Three-Dimensional Heart Modeling of Hypertrophic Obstructive Cardiomyopathy for In Situ Patient-Specific Simulation to Optimize Septal Myectomy.

IF 1.6 Q2 SURGERY
Karin C Smits, Ron G H Speekenbrink, Edsko E G Hekman, Maaike A Koenrades, Tijn J P Heeringa, Jutta Arens, Frank R Halfwerk
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Abstract

Objective: Hypertrophic obstructive cardiomyopathy (HOCM) develops in at least 1 out of 715 young adults. Patients who are refractory to medical therapy qualify for septal myectomy. Due to anatomy, serious complications such as ventricular septal defect and heart block may occur. Establishing cardiovascular magnetic resonance (CMR)-based 3-dimensional (3D) models as part of preoperative planning and training has the potential to decrease procedure-related complications and improve results.

Methods: CMR images were used to segment cardiac structures. Left ventricular wall thickness was calculated and projected on top of the in silico model. A 3D model was printed with a red layer indicating a wall thickness exceeding 15 mm and used for preoperative resection planning and patient counseling. To provide preoperative patient-specific in situ simulation, the planned resection volume was replaced with silicone in a second model. For perioperative quality control, resected silicone was compared with resected myocardial tissue. The impact of the models was evaluated descriptively through consultation of both the cardiothoracic surgeon and patients and through patient outcomes.

Results: Three-dimensional in silico and 3D-printed heart models of 5 patients were established preoperatively. Since the introduction of the models in October 2020, the surgeon feels better prepared, more confident, and less difficulty with making decisions. In addition, patients feel better informed preoperatively.

Conclusions: Using 3D heart models optimized preoperative planning and training, intraoperative quality control, and patient consultation. Reduction of procedure-related complications and clinical outcome should be studied in larger cohorts.

肥厚型梗阻性心肌病的三维心脏建模,用于原位患者特异性模拟,以优化房间隔切除术。
目的:在 715 名年轻成年人中,至少有 1 人患有肥厚性梗阻性心肌病(HOCM)。对药物治疗无效的患者可接受房间隔切除术。由于解剖结构的原因,可能会出现室间隔缺损和心脏传导阻滞等严重并发症。建立基于心血管磁共振(CMR)的三维(3D)模型作为术前计划和培训的一部分,有可能减少手术相关并发症并改善手术效果:方法:使用 CMR 图像分割心脏结构。方法:利用 CMR 图像对心脏结构进行分割,计算左心室壁厚度,并将其投影到硅学模型之上。打印出的三维模型带有红色层,表示室壁厚度超过 15 毫米,用于术前切除计划和患者咨询。为了提供术前患者特异性原位模拟,在第二个模型中用硅胶替代了计划的切除体积。为了进行围手术期质量控制,将切除的硅胶与切除的心肌组织进行比较。通过对心胸外科医生和患者的咨询以及患者的预后,对模型的影响进行了描述性评估:结果:术前为 5 名患者建立了三维硅胶和三维打印心脏模型。自 2020 年 10 月引入模型以来,外科医生感觉准备更充分、更自信,做出决定的难度也降低了。此外,患者在术前也能更好地了解情况:使用三维心脏模型优化了术前计划和培训、术中质量控制和患者咨询。减少手术相关并发症和临床结果应在更大的群体中进行研究。
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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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