使用脉搏复制器对患者特异性二尖瓣进行血流动力学测试:三维打印的临床应用
Hemodynamic Testing of Patient-Specific Mitral Valves Using a Pulse Duplicator: A Clinical Application of Three-Dimensional Printing.
作者信息
Mashari Azad, Knio Ziyad, Jeganathan Jelliffe, Montealegre-Gallegos Mario, Yeh Lu, Amador Yannis, Matyal Robina, Saraf Rabya, Khabbaz Kamal, Mahmood Feroze
机构信息
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
出版信息
J Cardiothorac Vasc Anesth. 2016 Oct;30(5):1278-85. doi: 10.1053/j.jvca.2016.01.013. Epub 2016 Jan 12.
OBJECTIVE
To evaluate the feasibility of obtaining hemodynamic metrics of echocardiographically derived 3-dimensional printed mitral valve models deployed in a pulse-duplicator chamber.
DESIGN
Exploratory study.
SETTING
Tertiary-care university hospital.
PARTICIPANTS
Percutaneous MitraClip procedure patient.
INTERVENTIONS
Three-dimensional R-wave gated, full-volume transesophageal echocardiography images were obtained after deployment of the MitraClip device. A high-quality diastolic frame of the mitral valve was segmented using Mimics Innovation Suite and merged with a flange. The data were exported as a stereolithography (.stl) file, and a rigid 3-dimensional model was printed using a MakerBot Replicator 2 printer. A flexible silicone cast then was created and deployed in the pulse-duplicator chamber filled with a blood-mimicking fluid.
MEASUREMENTS AND MAIN RESULTS
The authors were able to obtain continuous-wave Doppler tracings of the valve inflow with a transesophageal echocardiography transducer. They also were able to generate diastolic ventricular and atrial pressure tracings. Pressure half-time and mitral valve area were computed from these measurements.
CONCLUSION
This pulse duplicator shows promising applications in hemodynamic testing of patient-specific anatomy. Future modifications to the system may allow for visualization and data collection of gradients across the aortic valve.
目的
评估获取部署在脉搏复制腔室中的经超声心动图衍生的三维打印二尖瓣模型血流动力学指标的可行性。
设计
探索性研究。
地点
三级医疗大学医院。
参与者
经皮二尖瓣夹合术患者。
干预措施
在部署二尖瓣夹合装置后,获取三维R波门控的全容积经食管超声心动图图像。使用Mimics Innovation Suite对二尖瓣的高质量舒张期帧进行分割,并与一个凸缘合并。数据以立体光刻(.stl)文件导出,并使用MakerBot Replicator 2打印机打印出一个刚性三维模型。然后制作一个柔性硅胶铸件,并将其部署在充满模拟血液流体的脉搏复制腔室中。
测量和主要结果
作者能够使用经食管超声心动图换能器获得瓣膜流入的连续波多普勒描记图。他们还能够生成舒张期心室和心房压力描记图。根据这些测量结果计算压力半衰期和二尖瓣面积。
结论
这种脉搏复制器在针对患者特定解剖结构的血流动力学测试中显示出有前景的应用。对该系统未来的改进可能允许对主动脉瓣跨瓣压差进行可视化和数据收集。