Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
J Cardiovasc Comput Tomogr. 2018 Mar-Apr;12(2):153-157. doi: 10.1016/j.jcct.2017.12.007. Epub 2018 Jan 4.
There is considerable interest in transcatheter prosthetic valve treatment for mitral valve disease in high-risk individuals. Although the presence of mitral annular calcium (MAC) may provide an anchoring zone for such devices, results to date have been modest with reported technical failure rates approaching 30% in specialist centers. This in part relates to the risk of left ventricular outflow tract obstruction and device dislodgment but also to the lack of specific imaging guidelines to plan for such procedures. We present the use of finite element analysis and computer simulation based on cardiac CT in three patients with severe MAC in whom transcatheter devices were considered. In the first two cases, the computer simulations were performed after the clinical procedure and were concordant with the clinical outcome. For the third case, computer simulation was performed prior to the clinical procedure. This indicated unsuitability for transcatheter device deployment and a subsequent medical management was adopted. Overall, our initial results suggest that computer simulation may have the potential to improve patient selection for transcatheter mitral valve replacement in the presence of significant MAC.
对于高危人群的二尖瓣疾病，经导管人工瓣膜治疗有很大的兴趣。尽管二尖瓣环钙（MAC）的存在可能为这些设备提供锚固区，但迄今为止的结果并不理想，报告的技术失败率在专业中心接近 30%。这部分与左心室流出道阻塞和器械移位的风险有关，但也与缺乏特定的影像学指南来规划此类手术有关。我们介绍了在三名患有严重 MAC 的患者中使用基于心脏 CT 的有限元分析和计算机模拟，这些患者被认为适合经导管器械治疗。在前两种情况下，在临床手术后进行了计算机模拟，与临床结果一致。对于第三种情况，在临床手术前进行了计算机模拟。这表明不适合经导管器械部署，并采用了随后的药物治疗。总的来说，我们的初步结果表明，计算机模拟可能有潜力改善存在大量 MAC 的经导管二尖瓣置换术患者的选择。
