3D打印技术在指导经导管二尖瓣介入手术中的应用与展望Application and prospect of 3-dimensional printing in guiding transcatheter mitral valve interventions
毛予,翟蒙恩,刘洋,杨剑
摘要(Abstract):
二尖瓣疾病是危害人类心血管健康的常见瓣膜病之一。当前,已开发多种介入术式来治疗二尖瓣疾病。由于二尖瓣复合体特殊的解剖结构,导致介入手术难度增大,围术期并发症发生率居高不下。随着心血管3D打印技术的不断发展,3D可打印材料的更新和多学科协作相结合,3D打印成为经导管二尖瓣介入治疗中促进创新、提升手术成功率的技术。目前,患者特定的3D打印模型已用于经导管二尖瓣介入术前的器械尺寸调整、手术并发症的模拟预测等。通过运用二尖瓣介入模拟器模拟测试和多材料打印的创新方法,可以更好地预测器械将如何与患者特定的二尖瓣解剖结构相互作用。本文通过举例,阐述了3D打印在经导管二尖瓣介入治疗中的应用以及未来的发展方向。
关键词(KeyWords): 二尖瓣;介入;3D打印
基金项目(Foundation): 国家重点研发计划项目(2020YFC2008100);; 陕西省创新能力支撑计划-科技创新团队项目(2020TD-034)
作者(Author): 毛予,翟蒙恩,刘洋,杨剑
参考文献(References):
- [1] Nkomo VT,Gardin JM,Skelton TN,et al. Burden of valvular heart diseases:a population-based study[J].Lancet,2006,368(9540):1005-1011. DOI:10.1016/S0140-6736(06)69208-8.
- [2] Wilbring M,Alexiou K,Tugtekin SM,et al. Pushing the limitsFurther evolutions of transcatheter valve procedures in the mitral position,including valve-in-valve,valve-in-ring,and valve-in-nativering[J]. J Thorac Cardiovasc Surg,2014,147(1):210-219. DOI:10.1016/j.jtcvs.2013.09.021.
- [3] De Backer O,Piazza N,Banai S,et al. Percutaneous transcatheter mitral valve replacement:an overview of devices in preclinical and early clinical evaluation[J]. Circ Cardiovasc Interv,2014,7(3):400-409. DOI:10.1161/CIRCINTERVENTIONS.114.001607.
- [4] Witkowski A,Ku?mierski K,Chmielak Z,et al. Firsti n-m a n simultaneous transcatheter aortic and mitral valve replacement to treat severe native aortic and mitral valve stenoses[J].JACC Cardiovasc Interv,2015,8(10):1399-1401. DOI:10.1016/j.jcin.2015.03.039.
- [5] Hasan R,Mahadevan VS,Schneider H,et al. First in human transapical implantation of an inverted transcatheter aortic valve prosthesis to treat native mitral valve stenosis[J]. Circulation,2013,128(6):e74-e76. DOI:10.1161/CIRCULATIONAHA.113.001466.
- [6] Goode D,Dhaliwal R,Mohammadi H. Transcatheter mitral valve replacement:state of the art[J].Cardiovasc Eng Technol,2020,11(3):229-253. DOI:10.1007/s13239-020-00460-4.
- [7] Farooqi KM,Sengupta PP. Echocardiography and three-dimensional printing:sound ideas to touch a heart[J]. J Am Soc Echocardiogr,2015,28(4):398-403. DOI:10.1016/j.echo.2015.02.005.
- [8] Mahmood F,Owais K,Taylor C,et al. Three-dimensional printing of mitral valve using echocardiographic data[J].JACC Cardiovasc Imaging,2015,8(2):227-229. DOI:10.1016/j.jcmg.2014.06.020.
- [9] Olivieri LJ,Krieger A,Loke YH,et al. Three-dimensional printing of intracardiac defects from three-dimensional echocardiographic images:feasibility and relative accuracy[J]. J Am Soc Echocardiogr,2015,28(4):392-397. DOI:10.1016/j.echo.2014.12.016.
- [10] Witschey WRT,Pouch AM,Mc Garvey JR,et al. Three-dimensional ultrasound-derived physical mitral valve modeling[J]. Ann Thorac Surg,2014,98(2):691-694. DOI:10.1016/j.athoracsur.2014.04.094.
- [11] Vukicevic M,Mosadegh B,Min JK,et al. Cardiac 3D printing and its future directions[J]. JACC Cardiovasc Imaging,2017,10(2):171-184. DOI:10.1016/j.jcmg.2016.12.001.
- [12] Mahmood F,Owais K,Montealegre-Gallegos M,et al.Echocardiography derived three-dimensional printing of normal and abnormal mitral annuli[J]. Ann Card Anaesth,2014,17(4):279-283. DOI:10.4103/0971-9784.142062.
