Surgical Planning Tool for Aortic Valve Reconstruction

描述（由申请人提供）：主动脉瓣疾病是第三大最常见的先天性左心病变，影响8%的先天性心脏缺陷儿童。儿童主动脉瓣置换术（AVR）虽然可行，但具有显著的早期和晚期发病率和死亡率，因此到AVR后10年，只有47%的儿童存活且没有瓣膜再次置换。抗凝、感染和瓣膜功能障碍的并发症是活跃儿童发病率和死亡率的一些原因。出于这个原因，诸如主动脉瓣修复（AVre）的替代手术仍然是假体置换的优选方法。然而，AVre是一个技术要求很高的程序。术中必须在心脏停搏和主动脉开放时分析瓣膜功能障碍的机制，精确测量瓣叶和根部几何形状，并决定修补补片的尺寸。然而，在经验丰富的中心，AVre的短期和长期结果都很好，但修复率仍然不理想，这在很大程度上是由于采用了试错法。AVre的主要目标是使用非瓣叶组织（用戊二醛处理的心包）修复瓣叶的几何形状，以在瓣膜植入期间实现瓣膜闭合。虽然经验丰富的外科医生能够在术中做到这一点，但由于该手术的陡峭“学习曲线”，AVre的一致结果和广泛应用受到限制。为了更广泛地解决AVre应用的这些障碍，我们建议利用三维超声成像的最新进展，结合图像处理和建模技术，开发一种用于主动脉瓣功能术前分析和手术规划的工具。最终，我们的目标是拥有一种可以在手术室使用的工具，利用术中成像进行分析和规划。我们提出三个具体目标：目标1。制定用于定义瓣膜几何形状的方法，包括：分割、统计几何模型和计算网格。目标2.开发并验证基于患者特定有限元的主动脉瓣关闭和瓣膜修复模拟。目标3.在临床医生和技术开发人员之间创建接口，以实现主动脉瓣修复计划的工作流程，包括端模板。为了实现这些目标，我们将与3D超声图像处理、模型构建和临床主动脉瓣修复方面的专业人员合作。这种合作关系在临床护理、工业工程和建模方面具有独特的优势，并且有着长期的合作记录。 公共卫生相关性：主动脉瓣疾病是第三大常见的先天性左心病变，影响8%的先天性心脏缺陷儿童，也是年轻人最常见的心脏瓣膜缺陷之一。虽然主动脉瓣置换术是可行的，但儿童的长期结果较差。然而，主动脉瓣修复术避免了植入过大瓣膜的广泛主动脉根部扩大手术和抗凝治疗的需要，而抗凝治疗是人工瓣膜置换术并发症的主要来源。本项目的目标是开发一种工具，以帮助外科医生分析病变瓣膜中的解剖缺陷并计划患者特定的修复技术。3D超声成像和计算方法的进步已经达到了可以在手术室中实施该技术的水平。

DESCRIPTION (provided by applicant): Aortic valve disease is the third most common congenital left heart lesion, affecting 8% of all children born with heart defects. Aortic valve replacement (AVR) in children, while feasible, carries a significant early and late morbidity and mortality such that by 10 years following AVR only 47% of children are alive and without valve re-replacement. Complications of anticoagulation, infection and valve dysfunction are some of the causes of morbidity and mortality in active children. For this reason alternative procedures such as aortic valve repair (AVre), remain a preferable approach to prosthetic replacement. AVre, however, is a technically demanding procedure. Analysis of mechanisms of valve dysfunction, precise measurement of leaflet and root geometry, and decisions regarding repair patch size, must be made intra-operatively while the heart is arrested and the aorta open. In experienced centers, however, the short and long-term results of AVre are excellent but the repair rate remains suboptimal due in great part to the trial and error method applied. The main goal of AVre is to repair the geometry of the valve leaflets using non-leaflet tissue (pericardium treated with gluteraldehyde) to generate valve closure during diastole. While experienced surgeons are able to do this intra-operatively, consistent results and widespread application of AVre has been limited due to the steep "learning curve" with the procedure. To address these impediments to the application of AVre more widely, we propose to utilize the recent advances in 3D ultrasound imaging combined with image processing and modeling techniques to develop a tool for pre-procedure analysis of aortic valve function, and for surgical planning. Ultimately, the goal is to have a tool that can be used in the operating room, utilizing intra-operative imaging for analysis and planning. We propose three Specific Aims: Aim 1. Develop methodology for defining valve geometry, including: segmentation, statistical geometric models, and computational meshes. Aim 2. Develop and validate patient-specific finite element- based simulation of aortic valve closure and of valve repair. Aim 3. Create an interface between clinicians and technical developments to enable the work-flow for aortic valve repair planning, including end-template. To accomplish these goals we will employ a partnership with expertise in 3D ultrasound image processing, model building, and clinical aortic valve repair. This partnership has unique access to clinical care, industrial engineering and modeling, and a long track record of collaboration. PUBLIC HEALTH RELEVANCE: Aortic valve disease is the third most common congenital left heart lesion, affecting 8% of all children born with heart defects and one of the most common heart valve defects in young adults. While aortic valve replacement is feasible, the long term results in children are poor. Aortic valve repair, however, avoids the need for extensive aortic root enlargement procedures to implant oversize valves, and anticoagulation, which are the main source of complications with prosthetic valve replacement. The goal of this project is to develop a tool to aid surgeons in analyzing the anatomic defect in the diseased valve and planning a patient specific repair technique. Advances in 3D ultrasound imaging and computational methods have reached a level where this technology can be implemented in the operating room.