基于经食管超声心动图的左心耳3D模型构建及其在术前模拟左心耳封堵中的价值  

Construction of left atrial appendage three-dimensional model based on transesophageal echocardiography and its value in preoperative simulated left atrial appendage closure

作　　者：王益佳[1] 周青[1] 宋宏宁[1] 邓倾[1] 陈思楷 郭瑞强[1] Wang Yijia;Zhou Qing;Song Hongning;Deng Qing;Chen Sikai;Guo Ruiqiang(Department of Ultrasonography,Renmin Hospital of Wuhan University,Wuhan 430060,China)

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》2018年第8期650-655,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81771849）;湖北省卫生和计划生育委员会青年人才项目（WJ2017Q009）

摘　　要：目的使用经食管三维超声心动图（3DTEE）和软性3D打印材料，获得左心耳3D模型，评估软性材料左心耳3D模型体外模拟封堵操作的准确性及应用价值。方法按比例混合硅胶与水凝胶，获得与实体心肌组织手感近似的3D打印材料。对硅胶与水凝胶混合材料、硅胶及Tangoplus进行力学检测及超声剪切波弹性成像检测。对21例行经皮左心耳封堵术患者术前3DTEE左心耳图像后处理，获取硅胶与水凝胶左心耳3D模型、硅胶模型、Tangoplus模型，评估3D模型准确性，体外模拟左心耳封堵操作，将模型中封堵器压缩比与术中测值对比。结果成功制备硅胶与水凝胶混合材料，测得其弹性模量、应力应变曲线更接近于心肌组织。21例患者均基于3D-TEE图像获取三种材料3D打印模型，3D模型左心耳锚定区测量值与3D-TEE测量值差异无统计学意义（P〉0．05），3D模型测量值与3D—TEE测量值具有一致性。三种材料3D模型中封堵器压缩比均大于术中测值，硅胶与水凝胶材料3D模型中封堵器压缩比与术中测值具有更好的相关性（r=0．900，P〈0．01）。结论基于3D-TEE获得硅胶与水凝胶材料左心耳3D模型可以提高左心耳封堵术前模拟的准确性，可优化与完善左心耳封堵术前准备。Objective To evaluate the accuracy of simulated operation before the left atrial appendage （LAA） occlusion by filed LAA model with soft materials, which is based on transesophageal threedimensional echocardiography （3D-TEE）. Methods Silica and hydrogel were mixed to imitate cardiac tissue. Silica and hydrogel mixed materials, silica and Tangoplus were subjected to mechanical detection and ultrasonic shear wave elastography （SWE）. The preoperative and postoperative 3D-TEE image processing was performed on 21 patients undergoing LAA occlusion. The silica and hydrogel LAA 3D model, silicone model and Tangoplus model were acquired to evaluate the accuracy of 3D model. LAA closure was simulated using the 3D models and the compression ratio of the device in models was compared with the value measured in operation. Results The silica and hydrogel mixed materials were successfully prepared. The elastic modulus and stress-strain curve were closer to the myocardial tissue. Twenty-one 3D printing models of three materials were obtained in 21 patients based on 3D-TEE images. There was no significant difference in the anchor zone between the 3D model and 3D-TEE （ P 〉0. 05）. The 3D model measurements were consistent with the 3D-TEE measurements. The compression ratios of the decive in the 3D models of all three materials were greater than those measured in operation, and the compression ratio of the device in the 3D model of silica and hydrogel materials had a better correlation with that measured in operation （ r = 0.900, P 〈0.01）. Conclusions The 3D model of LAA made of silica and hydrogel material based on 3D- TEE can improve the accuracy of the LAA occlusion simulation,also can optimize the preparation of LAA occlusion.

关 键 词：超声心动描记术 经食管 三维 3D打印 左心耳 软性打印材料 

分 类 号：R540.45[医药卫生—心血管疾病]