Application of 3Dprinting technology in diagnosis and preoperative planning of coronary artery abnormalities
-
摘要: 目的:探讨使用3D打印技术打印的3D心脏模型诊断和指导冠状动脉异常矫治手术的可行性和临床价值。方法:基于3例冠状动脉异常的心脏CT数据,包括右冠状动脉-左室瘘1例,左、右冠状动脉共同起源于右冠状窦合并左、右冠状动脉-肺动脉瘘1例、左冠状动脉起源于肺动脉1例。采用Mimics 19.0软件对患者CT进行图像分割,建立STL格式的3D心脏模型,显示冠状动脉与主动脉和肺动脉的空间关系。使用3D打印机打印心脏冠脉模型,对心脏冠脉模型进行评估。结果:3例3D心血管实体模型可清晰显示左右冠状动脉与肺动脉、主动脉间的空间关系,冠状动脉瘘的大小、位置,且实体模型与数据模型吻合,并无明显差异。手术全部顺利完成,恢复良好,无严重并发症出现。结论:将3D打印技术应用于冠状动脉异常有助于诊断和制定适合的手术计划,使得医师可以个性化精准诊疗冠状动脉异常的解剖结构,指导手术更顺利安全进行,有显著的临床应用价值。Abstract: Objective: To explore the feasibility and clinical value of 3 D printed heart model in the diagnosis and guidance of coronary artery abnormalities surgery.Methods: This study mainly based on cardiac CT data of 3 patients with coronary artery abnormalities, including 1 case of right coronary artery-left ventricular fistula, 1 case of left and right coronary artery all originating from right coronary sinus combined with left coronary artery-pulmonary artery fistula and right coronary artery-pulmonary artery fistula, and 1 case of Anomalous left coronary artery from the pulmonary artery(ALCAPA). Mimics 19.0 software was used to segment CT images and established a 3 D heart model in STereoLithography. It formated to display the spatial relationship between coronary arteries, aorta and pulmonary artery. The coronary artery model was printed by 3 D printer and evaluated.Results: These 3 D printed heart models of three cases can clearly show the spatial relationship between coronary arteries and pulmonary arteries, and the size and the location of coronary artery fistula. What's more, there was no significant difference between this model and data model. All surgery operations were completed successfully and patients were recovered well without serious complications.Conclusion: The application of 3 D printing technology on coronary artery anomalies is valuable to diagnosis and formulate appropriate surgical plan.
-
-
[1] 危小东,肖勋刚,邹康,等.3D打印技术在复杂肱骨近端骨折中的应用[J].实用医学杂志,2018,34(2):335-336.
[2] 黄海,严中亚,申运华,等.3D打印技术在不停跳冠状动脉旁路移植术中的应用[J].临床心血管病杂志,2019,35(11):1033-1036.
[3] Wang DD,Qian Z,Vukicevic M,et al.3D printing,computational modeling,and artificial intelligence for structural heart disease[J].JACC Cardiovasc Imaging,2020,S1936-878X(20):30515-5.
[4] 丁鹏,刘洋,徐臣年,等.3D打印技术结合经心尖导管主动脉瓣植入15例[J].中国体外循环杂志,2019,17(5):261-264+298.
[5] 董柱,张本,曹一秋,等.3D打印技术在干下型室间隔缺损精准个性化微创治疗中的应用[J].临床心血管病杂志,2020,36(2):173-177.
[6] Zhen Q,Kan W,Liu SZ,et al.Quantitative prediction of paravalvular leak in transcatheter aortic valve replacement based on tissue-mimicking 3D printing[J].JACC Cardiovasc Imaging,2017,10(7):719-731.
[7] Zhao L,Zhou S,Fan T,et al.Three-dimensional printing enhances preparation for repair of double outlet right ventricular surgery[J].J Card Surg,2018,33(1):24-27.
[8] Anwar S,Rockefeller T,Raptis DA,et al.3D printing provides a precise approach in the treatment of tetralogy of fallot,pulmonary atresia with major aortopulmonary collateral arteries[J].Curr Treat Options Cardiovasc Med,2018,20(1):5-5.
[9] Vukicevic M,Mosadegh B,Min JK,et al.Cardiac 3D printing and its future directions[J].JACC Cardiovasc Imaging,2017,10(2):171-184.
[10] Finotello A,Marconi S,Pane B,et al.Twelve-year follow-up post-thoracic endovascular repair in type B aortic dissection shown by three-dimensional printing[J].Ann Vasc Surg,2019,55:309.e13-309.e19.
[11] Vaidya YP,Green GR.Coronary artery fistula[J].J Card Surg,2019,34(12):1608-1616.
[12] Uzuka T,Nakamura M,Nakajima T,et al.Surgery of giant right coronary artery aneurysm complicated with coronary artery fistula to left ventricle[J].J Card Surg,2018,33(2):95-96.
[13] Jama A,Barsoum M,Bjarnason H,et al.Percutaneous closure of congenital coronary artery fistulae:results and angiographic follow-up[J].JACC Cardiovasc Interv,2011,4(7):814-821.
[14] Song L,Dong Y,Wang B,et al.The evolution of the minimally invasive approach and conventional median sternotomy for coronary artery fistula correction[J].Heart Lung Circ,2019,28(8):1277-1282.
[15] Van Loo I,Sonck J,Tanaka K,et al.Thoracoscopic off-pump closure of a large left circumflex coronary artery fistula:A novel minimally invasive approach[J].J Thorac Cardiovasc Surg,2018,156(4):e159-e161.
[16] Zhang J,Ma W,Zhang W,et al.3-dimensional printed models-guided surgical repair for recurrent coronary artery fistula[J].Ann Thorac Surg,2018,S0003-4975(18):31340-31347.
[17] 邱海龙,庄建,岑坚正,等.虚拟现实技术在冠状动脉瘘和冠状动脉异常起源外科诊疗中的应用价值[J].中国胸心血管外科临床杂志,2019,26(3):1-5.
[18] Zhang W,Hu R,Zhu Y,et al.Surgical outcomes for anomalous left coronary artery from the pulmonary artery:Influence of late presentation[J].J Thorac Cardiovasc Surg,2020,159(5):1945-1952.e1.
[19] Mangukia CV.Coronary artery fistula[J].Ann Thorac Surg,2012,93(6):2084-2092.
[20] 董柱,张本,王晓武,等.先天性冠状动脉瘘早中期手术疗效分析[J].临床心血管病杂志,2020,36(8):760-764.
[21] Huang Z,Liu Z,Ye S.The role of the fractional flow reserve in the coronary steal phenomenon evaluation caused by the coronary-pulmonary fistulas:case report and review of the literature[J].J Cardiothorac Surg,2020,15(1):32.
[22] Bramlet M,Olivieri L,Faeooqi K,et al.Impact of Three-Dimensional printing on the study and treatment of congenital heart disease[J].Circ Res,2017,120(6):904-907.
-
计量
- 文章访问数: 1010
- PDF下载数: 1135
- 施引文献: 0