不同国产自膨式人工瓣膜的参数化建模及其虚拟置入0型二叶式主动脉瓣的术前预估疗效差异  

Parametric modeling of domestic self-expanding aortic valves and clinical estimation of efficacy differences in their pre-procedural virtual implantation in patients with type 0 bicuspid aortic valve

作　　者：吴信雷[1] 蒋亦秋 刘星 阮志盛 刘咏芳[1] 吴道珠[1] 吴连拼[1] 张新民[1] Wu Xinlei;Jiang Yiqiu;Liu Xing;Ruan Zhisheng;Liu Yongfang;Wu Daozhu;Wu Lianpin;Zhang Xinming(Department of Cardiology,International Joint Laboratory for Precision Diagnosis and Treatment of Heart Valve Diseases of Zhejiang Province,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院血管内科、浙江省心脏瓣膜病精准诊治国际联合实验室,温州325027

出　　处：《中华生物医学工程杂志》2023年第6期618-625,共8页Chinese Journal of Biomedical Engineering

基　　金：浙江省医药卫生科技计划项目(2023RC210, 2024KY160);温州市基础性医疗卫生科技项目(Y20220132)。

摘　　要：目的实现不同国产自膨式人工瓣膜的计算机模型并虚拟植入0型二叶式主动脉瓣(BAV)狭窄患者模拟方法,并探索该方法指导临床经导管主动脉瓣置换(TAVR)制定术前策略的可行性。方法利用参数化建模方法构建国产不同制造商的自膨式人工瓣膜计算机模型,建立虚拟人工瓣膜模型数据库。筛选于我院经TAVR治疗的三例0型BAV严重狭窄伴钙化患者,基于其术前心脏CT造影影像进行三维模型重建。定量化分析主动脉根部解剖结构,选择并比较三款产品虚拟置入的潜在锚定效果及冠脉闭塞风险等差异,及拟选定瓣膜型号不同植入深度的潜在瓣周漏风险差异。结果共创建12个不同规格人工瓣膜计算机模型,以适当的个体化瓣环参数压缩比为依据,选择潜在匹配的人工瓣膜型号。三款瓣膜模型(沛嘉26号、微创27号、启明26号)均可实现封堵且无冠脉闭塞风险(三例左右冠脉开口高度均>14.0 mm)。但扩张的升主动脉,造成顶部瓣架均未形成锚定,选择适当高压缩比的人工瓣膜以增强瓣环及瓣叶层面锚定效果。人工瓣膜的高位植入可减少冠窦联合处的瓣周漏风险。临床TAVR术采用高位植入,术后结果表明峰值压差显著下降且反流小。结论对于0型BAV,两窦联合处高,且大弯侧两窦联合点高度显著高于小弯侧,宜高位且往小弯侧倾倒的植入策略。TAVR术前虚拟置入方法是可行的,并提供了一种直观地评估方法,但更精准、高效的系统仍待进一步开发,以期应用于临床常规术前评估。Objective To implement a method of the computer modeling of different indigenous self-expanding artificial valves and virtually implanted in the patients with Type 0 Bicuspid Aortic Valve(BAV)stenosis,and to explore the feasibility of guiding the pre-procedural strategy for transcatheter aortic valve replacement(TAVR)by using this method.Methods Several computer models of self-expanding valve prostheses from various domestic manufacturers were constructed by utilizing a parametric modeling approach,forming a virtual artificial valve model database.Three Type 0 BAV patients with severe stenosis and calcification,who underwent TAVR treatment at our hospital were selected.Three-dimensional models of aortic root were reconstructed based on pre-procedural cardiac CT angiography.Quantitative analysis of the aortic root anatomy was performed for selecting the appropriate sizes of virtual valves.The potential effects of anchoring and coronary obstruction risks of the three virtual valve placements were compared.Differences in potential paravalvular leakage risks and implantation depths were also examined for different valve models.Results A total of 12 computer models of different specifications for artificial valves were created.Three valve models was identified based on appropriate patient-specific oversize between annulus and the prostheses.All three valve models(Peijia 26,MicroPort 27,and Venus 26)demonstrated good sealing with no risk of coronary obstruction(both left and right coronary ostia heights>14.0 mm in three patient cases).However,no anchoring was found at the top of the valve frame due to the expanded ascending aorta.The artificial valves with an appropriate high oversize were necessary to enhance the anchoring effect at the annulus and leaflet levels.High positioning of the artificial valves reduced the risk of paravalvular leakage at the coronary sinus junction.The outcomes of clinical TAVR treatment with high position implantation resulted in a significant decrease in peak pressure gradient and minimal

关 键 词：经导管主动脉瓣置换术 人工瓣膜 患者个体化 冠脉CT造影 计算机模拟 

分 类 号：R654.2[医药卫生—外科学]