortic root and implanted valves. With additional optimization, 3D models may complement traditional techniques used for predicting which patients are more likely to develop PAR.
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