Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Catheter Cardiovasc Interv. 2018 Dec 1;92(7):E537-E549. doi: 10.1002/ccd.27488. Epub 2018 Jan 23.
Three-dimensional (3D) prototyping is a novel technology which can be used to plan and guide complex procedures such as transcatheter mitral valve replacement (TMVR).
Eight patients with severe mitral annular calcification (MAC) underwent TMVR. 3D digital models with digital balloon expandable valves were created from pre-procedure CT scans using dedicated software. Five models were printed. These models were used to assess prosthesis sizing, anchoring, expansion, paravalvular gaps, left ventricular outflow tract (LVOT) obstruction, and other potential procedure pitfalls. Results of 3D prototyping were then compared to post procedural imaging to determine how closely the achieved procedural result mirrored the 3D modeled result.
3D prototyping simulated LVOT obstruction in one patient who developed it and in another patient who underwent alcohol septal ablation prior to TMVR. Valve sizing correlated with actual placed valve size in six out of the eight patients and more than mild paravalvular leak (PVL) was simulated in two of the three patients who had it. Patients who had mismatch between their modeled valve size and post-procedural imaging were the ones that had anterior leaflet resection which could have altered valve sizing and PVL simulation. 3D printed model of one of the latter patients allowed modification of anterior leaflet to simulate surgical resection and was able to estimate the size and location of the PVL after inserting a valve stent into the physical model.
3D prototyping in TMVR for severe MAC is feasible for simulating valve sizing, apposition, expansion, PVL, and LVOT obstruction.
三维（3D）原型制作是一种新颖的技术，可用于规划和指导经导管二尖瓣置换术（TMVR）等复杂程序。
8 名患有严重二尖瓣环钙化（MAC）的患者接受了 TMVR。使用专用软件从术前 CT 扫描创建具有数字球囊可扩张瓣膜的 3D 数字模型。打印了 5 个模型。这些模型用于评估假体尺寸、锚固、扩张、瓣周漏、左心室流出道（LVOT）阻塞和其他潜在的手术缺陷。然后将 3D 原型的结果与术后成像进行比较，以确定所实现的手术结果与 3D 模型结果的吻合程度。
3D 原型在一名出现 LVOT 阻塞的患者和另一名在 TMVR 前接受酒精室间隔消融术的患者中模拟了 LVOT 阻塞。在 8 名患者中的 6 名中，3D 原型模拟的瓣膜尺寸与实际放置的瓣膜尺寸相关，在 3 名有瓣周漏的患者中有 2 名模拟了超过轻度瓣周漏。在模型瓣膜尺寸与术后成像不匹配的患者中，进行了前瓣叶切除术，这可能改变了瓣膜尺寸和瓣周漏模拟。其中一名后者患者的 3D 打印模型允许对前瓣叶进行修改以模拟手术切除，并能够在将瓣膜支架插入物理模型后估计瓣周漏的大小和位置。
在严重 MAC 的 TMVR 中进行 3D 原型制作可用于模拟瓣膜尺寸、贴附、扩张、瓣周漏和 LVOT 阻塞。
