3D打印模型在复杂经皮瓣周漏介入治疗中的应用
The utility of 3D printed models in complex percutaneous paravalvular leak interventions.
作者信息
ElGuindy Ahmed, Osman Ahmed, Elborae Ahmed, Nagy Mohamed
机构信息
Aswan Heart Centre, Aswan, Egypt.
Faculty of Medicine, Cairo University, Egypt.
出版信息
Glob Cardiol Sci Pract. 2020 Nov 30;2020(2):e202027. doi: 10.21542/gcsp.2020.27.
Paravalvular leaks (PVL) are seen in 5-17% of patients after surgical mitral and aortic valve replacement. This is usually well-tolerated in the majority of patients; however, up to 5% will require re-intervention due to either hemodynamically significant regurgitation or hemolysis requiring repeated blood transfusion. Transcatheter closure of PVLs is becoming the treatment of choice in many patients owing to the high risk of redo surgery, high rates of recurrence with the surgical approach, and substantial improvements in device technology and growing expertise in structural heart disease interventions. Careful selection of the appropriate candidates by the Heart Team with in-depth analysis of clinical and multimodality imaging data is critical to ensuring good short- and long-term outcomes. The defect is usually oval/crescentic and often serpiginous in nature, which poses significant challenges in choosing the optimal size and number of devices to implant - especially with large size defects. Generally, defects involving more than 25-30% of the sewing ring are deemed unsuitable for percutaneous closure. While the Amplatzer family of vascular plugs (e.g. AVP3 and AVP2) is commonly used for percutaneous closure of PVLs, there are currently no approved dedicated devices for this indication, except the paravalvular leak device (Occlutech) which is not universally available. Small and relatively circular defects can usually be closed using a single plug, conventionally utilizing a size that is 25-30% larger than the mean diameter of the defect. Larger and crescentic defects on the other hand frequently require more than one plug and can be quite challenging in terms of choosing the appropriate size(s). We report two cases with very large defects with irregular shape in which 3D printed modeling was extremely useful for bench testing to optimize the number and sizes of devices to be implanted.
人工瓣膜周漏(PVL)见于5%至17%的二尖瓣和主动脉瓣置换术后患者。大多数患者通常对此耐受良好;然而,高达5%的患者因血流动力学显著反流或溶血需要反复输血而需要再次干预。由于再次手术风险高、手术方法复发率高以及器械技术的显著改进和结构性心脏病介入专业知识的不断增加,经导管封堵PVL正成为许多患者的首选治疗方法。心脏团队通过深入分析临床和多模态影像数据仔细选择合适的候选人对于确保良好的短期和长期结果至关重要。缺损通常呈椭圆形/新月形,且形态往往蜿蜒曲折,这在选择植入器械的最佳尺寸和数量时带来了重大挑战——尤其是对于大尺寸缺损。一般来说,涉及缝合环超过25%至30%的缺损被认为不适合经皮封堵。虽然血管封堵器家族(如AVP3和AVP2)常用于经皮封堵PVL,但目前除了并非普遍可用的人工瓣膜周漏封堵器(Occlutech)外,尚无针对该适应症的获批专用器械。小且相对圆形的缺损通常可以使用单个封堵器关闭,传统上使用比缺损平均直径大25%至30%的尺寸。另一方面,较大的新月形缺损通常需要不止一个封堵器,在选择合适尺寸方面可能颇具挑战性。我们报告了两例形状不规则的非常大的缺损病例,其中3D打印建模对于体外测试以优化植入器械的数量和尺寸极为有用。
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