Invention of a novel three-dimensional virtual and realistic model of the mitral complex by using three-dimensional echocardiography

环状成形术是目前治疗缺血/功能性MR的一种常用手术策略，即使环状成形术后MR常常持续存在。最近，新的手术策略有望减少环状成形术后的慢性持续性缺血性MR。然而，在临床上，尽管弯曲的二尖瓣和马鞍形的二尖瓣环具有独特的外形，但以前在二尖瓣组件的单个层面上通过二维超声心动图来评估二尖瓣小叶和二尖瓣环的几何变化程度。因此，目前临床研究中用于测量帐篷长度(搭接长度)或帐篷面积的二维成像平面可能会错过最大系留部位。此外，目前的手术方法是基于动物实验的有益结果而开发的，在临床环境中忽略了每个患者的各种三维几何畸形。准确、全面地了解整个…的三维几何变化临床上需要更多的二尖瓣叶和二尖瓣环才能成功修复瓣膜。我们开发了一个独创的软件系统，该系统可以提供二尖瓣叶和瓣环的三维几何形状，明确二尖瓣叶的最大帐篷位置，并量化人类二尖瓣帐篷和瓣环畸形的程度。在本课题中，我们制作了一个独创的软件系统来创建二尖瓣复合体的三维图像，并检验了三维评估的临床应用价值。在临床和实验研究中，我们证明了由重建的虚拟3D图像得到的3D凝聚指数是一个有用的参数，是评估功能性二尖瓣反流机制的关键。此外，我们成功地利用三维数据集制作了二尖瓣复合体的真实模型，使我们能够在手术前检查二尖瓣组件的复杂形状。较少

Annuloplasty is currently a common surgical strategy for ischemic/functional MR, even if MR often persists after annuloplasty. Recently, new surgical strategies have been expected to reduce chronic persistent ischemic MR after annuloplasty. However, in the clinical setting, the degree of geometric changes of the mitral leaflets and annulus has previously assessed in a single slice of the mitral valve component by 2-D echocardiography, in spite of the unique configuration of the curved mitral valve and saddle-shaped mitral annulus. Hence, 2-D imaging plane that is currently used for the measurement of tenting length (coaptation length) or tenting area in the clinical studies may miss the maximum tethering site. Besides, present surgical approaches have been developed based on the beneficial result from animal experiments ignoring the various 3-D geometric deformities in each patient in the clinical setting. Precise and comprehensive understanding of the 3-D geometric change of the whole … More mitral leaflets and annulus is needed for successful valve repair in the clinical setting. We have developed a original software system which can provide 3-D geometry of the mitral leaflets and annulus, clarify the maximum tenting site of the mitral leaflet, and quantify the degree of mitral valve tenting and annular deformity in humans. It will be helpful for surgeon to know the precise mechanisms of the ischemic MR and to make a proper decision for the surgical strategy in each individual.In the present project, we made an original software system to create a 3D images of the mitral valve complex, and examine the clinical utility of the 3D assessment. In clinical and experimental studies, we demonstrated that the 3D coaptation index derived by the reconstructed virtual 3D images was a useful parameter that is a key to assess the mechanisms of functional mitral regurgitation. Furthermore, we succeeded to make a real model of the mitral complex by utilizing the 3D dataset, which allows us to examine the complicated shape of the mitral valve components before surgery. Less