Vaquerizo Beatriz, Theriault-Lauzier Pascal, Piazza Nicolo
Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, Montreal, Québec, Canada; Department of Cardiology, Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, Montreal, Québec, Canada.
Rev Esp Cardiol (Engl Ed). 2015 Dec;68(12):1165-73. doi: 10.1016/j.rec.2015.08.005. Epub 2015 Oct 23.
Mitral regurgitation is the most prevalent valvular heart disease worldwide. Despite the widespread availability of curative surgical intervention, a considerable proportion of patients with severe mitral regurgitation are not referred for treatment, largely due to the presence of left ventricular dysfunction, advanced age, and comorbid illnesses. Transcatheter mitral valve replacement is a promising therapeutic alternative to traditional surgical valve replacement. The complex anatomical and pathophysiological nature of the mitral valvular complex, however, presents significant challenges to the successful design and implementation of novel transcatheter mitral replacement devices. Patient-specific 3-dimensional computer-based models enable accurate assessment of the mitral valve anatomy and preprocedural simulations for transcatheter therapies. Such information may help refine the design features of novel transcatheter mitral devices and enhance procedural planning. Herein, we describe a novel medical image-based processing tool that facilitates accurate, noninvasive assessment of the mitral valvular complex, by creating precise three-dimensional heart models. The 3-dimensional computer reconstructions are then converted to a physical model using 3-dimensional printing technology, thereby enabling patient-specific assessment of the interaction between device and patient. It may provide new opportunities for a better understanding of the mitral anatomy-pathophysiology-device interaction, which is of critical importance for the advancement of transcatheter mitral valve replacement.
二尖瓣反流是全球最常见的心脏瓣膜病。尽管有广泛可用的根治性手术干预方法,但相当一部分重度二尖瓣反流患者未被转诊接受治疗,主要原因是存在左心室功能障碍、高龄和合并症。经导管二尖瓣置换术是传统外科瓣膜置换术一种很有前景的治疗替代方法。然而,二尖瓣复合体复杂的解剖和病理生理特性给新型经导管二尖瓣置换装置的成功设计和实施带来了重大挑战。基于患者特异性三维计算机模型能够准确评估二尖瓣解剖结构,并对经导管治疗进行术前模拟。此类信息可能有助于优化新型经导管二尖瓣装置的设计特点并加强手术规划。在此,我们描述一种基于医学图像的新型处理工具,通过创建精确的三维心脏模型,有助于对二尖瓣复合体进行准确、无创评估。然后使用三维打印技术将三维计算机重建模型转换为物理模型,从而能够对装置与患者之间的相互作用进行患者特异性评估。它可能为更好地理解二尖瓣解剖 - 病理生理 - 装置相互作用提供新机会,这对经导管二尖瓣置换术的进展至关重要。
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