Chen Wei-Ling, Kan Chung-Dann
Annu Int Conf IEEE Eng Med Biol Soc. 2018 Jul;2018:4548-4551. doi: 10.1109/EMBC.2018.8513179.
Percutaneous pulmonary valve implantation is a technique to treat narrowed pulmonary valves or leaky pulmonary valves in congenital heart disease. This technique provides a promising strategy to reduce surgical risk. In clinical cases, due to stent size restrictions, commercial valve stents are sometimes unsuitable for children or certain patients. Hence, handmade pulmonary valved conduits prove useful because a customized size can be obtained for valve replacement. We propose a meta-learning-based intelligent model to train an estimator (including two sub-estimators) to determine optimal trileaflet parameters for customized trileaflet valve reconstruction. The purpose of this study was to investigate the hemodynamic and functional consequences of the novel design by employing a mock circulation system. We recorded the diastolic valve leakage and calculated the pulmonary regurgitation, regurgitation fraction, and ejection efficiency in a pulsatile setting. The prosthetic leaflet behavior was assessed using an endoscope camera and the pressure drops through valves were measured. All the in vitro parameters indicated that the expanded polytetrafluoroethylene (ePTFE) valved conduits were not inferior to commercial mechanical or tissue valve conduits and could decrease the regurgitation volume and increase the efficiency. Compatible early clinical outcomes were also identified between ePTFE valved conduits and other valved conduits used for right ventricular outflow tract reconstruction. The ePTFE valved conduits could be implanted in relatively small patients. An in vitro experimental study provided evidence that a handmade ePTFE valved conduit could be an attractive alternative to other commercialized valved conduits used for right ventricle-pulmonary artery continuity reconstruction.
经皮肺动脉瓣植入术是一种治疗先天性心脏病中肺动脉瓣狭窄或肺动脉瓣反流的技术。该技术为降低手术风险提供了一种有前景的策略。在临床病例中,由于支架尺寸限制,商用瓣膜支架有时不适用于儿童或某些患者。因此,手工制作的带瓣管道被证明是有用的,因为可以获得定制尺寸用于瓣膜置换。我们提出一种基于元学习的智能模型来训练一个估计器(包括两个子估计器),以确定定制三叶瓣瓣膜重建的最佳三叶瓣参数。本研究的目的是通过使用模拟循环系统来研究这种新颖设计的血流动力学和功能后果。我们记录了舒张期瓣膜反流情况,并计算了搏动状态下的肺动脉反流、反流分数和射血效率。使用内窥镜摄像头评估人工瓣膜叶的行为,并测量通过瓣膜的压力降。所有体外参数均表明,膨体聚四氟乙烯(ePTFE)带瓣管道并不逊色于商用机械或组织瓣膜管道,且可减少反流体积并提高效率。在ePTFE带瓣管道与用于右心室流出道重建的其他带瓣管道之间也发现了相符的早期临床结果。ePTFE带瓣管道可植入相对较小的患者体内。一项体外实验研究提供了证据,表明手工制作的ePTFE带瓣管道可能是用于右心室 - 肺动脉连续性重建的其他商业化带瓣管道的有吸引力的替代方案。
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