Hoashi Takaya, Ichikawa Hajime, Nakata Tomohiro, Shimada Masatoshi, Ozawa Hideto, Higashida Akihiko, Kurosaki Kenichi, Kanzaki Suzu, Shiraishi Isao
Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Interact Cardiovasc Thorac Surg. 2018 Nov 1;27(5):749-755. doi: 10.1093/icvts/ivy160.
The objective of this study was to assess the utility of 3D printed heart models of congenital heart disease for preoperative surgical simulation.
Twenty patient-specific 3D models were created between March 2015 and August 2017. All operations were performed by a young consultant surgeon who had no prior experience with complex biventricular repair. All 15 patients with balanced ventricles had outflow tract malformations (double-outlet right ventricle in 7 patients, congenitally corrected transposition of great arteries in 5, transposition of great arteries in 1, interrupted aortic arch Type B in 1, tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries in 1). One patient had hypoplastic left heart complex, and the remaining 4 patients had a functional single ventricle. The median age at operation was 1.4 (range 0.1-5.9) years. Based on a multislice computed tomography data set, the 3D models were made of polyurethane resins using stereolithography as the printing technology and vacuum casting as the manufacturing method.
All but 4 patients with a functional single ventricle underwent complete biventricular repair. The median cardiopulmonary bypass time and aortic cross-clamp time were 345 (110-570) min and 114 (35-293) min, respectively. During the median follow-up period of 1.3 (0.1-2.5) years, no mortality was observed. None of the patients experienced surgical heart block or systemic ventricular outflow tract obstruction.
Three-dimensional printed heart models showed potential utility, especially in understanding the relationship between intraventricular communications and great vessels, as well as in simulation for creating intracardiac pathways.
本研究的目的是评估先天性心脏病的3D打印心脏模型在术前手术模拟中的效用。
在2015年3月至2017年8月期间创建了20个患者特异性3D模型。所有手术均由一位年轻的顾问外科医生进行，其此前没有复杂双心室修复的经验。15例心室平衡的患者均有流出道畸形（7例为右心室双出口，5例为先天性矫正型大动脉转位，1例为大动脉转位，1例为B型主动脉弓中断，1例为法洛四联症合并肺动脉闭锁及主要体肺侧支动脉）。1例患者患有左心发育不全综合征，其余4例患者有功能性单心室。手术时的中位年龄为1.4岁（范围0.1 - 5.9岁）。基于多层计算机断层扫描数据集，3D模型采用立体光刻作为打印技术、真空铸造作为制造方法，由聚氨酯树脂制成。
除4例功能性单心室患者外，所有患者均接受了完全双心室修复。体外循环时间和主动脉阻断时间的中位数分别为345（110 - 570）分钟和114（35 - 293）分钟。在中位随访期1.3（0.1 - 2.5）年期间，未观察到死亡病例。所有患者均未发生外科性心脏传导阻滞或系统性心室流出道梗阻。
三维打印心脏模型显示出潜在的效用，特别是在理解心室内交通与大血管之间的关系以及模拟创建心内通道方面。
