Ching Stephen, Zelonis Christopher, Herz Christian, Sabin Patricia, Daemer Matthew, Nuri Muhammad, Wang Yan, Laurence Devin W, Chen Jonathan M, Rogers Lindsay S, Quartermain Michael D, Moore John, Peters Terry, Chen Elvis, Jolley Matthew A
Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care Medicine, Philadelphia, PA.
Children's Hospital of Philadelphia, Division of Cardiothoracic Surgery, Philadelphia, PA.
ArXiv. 2025 Aug 18:arXiv:2508.09285v3.
To develop and evaluate a dynamic, image-derived patient-specific physical simulation platform for the assessment of left atrioventricular valve (LAVV) repair strategies in pediatric patients with repaired atrioventricular canal defects.
3D transesophageal echocardiographic images of two patients with regurgitant LAVVs were identified from an institutional database. Custom code in SlicerHeart was used to segment leaflets, define the annulus, and generate patient-specific valve molds. Silicone valve models were fabricated and tested in a pulse duplicator under simulated physiological conditions. Five unrepaired valves were analyzed for manufacturing consistency, and multiple surgical repair techniques were compared for two patient-specific models.
Manufacturing variability was low in annular metrics (CV for annular circumference: 2.1%; commissural distance: 4.1%; annulus height: 14.7%) but higher in leaflet closure metrics (billow height: 11.1%; billow volume: 18.9%; tenting height: 45.9%; tenting volume: 73.5%). In Patient 1, cleft closure and an Alfieri stitch both eliminated the regurgitant orifice area, but the Alfieri stitch resulted in elevated mean pressure gradient (17 mmHg vs. 4-9 mmHg for other repairs) and deteriorated with repeated loading. In Patient 2, no repair eliminated regurgitation entirely; however, combining an 11 mm patch augmentation with commissuroplasty reduced regurgitant area to 0.147 cm, the smallest observed among tested strategies.
This study demonstrates the feasibility of a dynamic physical simulation platform for preclinical LAVV repair evaluation. Although challenges remain in accurately modeling leaflet closure and chordal mechanics, this proof-of-concept work highlights the platform's potential for refining repair strategies before clinical application, which may be particularly relevant in small and heterogeneous populations with congenital heart disease.
开发并评估一个动态的、基于图像的患者特异性物理模拟平台，用于评估患有房室管缺损修复术后的儿科患者的左房室瓣（LAVV）修复策略。
从机构数据库中识别出两名患有LAVV反流的患者的三维经食管超声心动图图像。使用SlicerHeart中的自定义代码对瓣叶进行分割、定义瓣环并生成患者特异性瓣膜模型。制造硅胶瓣膜模型并在模拟生理条件下的脉搏复制器中进行测试。分析了五个未修复瓣膜的制造一致性，并比较了两个患者特异性模型的多种手术修复技术。
瓣环指标的制造变异性较低（瓣环周长的CV：2.1%；连合距离：4.1%；瓣环高度：14.7%），但瓣叶闭合指标的变异性较高（波峰高度：11.1%；波峰体积：18.9%；帐篷高度：45.9%；帐篷体积：73.5%）。在患者1中，裂隙闭合和Alfieri缝合均消除了反流口面积，但Alfieri缝合导致平均压力梯度升高（17 mmHg，而其他修复为4 - 9 mmHg），并且在反复加载后情况恶化。在患者2中，没有一种修复能完全消除反流；然而，将11 mm补片增大与连合部成形术相结合可将反流面积减少至0.147 cm²，这是测试策略中观察到的最小面积。
本研究证明了动态物理模拟平台用于临床前LAVV修复评估的可行性。尽管在准确模拟瓣叶闭合和弦索力学方面仍存在挑战，但这项概念验证工作突出了该平台在临床应用前优化修复策略的潜力，这在患有先天性心脏病的小型和异质性人群中可能尤为重要。
