超声影像数据源3D打印结合模拟循环系统制作体外动态二尖瓣模型的可行性研究  

Feasibility study of three-dimensional printing combined with mock circulatory system to make compliant mitral valve model for hemodynamic testing in vitro based on ultrasound image data

作　　者：王浩[1] 张斌[2] 宋宏宁[1] 杨远婷 邓倾[1] 加丹 郭娟[1] 任伟[3] 周青[1] Wang Hao;Zhang Bin;Song Hongning;Yang Yuanting;Deng Qing;Jia Dan;Guo Juan;Ren Wei;Zhou Qing(Department of Ultrasound Imaging,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Equipment,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Cardiovascular Surgery,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 [2]武汉大学人民医院设备处,430060 [3]武汉大学人民医院心血管外科,430060

出　　处：《中华超声影像学杂志》2020年第3期206-212,共7页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目(81771849)。

摘　　要：目的探讨超声影像数据源3D打印结合模拟循环系统(mock circulatory system,MCS)制作体外动态二尖瓣模型的可行性,以期实现3D打印瓣膜模型从静态到动态、从结构到功能的转变,从而辅助二尖瓣病变的手术治疗选择。方法回顾性收集2017年2月至2018年12月于武汉大学人民医院行经食管三维超声心动图(3D-TEE)检查的10例非瓣膜病患者作为二尖瓣正常组,另选10例同期于我院诊断为二尖瓣狭窄的患者作为二尖瓣狭窄组,10例诊断为二尖瓣关闭不全的患者作为二尖瓣关闭不全组。各组受检者先行经胸二维超声心动图检查,获取二尖瓣瓣口流速(E峰)、压差等血流动力学参数,对二尖瓣狭窄及关闭不全的患者,同时评估瓣膜狭窄及反流程度。行3D-TEE检查,获取二尖瓣三维图像。经图像后处理、3D建模后,应用可溶性材料(PVA)打印瓣膜模具,将人体皮肤硅胶、硅油、淀粉、固化剂等按照一定配比混合后灌注于二尖瓣模具中制作出柔性的硅胶二尖瓣模型。后将模型置于体外MCS中,以实现瓣膜动态启闭。于体外装置中再次测量二尖瓣上述血流动力学参数及评估狭窄和反流程度。应用配对t检验对各组体内外测量值进行统计学分析,并行一致性检验。结果所有受检者二尖瓣3D-TEE图像均成功进行后处理,打印、制作出柔软的二尖瓣模型,并完成体外血流动力学测试。瓣膜模型于体外装置中的启闭状态与体内相似。各组于体外测得的各血流动力学参数与体内相比差异无统计学意义(P>0.05),且一致性较高(r=0.76)。对10例二尖瓣狭窄及10例二尖瓣关闭不全患者的定性评估中,18例与体内评估程度相同。结论以超声为数据源3D打印结合MCS制作体外动态二尖瓣模型是可行的,且准确性较高。动态二尖瓣模型于体外再现了二尖瓣生理和病理状态下的血流动力学特征,可为进一步的临床诊疗、术式模拟提供�Objective To explore the feasibility of three-dimensional(3D)printing combined with mock circulatory system of flexible mitral valve model for hemodynamic testing in vitro based on ultrasound image data,making the transformation of 3D printing valve model from static to dynamic and from anatomical to functional,as well as assisting surgical plan for mitral valve diseases.Methods A total of 10 subjects underwent three-dimensional transesophageal echocardiography(3D-TEE)and proved to be without mitral diseases were collected as mitral normal group from February 2017 to December 2018 in Renmin Hospital of Wuhan University,10 mitral stenosis patients were collected as mitral stenosis group,and 10 mitral regurgitation patients were collected as mitral regurgitation group.Hemodynamic parameters of velocity(peak E),pressure gradient were obtained by two-dimensional transthoracic echocardiography in three groups,and the degree of mitral valve stenosis and regurgitation were also evaluated.Then 3D-TEE was performed to obtain the 3D volume image of mitral valve.After image post-processing and 3D modeling,the valve mold was printed with soluble material polyvinyl alcohol(PVA).The mixture of human skin silicone,silicone oil,starch and curing agent were poured into the mitral valve mold in a certain proportion to make flexible silicone mitral valve model.Then,the compliant valve model was placed in mock circulatory system(MCS),regularly opening and closing as it in vivo in the heart cycle.The hemodynamic parameters of mitral valve were measured again in vitro and the degree of stenosis and regurgitation was also evaluated respectively.Paired t test was used for statistical analysis of in vivo and in vitro measurements in two groups,and the consistency test was performed.Results The mitral valve 3D-TEE images of all patients were successfully post-processed,mitral valve molds were printed and flexible models were made.In vitro hemodynamic tests were all completed.The opening and closing state of the valve model in vitro was si

关 键 词：3D打印 二尖瓣狭窄 二尖瓣关闭不全 血流动力学 模拟循环系统 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.51[医药卫生—诊断学]