经胸超声引导3D打印模型评估结构性心脏病的初步分析  

Initial study of transthoracic echocardiography guided three-dimensional printing on the application of assessment of structural heart disease

作　　者：朱延波[1,2] 刘建实[3] 王联群[3] 关欣[2] 骆永娟[2] 耿婕[4] 耿庆国[2] 林云佳[2] 张利霞[2] 李锡雪[2] 芦雅萍[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津市胸科医院超声科 [3]天津市胸科医院心外科 [4]天津市胸科医院心脏病重症监护病房

出　　处：《中华医学杂志》2017年第29期2280-2283,共4页National Medical Journal of China

基　　金：天津市卫生行业重点攻关项目（14KG125）;天津市卫生局科技基金（2012KY26,2015KY31）

摘　　要：目的探讨经胸超声心动图引导3D打印模型在结构性心脏病术前评估应用中的可行性及诊断价值。方法2016年2至10月在天津市胸科医院应用经胸超声心动图引导3D打印模型对44例患者进行术前评估，其中男25例、女19例，年龄3～75（44±22）岁，对比常规三维经胸超声心动图，并以术中直视所见为＂金标准＂ 。结构性心脏病患者12例，其中包含二尖瓣脱垂4例，部分性心内膜垫缺损2例，继发孔房间隔缺损2例，风湿性心脏病二尖瓣狭窄2例，法洛四联症1例，室间隔缺损1例，非结构性心脏病患者32例作为阴性对照。结果TTE Guided 3D PM的灵敏度、特异度均大于或等于3D－TTE；McNemar检验3D－TTE的P〉0.05，差异无统计学意义，kappa值0.745，P〈0.01，说明3D－TTE和金标准两种方法结果一致性一般。McNemar检验TTE Guided 3DPM的P〉0.05，差异无统计学意义，kappa值0.955，P〈0.01，说明TTE Guided 3DPM和金标准两种方法结果一致性较高。3D－TTE与TTE Guided 3DPM比较，P〉0.05，差异无统计学意义，kappa值0.879，P〈0.01，说明3D－TTE和TTE Guided 3DPM两种方法结果一致性较高。经胸超声心动图引导3D打印模型能够清晰显示结构性心脏病病变的实体三维结构，与术中所见基本一致。结论经胸超声心动图引导3D打印模型为结构性心脏病外科术前评价及决策提供了重要信息。ObjectiveTo investigate the feasibility and diagnostic value of preoperative transthoracic echocardiography guided three dimensional printing model （TTE Guided 3DPM） on the assessment of structural heart disease （SHD）.MethodsFrom February 2016 to October 2016, 44 patients underwent cardiac surgery in Tianjin Chest Hospital, forty-four patients were assessed preoperatively using TTE Guided 3DPM, including 25 males and 19 females, aged 3-75 years, with an average of （44±22） years. compared to conventional three dimensional transthoracic echocardiography （3D-TTE）, and took direct intraoperative findings as ＂Golden Standard＂ simultaneously. There are twelve patients with SHD, including four cases with mitral prolapse, two cases with partial endocardial cushion defect, two cases with secondary atrial septal defect, two cases with rheumatic mitral stenosis, one case with tetralogy of Fallot, one case with ventricular septal defect （VSD）, thirty-two patients without SHD were designed as negative control.ResultsThe sensitivity and specificity of TTE Guided 3DPM were greater than or equal to 3D-TTE, P value of McNemar test of 3D-TTE was greater than 0.05, the difference was not statistically significant, kappa=0.745, P〈0.01, indicated that the results of 3DTTE and the gold standard were generally consistent.P value of McNemar test of TTE Guided 3DPM was greater than 0.05, the difference was not statistically significant, kappa=0.955, P〈0.01, indicated that the results of TTE Guided 3DPM and gold standards were consistent. Compared with 3D-TTE and TTE Guided 3DPM, P value was greater than 0.05, the difference was not statistically significant, kappa=0.879, P〈0.01, indicated that the results of 3D-TTE and TTE Guided 3DPM were consistent. TTE Guided 3DPM displayed the three-dimensional structure of SHD cardiac lesions clearly, which were consistent with intraoperative findings.ConclusionTTE Guided 3DPM provides essential information for the preoperative evaluation and decision of SHD.

关 键 词：超声心动描记术 三维 心脏病 三维打印 

分 类 号：R540.45[医药卫生—心血管疾病]