三维新左心室外流通道模拟的准确性与跨导管中枢替换在不同的中枢表现型中
Mark M P van den Dorpel1, Lucas Uchoa de Assis1,2, Jenna van Niekerk1
1Department of Cardiology, Thoraxcenter, Cardiovascular Institute, Erasmus Medical Center, Rotterdam, The Netherlands.
概括
在三维计算模型准确地预测新左心室外流通道尺寸后,在中枢-in-ring和中枢-in-valve的情况下,在跨导管中枢更换后. 在门在MAC的情况下,准确性是有限的,需要进一步改进模拟.
科学领域:
- 心血管成像和干预心血管成像和干预
- 医学中的计算流体动力学
- 假肢的性能分析
背景情况:
- 过导管 mitra 置换 (TMVR) 是一种正在发展中的治疗方法,用于治疗各种 mitra 病理,包括 valve-in-MAC, mitral-valve-in-ring (MViR) 和 mitral-valve-in-valve (MViV).
- 新左心室外流管 (新-LVOT) 阻塞在TMVR之后是一个显著的风险.
- 来自多切片计算机断层扫描 (MSCT) 的三维计算模型 (3DCM) 用于预测新LVOT区域,但它们在不同肌表型中的准确性尚未得到充分证实.
研究的目的:
- 评估程序前3DCM在TMVR后预测新LVOT尺寸的准确性.
- 为了比较3DCM在不同的TMVR指示中的预测准确度:门内MAC (ViMAC),MViR和MViV.
主要方法:
- 程序前3DCM是为接受ViMAC,MViR和MViV的TMVR的患者构建的.
- 在整个心脏周期中,从3DCM中半自动计算新-LVOT尺寸.
- 来自3DCM的预测新低度区域与手术后的MSCT测量结果进行了比较.
主要成果:
- 在12个TMVR病例中,预测和实际的新LVOT面积之间的平均差异因表型而异.
- 观察到MViR (ICC=0.89) 和MViV (ICC=0.81) 的高度一致,这表明预测准确度很好.
- 对于ViMAC,发现了较低的一致性 (ICC=0.41),这表明预测该组中新-LVOT维度的局限性.
结论:
- 3DCM在预测MViR和MViV的TMVR后新-LVOT维度方面表现出很高的准确性.
- 对于ViMAC案例,3DCM的预测准确性是有限的.
- 未来的研究应该专注于将设备与主机的相互作用和血液动力学变化纳入模拟中,以提高所有 mitra 类型的准确性.
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