应用三维打印技术构建心脏瓣膜病术前主动脉根部模型的可行性研究
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摘要
目的探讨应用三维(three dimensional,3D)打印技术构建心脏瓣膜病术前主动脉根部模型的可行性。方法前瞻性入选术前接受CT检查且拟行主动脉瓣置换术的患者8例,其中6例的主动脉疾病手术指征为主动脉瓣重度狭窄(2例合并主动脉瓣二叶式畸形),1例为人工生物瓣置入术后瓣膜失功能,1例为主动脉根部瘤合并主动脉瓣反流。CT扫描均使用前瞻性心电门控采集,将患者收缩期CT图像导入Mimics、3-matic、Magics、Freeform等医学三维图像建模及编辑软件,逐一进行疾病三维模型的构建,并打印出实物模型。结果 8例患者的主动脉疾病模型均成功构建,模型质量满意,有3例模型得到了手术验证。患者中位年龄为74岁(52～82岁),三维建模的中位耗时为4.5 h(3.0～5.5 h),3D打印的中位耗时为5 h(5～9 h),中位材料成本为3050元(2600～9700元)。结论应用3D打印技术构建心脏瓣膜病术前主动脉根部模型是可行的。
Objective To investigate the feasibility of three dimensional( 3D) model printing of aortic root before aortic valve disease surgery. Methods Eight patients undergoing CT examination who would undergone cardiac aortic valve replacement were prospectively enrolled. Six patients' aortic disease indicated for severe aortic stenosis( two patients were with bicuspid aortic valve deformity),one patient was with artificial bioprosthetic valve dysfunction after implantation, one patient was with main artery root aneurysm and aortic regurgitation.Prospective ECG gated acquisition was used for CT scan. The CT images of systolic were imported intoMimics、3-matic、Magics、Freeformand other 3D modeling and editing software,then the 3D models of disease were built one by one,and physical models were printed. Results Models of aortic valve disease of all eight cases were successfully constructed,with good qualities,three of which were confirmed by open surgery. The median age was 74 years( the age range of 52-82 years). The median time cost of three-dimensional modeling was 4.5 hours( the time range of 3. 0-5. 5 hours),and the median time cost of 3D model printing was 5 hours( the time range of 5-9 hours),and the median material cost was $ 3050( the cost range of $ 2600-9700). Conclusions 3D model printing of aortic valve disease before operation is feasible.
Objective To investigate the feasibility of three dimensional( 3D) model printing of aortic root before aortic valve disease surgery. Methods Eight patients undergoing CT examination who would undergone cardiac aortic valve replacement were prospectively enrolled. Six patients' aortic disease indicated for severe aortic stenosis( two patients were with bicuspid aortic valve deformity),one patient was with artificial bioprosthetic valve dysfunction after implantation, one patient was with main artery root aneurysm and aortic regurgitation.Prospective ECG gated acquisition was used for CT scan. The CT images of systolic were imported intoMimics、3-matic、Magics、Freeformand other 3D modeling and editing software,then the 3D models of disease were built one by one,and physical models were printed. Results Models of aortic valve disease of all eight cases were successfully constructed,with good qualities,three of which were confirmed by open surgery. The median age was 74 years( the age range of 52-82 years). The median time cost of three-dimensional modeling was 4.5 hours( the time range of 3. 0-5. 5 hours),and the median time cost of 3D model printing was 5 hours( the time range of 5-9 hours),and the median material cost was $ 3050( the cost range of $ 2600-9700). Conclusions 3D model printing of aortic valve disease before operation is feasible.
引文
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[13] Fujita B,Kutting M,Seiffert M,et al. Calcium distribution patterns of the aortic valve as a risk factor for the need of permanent pacemaker implantation after transcatheter aortic valve implantation[J]. European Heart Journal-Cardiovascular Imaging,2016,17:1385-1393.
[14] Gallo M,D’Onofrio A,Tarantini G,et al. 3D-printing model for complex aortic transcatheter valve treatment[J]. International Journal of Cardiology,2016,210:139-140.
