Man Jelle P, Bouma Berto J, Asselbergs Folkert, Chamuleau Steven A J, Schuuring Mark J
Department of Cardiology, Amsterdam UMC, Heart Center, Amsterdam, the Netherlands.
Netherlands Heart Institute, Amsterdam, the Netherlands.
Echocardiography. 2025 May;42(5):e70184. doi: 10.1111/echo.70184.
AIM: Transesophageal echocardiography (TEE) is the modality of choice for mitral valve (MV) interventional planning. However, computed tomography (CT) has been proposed as a standard screening tool for MV interventions to assess the risk of injury to the left circumflex artery. We aimed to develop a pipeline to fuse CT and MV modalities and create three-dimensional (3D) printable models of the MV apparatus to enhance interventional planning and assessed its usability among clinicians. METHODS AND RESULTS: The design, production, and assessment of the 3D-printed personalized models were based on TEE enriched with data from CT. The digital pipeline consisted of fusion with a mutual information algorithm using 3D Slicer (Slicer) and Elastix toolboxes. Flexible 3D printing was performed using Agilus 30 Clear. The pipeline was feasible for achieving semiautomatic fusion of anatomical structures related to MV interventional planning. Visualization of fused synergistic information for 3D planning could be provided in three distinct cases of MV regurgitation (secondary MR with tenting, flail leaflet, and prolapse). The 3D printing resulted in a flexibility in line with actual tissue allowing for tactile modification. An average System Usability Score of 71 indicates a moderately good usability among imaging cardiologists, intervention cardiologists, and cardiac surgeons. CONCLUSION: The presented pipeline with digital planning and personalized 3D printing has reached the technology readiness level for application in mitral valve interventions, and prospective clinical trials with endpoints of surgical effectiveness. Comprehensive and efficient interactions between clinicians and technical staff are essential to establish well-designed patient-specific interventions.
目的:经食管超声心动图(TEE)是二尖瓣(MV)介入治疗规划的首选方式。然而,计算机断层扫描(CT)已被提议作为MV介入治疗的标准筛查工具,用于评估左旋支动脉损伤风险。我们旨在开发一种将CT和MV模态融合的流程,并创建MV装置的三维(3D)可打印模型,以加强介入治疗规划,并评估其在临床医生中的可用性。 方法与结果:3D打印个性化模型的设计、制作和评估基于富含CT数据的TEE。数字流程包括使用3D Slicer(Slicer)和Elastix工具箱通过互信息算法进行融合。使用Agilus 30 Clear进行柔性3D打印。该流程对于实现与MV介入治疗规划相关的解剖结构的半自动融合是可行的。在MV反流的三种不同情况下(瓣叶帐篷样改变的继发性二尖瓣反流、连枷样瓣叶和脱垂),可为3D规划提供融合协同信息的可视化。3D打印产生的灵活性与实际组织相符,允许进行触觉修改。平均系统可用性得分71表明,在影像心脏病学家、介入心脏病学家和心脏外科医生中,可用性中等良好。 结论:所展示的具有数字规划和个性化3D打印的流程已达到可应用于二尖瓣介入治疗的技术成熟度水平,并开展了以外科手术效果为终点的前瞻性临床试验。临床医生和技术人员之间全面而高效的互动对于建立精心设计的针对患者的干预措施至关重要。
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