Dumont Karl-Andreas, Karlsen Jørn Skaarud, Helle-Valle Thomas, Fiane Arnt Eltvedt, Lundblad Runar, Urheim Stig
Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway.
Kalkulo AS, Martin Linges vei 17, 1364, Fornebu, Norway.
Cardiovasc Ultrasound. 2015 May 20;13:25. doi: 10.1186/s12947-015-0019-2.
We hypothesized that a novel three-dimensional virtual semi-transparent annulus plane (3D VSAP) presented on a holographic screen can be used to visualize the prolapsing tissue in degenerative mitral valve disease and furthermore, provide us with geometrical data of the mitral valve apparatus. Phantom and patient studies were designed to demonstrate the feasibility of creating a semi-automatic, semi-transparent mitral annulus plane visualized on a holographic display.
Ten pipe cleaners mimicking the mitral annulus with different shapes and three types of annuloplasty rings served as phantoms. We obtained 3D transoesophageal examination of the phantoms in a special designed box filled with water. Recordings were converted to the holographic display and a 3D VSAP was created. The ratio of the major and minor axes as well as the non-planar angles were calculated and compared with direct measures of the phantoms. Forty patients with degenerative mitral valve disease were then analyzed with 3D transthoracic echocardiography (TTE) and a 3D VSAP was created on the holographic display. A total of 240 segments were analyzed by two independent observers, one echo expert (observer I), and the other novice with limited echo experience (observer II). The two observers created the 3D VSAP in each patient before suggesting the valve pathology.
The major/minor axes ratio and non-planar angles by 3D VSAP correlated with direct measurements by r = 0.65, p < 0.02 and r = 0.99, p < 0.0001, respectively. The sensitivity and specificity of the 3D VSAP method in patients was 81 and 97%, respectively (observer I) and for observer II 77 and 96%, respectively. The accuracy and precisions were 93.9 and 89.4%, respectively (observer I), 92.3 and 85.1% (observer II). Mitral valve analysis adding a 3D VSAP was feasible with high accuracy and precision, providing a quick and less subjective method for diagnosing mitral valve prolapse. This novel method may improve preoperative diagnostics and may relieve a better understanding of the pathophysiology of mitral valve disease. Thus, based on the specific findings in each patient, a tailored surgical repair can be planned and hopefully enhance long-term repair patency in the future.
我们推测，在全息屏幕上呈现的新型三维虚拟半透明瓣环平面（3D VSAP）可用于可视化退行性二尖瓣疾病中的脱垂组织，并进一步为我们提供二尖瓣装置的几何数据。设计了模型和患者研究，以证明在全息显示器上创建半自动、半透明二尖瓣环平面的可行性。
用十条模仿不同形状二尖瓣环的清洁管道和三种类型的瓣环成形环作为模型。我们在一个特别设计的装满水的盒子里对模型进行了三维经食管检查。记录被转换到全息显示器上，并创建了一个3D VSAP。计算长轴与短轴的比例以及非平面角度，并与模型的直接测量值进行比较。然后，对40例退行性二尖瓣疾病患者进行三维经胸超声心动图（TTE）分析，并在全息显示器上创建3D VSAP。两名独立观察者，一名超声专家（观察者I）和另一名超声经验有限的新手（观察者II），共分析了240个节段。两名观察者在提出瓣膜病变之前，先为每位患者创建3D VSAP。
3D VSAP的长轴/短轴比例和非平面角度与直接测量值的相关性分别为r = 0.65，p < 0.02和r = 0.99，p < 0.0001。3D VSAP方法在患者中的敏感性和特异性分别为81%和97%（观察者I），观察者II分别为77%和96%。准确性和精密度分别为93.9%和89.4%（观察者I），92.3%和85.1%（观察者II）。添加3D VSAP的二尖瓣分析具有很高的准确性和精密度，是可行的，为诊断二尖瓣脱垂提供了一种快速且主观性较小的方法。这种新方法可能会改善术前诊断，并有助于更好地理解二尖瓣疾病的病理生理学。因此，根据每位患者的具体发现，可以规划量身定制的手术修复方案，并有望在未来提高长期修复的通畅率。
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