[15] Schmauss D,Schmitz C,Bigdeli AK,et al. Three-dimensional printing of models for preoperative planning and simulation of transcatheter valve replacement[J]. Annals of Thoracic Surgery,2012,93(2):e31-e33.
[16]刘坤,吕滨,任心爽,等. 3D打印技术应用于经导管主动脉瓣置入术前评估一例[J].中华心血管病杂志,2015,43(7):634-635.Liu K,Lyu B,Ren XS,et al. Application of 3D printing technique in preoperative evaluation of transcatheter aortic valve implantation[J].Chinese Journal of Cardiology,2015,43(7):634-635.
[2] Bonow RO,Leon MB,Doshi D,et al. Management strategies and future challenges for aortic valve disease[J]. Lancet,2016,387(10025):1312-1323.
[3] Vahl TP, Kodali SK, Leon MB. Transcatheter aortic valve replacement 2016:a modern-day “Through the looking-glass”adventure[J]. Journal of the American College of Cardiology,2016,67(12):1472-1487.
[4] Naoum C,Blanke P,Dvir D,et al. Clinical outcomes and imaging findings in women undergoing TAVR[J]. JACC Cardiovasc Imaging,2016,9(4):483-493.
[5] Renapurkar RD,El-Sherief AH,Prieto L,et al. Transcatheter structural cardiac intervention:a radiology perspective[J].American Journal of Roentgenology,2015,204(6):W648-W662.
[6]任心爽,吕滨. CT血管成像对经导管主动脉瓣置换术风险的评估[J].中华心血管病杂志,2016,44(1):83-85.Ren XS,Lyu B. Evaluation of CT angiography in the risk of transcatheter aortic valve replacement[J]. Chinese Journal of Cardiology,2016,44(1):83-85.
[7] Achenbach S,Delgado V,Hausleiter J,et al. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation(TAVI)/transcatheter aortic valve replacement(TAVR)[J]. Journal of Cardiovascular Computed Tomography,2012,6(6):366-380.
[8] Fedak PW,Barker AJ,Verma S. Year in review:bicuspid aortopathy[J].Current Opinion in Cardiology,2016,31(2):132-138.
[9] Kapetanakis EI,Maccarthy P,Monaghan M,et al. Trans-apical aortic valve implantation in a patient with stentless valve degeneration[J]. European Journal of Cardio-Thoracic Surgery,2011,39(6):1051-1053.
[10] Chambers JB,Myerson SG,Rajani R,et al. Multimodality imaging in heart valve disease[J]. Open Heart,2016,3(1):e330.
[11] Garcia-Martin A,Lazaro-Rivera C,Fernandez-Golfin C,et al.Accuracy and reproducibility of novel echocardiographic threedimensional automated software for the assessment of the aortic root in candidates for thanscatheter aortic valve replacement[J].European Heart Journal-Cardiovascular Imaging,2016,17(7):772-778.
[12] Kurup HK,Samuel BP,Vettukattil JJ. Hybrid 3D printing:a game-changer in personalized cardiac medicine?[J]. Expert Review of Cardiovascular Therapy,2015,13(12):1281-1284.
[13] Fujita B,Kutting M,Seiffert M,et al. Calcium distribution patterns of the aortic valve as a risk factor for the need of permanent pacemaker implantation after transcatheter aortic valve implantation[J]. European Heart Journal-Cardiovascular Imaging,2016,17:1385-1393.
[14] Gallo M,D’Onofrio A,Tarantini G,et al. 3D-printing model for complex aortic transcatheter valve treatment[J]. International Journal of Cardiology,2016,210:139-140.
[15] Schmauss D,Schmitz C,Bigdeli AK,et al. Three-dimensional printing of models for preoperative planning and simulation of transcatheter valve replacement[J]. Annals of Thoracic Surgery,2012,93(2):e31-e33.
[16]刘坤,吕滨,任心爽,等. 3D打印技术应用于经导管主动脉瓣置入术前评估一例[J].中华心血管病杂志,2015,43(7):634-635.Liu K,Lyu B,Ren XS,et al. Application of 3D printing technique in preoperative evaluation of transcatheter aortic valve implantation[J].Chinese Journal of Cardiology,2015,43(7):634-635.