3D计算建模在跨导管中对心心替换的影响和局限性 - - 两中心的荷兰经验
Mark M P van den Dorpel1, Mauricio Felippi de Sá Marchi1,2, Zouhair Rahhab1,3
1Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands.
概括
多切片计算机断层扫描 (MSCT) 衍生3D建模辅助跨导管中枢置换 (TMVR) 计划复杂病例. 这种方法有助于识别诸如左心室外流通道阻塞等风险,改善患者选择和结果.
科学领域:
- 心血管医学 心血管医学
- 医学成像医学成像
- 干预性心脏病学 干预性心脏病学
背景情况:
- 过导管 mitra 置换 (TMVR) 为高风险患者提供了一种最小侵入性的选择.
- 之前的研究表明,在特定条件下成功,如门内米特拉环化 (ViMAC),门内环 (MViR) 和门内 (MViV).
- 多切片计算机断层扫描 (MSCT) 衍生的3D建模可以增强对TMVR的解剖学理解.
研究的目的:
- 证明MSCT衍生的3D建模和模拟在TMVR程序前评估中的应用.
- 评估其在ViMAC,MViR和MViV的情况下的实用性.
主要方法:
- 连续接受TMVR查的患者的回顾性分析.
- 将MSCT数据与心声和临床结果进行比较.
- 利用3D建模来评估解剖学适应性和预测风险.
主要成果:
- 在被查的41名患者中,有16人接受TMVR (9个ViMAC,3个MViR,4个MViV).
- 排除标准包括不适当的尺寸 (11),定问题 (4),以及预测的左心室外流通道阻塞 (LVOTO) (10).
- TMVR显著降低了额头肌平均梯度 (9.5到5.0毫米平线,p=0.03),30天后没有残留的额头肌吐;然而,LVOTO发生在4名患者身上.
结论:
- 从MSCT获得的3D建模为ViMAC,MViR和MViV中的TMVR提供了关键的解剖洞察力.
- 这种技术对患者选择和程序规划有价值.
- 未来的规划策略应专注于减轻新LVOTO的风险.
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