Surgical Planning Tool for Aortic Valve Reconstruction

描述(申请人提供)：主动脉瓣疾病是第三种最常见的先天性左心病变，影响所有出生时患有心脏缺陷的儿童的8%。儿童主动脉瓣置换术(AVR)虽然可行，但具有明显的早期和晚期发病率和死亡率，到AVR后10年，只有47%的儿童存活，没有再次瓣膜置换。抗凝、感染和瓣膜功能障碍的并发症是活动儿童发病率和死亡率的一些原因。因此，主动脉瓣修复术(AVRE)等替代手术仍然是人工瓣膜置换术的首选方法。然而，AVRE是一个技术要求很高的程序。分析瓣膜功能障碍的机制，精确测量瓣叶和根部的几何形状，以及决定修补补片的大小，必须在术中心脏骤停和主动脉开放的情况下进行。然而，在有经验的中心，AVRE的短期和长期结果都很好，但修复率仍然不是最优的，这在很大程度上是由于采用了反复试验的方法。AVRE的主要目标是利用非瓣叶组织(用丙醛处理的心包)修复瓣叶的几何形状，以在舒张期产生瓣膜关闭。虽然有经验的外科医生能够在手术中做到这一点，但由于手术过程中陡峭的“学习曲线”，AVRE的一致结果和广泛应用一直受到限制。为了解决这些阻碍AVRE更广泛应用的问题，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的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。我们提出了三个具体目标：目标1.开发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。目的2.建立和验证患者特有的基于有限元的主动脉瓣关闭和瓣膜修复的模拟。目的3.在临床医生和技术开发人员之间建立接口，以支持包括末端模板在内的主动脉瓣修复计划的工作流程。为了实现这些目标，我们将与3D超声图像处理、建模和临床主动脉瓣修复方面的专业知识建立合作伙伴关系。这一合作伙伴关系在临床护理、工业工程和建模领域拥有独特的渠道，并拥有长期的合作记录。

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.