基于经食管三维超声心动图和3D打印的左心耳封堵术前模拟系统的建立和评估  

Establishment and assessment of an LAA occlusion preoperative simulation system based on 3D transesophagealechocardiography and 3D printing

作　　者：宋宏宁[1] 周青[1] 陈金玲[1] 张兰[1] 谭团团[1] 胡波[1] 郭瑞强[1] 

机构地区：[1]武汉大学人民医院超声影像科,430060

出　　处：《中华超声影像学杂志》2017年第1期1-6,共6页Chinese Journal of Ultrasonography

基　　金：中央高校基本科研业务重点重大培育专项基金（302410500246）

摘　　要：目的使用经食管三维超声心动图（3DTEE）和3D打印建立左心耳封堵模拟系统。对左心耳封堵过程中封堵伞的选择和释放、封堵器残余漏的大小以及封堵器的压缩比进行体外模拟。方法对15例行左心耳封堵的房颤患者的术前及术中3DTEE左心耳图像进行后处理，获得左心耳3D打印模型。使用3DTEE扫描3D打印获取的软性左心耳模型，建立左心耳封堵模拟系统，评估3D打印模型的准确性、封堵器压缩比和封堵器残余漏。将模型中测量值与术中测量值对比。结果15例患者均基于3DTEE图像获取3D打印模型。3D打印模型测量值与术中3DTEE测量值差异无统计学意义（P〉0．05）。3D打印模型测量值与术中3DTEE测量值具有一致性。3D打印模型中封堵器压缩比大于体内封堵器压缩比（P=0．04）。3D打印模型封堵器的压缩比与体内封堵器压缩比有显著相关性（r=0．949，P〈0．01）。3D打印模型模拟操作中，4例患者观察到封堵器残余漏，左心耳封堵术中实际操作中6例患者存在封堵器残余漏，其一致性Kappa值为0．706。结论基于3DTEE和3D打印的左心耳封堵术前模拟系统可以实现左心耳封堵的术前演练及评估，可作为左心耳封堵术前准备的重要补充。Objective To create an left atrial appendage（LAA） occlusion preoperative simulation system by three dimensional transesophageal echocardiography （3DTEE） and three dimensional printing （3DP）, and simulate the process of LAA occlusion including the selection and deployment of devices, leaks around devices and the compression rate of the devices in vitro. Methods Fifteen cases of LAA occlusion in patients with atrial fibrillation were selected in this study. Preoperative and intraoperative TEE was performed to acquire the volume data of LAA. Replicas of LAAs were created by 3DP. Then the simulation system was created by 3DTEE and the models. The models were scanned by 3DTEE to evaluate the accuracy of models, leaks around devices and the compression rate of the devices. The results were compared with intraoperative measurements. Results 3DP models of 15 patients were created based on the 3DTEE data. There was no significant difference in the values of measurements between models and cases in vivo by 3DTEE and there were agreements between these two methods. The compression rate of devices was higher in models than in case （ P = 0.04）. Compression rate in models correlated with that in cases （ r = 0. 949, P 〈0.01）. Four cases were observed with leaks in 3DP models and 6 cases were observed with leaks intraoperatively, the Kappa value of agreement was 0.706. Conclusions Preoperative exercise and evaluation of LAA occlusion can be acquired by the preoperative simulation system based on 3DTEE and 3DP, which can be an important supplement for preoperative preparation.

关 键 词：超声心动描记术 经食管 三维 3D打印 左心耳 

分 类 号：R540.45[医药卫生—心血管疾病]