3D 打印制作二尖瓣脱垂模型在二尖瓣成形术中的应用初探

摘要

Objective To evaluate the feasibility and accuracy of mitral valve prolapse( M VP) model made by three‐dimensional( 3D) printing based on three‐dimensional transesophageal echocardiography ( 3D‐T EE) data and the application value for mitral valvuloplasty . Methods 3D‐T EE volumetric data of 28 patients with M VP were acquired and postprocessed ,13 patients underwent mitral valve replacement and 15 patients underwent mitral valvuloplasty . A flexible material was used to made the valve 3D model by molding . T he areas of M VP identified by models were compared with surgical findings ,the circumference and the length and thickness of anterior and posterior mitral leaflets obtained from the valve specimens and the models were compared in the mitral valve replacement group . T he diameter between anterior and posterior ,the diameter between anterolaterior and posteromedial ,annulus area ,height of prolapsed leaflet and area of prolapsed leaflet were measured from 3D models and 3D‐T EE images in mitral valvuloplasty group . Surgical simulations were performed on the 3D models of the mitral valvuloplasty group ,and the water injection test was used to evaluate the surgical results and compared with the surgical results . Results 3D‐T EE volumetric data were successfully postprocessed and made as 3D M VP models in all patients . T he consistency of M VP location based on 3D models and surgical findings was 0 .92 . T he differences between the mitral valve replacement group and mitral valvuloplasty group were not significant ( P＞ 0 .05 ) . A simulation valvuloplasty was successfully performed on the 3D model in mitral valvuloplasty group ,2 patients underwent mitral valve replacement after water injection test . T he remaining 3D models successfully simulated the operation . Conclusions The M VP model made by 3D‐T EE and 3D printing technique has high feasibility and accuracy ,w hich may be promising for the mitral valvuloplasty of M VP .%目的 探讨应用经食管三维超声心动图(3D‐TEE)和3D打印技术制作二尖瓣脱垂模型的可行性及准确性,评价3D模型在二尖瓣成形术中的应用价值.方法 获取28例二尖瓣脱垂患者的术前3D‐T EE图像,拟行二尖瓣置换术13例,二尖瓣成形术15例,经图像软件后处理,使用铸模灌胶成型的方法制作二尖瓣脱垂3D模型.以外科手术结果为金标准,将3D模型与术中诊断脱垂瓣叶亚区的结果进行对比,二尖瓣置换组比较3D模型与瓣膜标本间二尖瓣前叶和后叶的长度、厚度及周长,二尖瓣成形组比较3D模型与3D‐T EE图像间二尖瓣前外 －后内径、前后径、瓣环面积、脱垂瓣叶高度及脱垂瓣叶面积.在二尖瓣成形组的3D模型上进行手术模拟,注水试验评估手术效果,并与手术结果进行对照.结果 28例患者的3D‐T EE图像均成功后处理并打印制作出二尖瓣脱垂3D模型,3D模型对脱垂瓣叶亚区的定位与手术结果一致性较好, Kappa值为0 .92 .二尖瓣置换组3D模型与瓣膜标本间各参数测量值、二尖瓣成形组3D模型与3D‐T EE图像各参数测值差异均无统计学意义( P ＞0 .05) .对15例拟行二尖瓣成形术患者3D模型进行手术模拟, 2例患者经注水试验评估后改行二尖瓣置换术,余患者3D模型均成功模拟了手术过程.结论 应用3D‐T EE为数据源,结合3D打印技术制作二尖瓣脱垂模型具有较高的可行性及准确性,在二尖瓣成形术中具有较好的应用前景.