- [13] Little SH,Vukicevic M,Avenatti E,et al. 3D printed modeling for patient-specifi c mitral valve intervention:repair with a clip and a plug[J]. JACC Cardiovasc Interv,2016,9(9):973-975. DOI:10.1016/j.jcin.2016.02.027.
- [14] Russ M,O’Hara R,Setlur Nagesh RV,et al. Treatment planning for image-guided neuro-vascular interventions using patient-specifi c3D printed phantoms[J]. Proc SPIE Int Soc Opt Eng,2015,9417:941726. DOI:10.1117/12.2081997.
- [15] Ionita CN,Mokin M,Varble N,et al. Challenges and limitations of patient-specific vascular phantom fabrication using 3D Polyjet printing[J]. Proc SPIE Int Soc Opt Eng,2014,9038:90380M. DOI:10.1117/12.2042266.
- [16] Kurenov SN,Ionita CN,Sammons D,et al. Three-dimensional printing to f acilitate anatomic study,device development,simulation,and planning in thoracic surgery[J]. J Thorac Cardiovasc Surg,2015,149(4):973-979. DOI:10.1016/j.jtcvs.2014.12.059.
- [17] Vukicevic M,Puperi DS,Jane Grande-Allen K,et al. 3D printed modeling of the mitral valve for catheter-based structural interventions[J]. Ann Biomed Eng,2017,45(2):508-519. DOI:10.1007/s10439-016-1676-5.
- [18]杨剑.心血管3D打印技术[M].北京:化学工业出版社,2020:119-135.
- [19] Kheradvar A,Groves EM,Simmons GA,et al. Emerging trends in heart valve engineering:partⅢ. Novel technologies for mitral valve repair and replacement[J]. Ann Biomed Eng,2015,43(4):858-870. DOI:10.1007/s10439-014-1129-y.
- [20] Maragiannis D,Jackson MS,Igo SR,et al. Functional 3D printed patient-specific modeling of severe aortic stenosis[J]. J Am Coll Cardiol,2014,64(10):1066-1068. DOI:10.1016/j.jacc.2014.05.058.
- [21] Maragiannis D,Jackson MS,Igo SR,et al. Replicating patientspecific severe aortic valve stenosis with functional 3D modeling[J].Circ Cardiovasc Imaging,2015,8(10):e003626. DOI:10.1161/CIRCIMAGING.115.003626.
- [22]周国磊,翟蒙恩,徐臣年,等.多模态影像及3D打印技术在经导管二尖瓣缘对缘修复术中的应用[J].心脏杂志,2022,33(4):484-488.DOI:10.12125/j.chj.202103089.
- [23] Vukicevic M,Vekilov DP,Grande-Allen JK,et al. Patient-specifi c3D valve modeling for structural intervention[J]. Structural Heart,2017,1(5~6):236-248. DOI:10.1080/24748706.2017.1377363.
- [24] Wunderlich NC,Beigel R,Ho SY,et al. Imaging for mitral interventions:methods and efficacy[J]. JACC Cardiovascular Imaging,2018,11(6):872-901. DOI:10.1016/j.jcmg.2018.02.024.
- [25] Iung B,Delgado V,Rosenhek R,et al. Contemporary presentation and management of valvular heart disease:the EURObservational research programme valvular heart diseaseⅡsurvey[J]. Circulation,2019,140(14):1156-1169. DOI:10.1161/CIRCULATIONAHA.119.041080.
- [26] Nicol ED,Norgaard BL,Blanke P,et al. The future of cardiovascular computed tomography:advanced analytics and clinical insights[J].JACC Cardiovasc Imaging,2019,12(6):1058-1072. DOI:10.1016/j.jcmg.2018.11.037.
- [27] Bax JJ,Debonnaire P,Lancellotti P,et al. Transcatheter interventions for mitral regurgitation:multimodality imaging for patient selection and procedural guidance[J]. JACC Cardiovasc Imaging,2019,12(10):2029-2048. DOI:10.1016/j.jcmg.2019.03.036.
- [28] Leipsic J,Blanke P. Predicting left ventricular outflow tract obstruction after transcatheter mitral valve replacement:from theory to evidence[J]. JACC Cardiovasc Interv,2019,12(2):194-195.DOI:10.1016/j.jcin.2018.12.010.
- [29] Wang DD,Eng MH,Greenbaum AB,et al. Validating a prediction modeling tool for left ventricular outfl ow tract(LVOT)obstruction after transcatheter mitral valve replacement(TMVR)[J]. Catheter Cardiovasc Interv,2018,92(2):379-387. DOI:10.1002/ccd.27447.
- [30] Meduri CU,Reardon MJ,Lim DS,et al. Novel multiphase assessment for predicting left ventricular outfl ow tract obstruction bef ore transcatheter mitral valve replacement[J]. JACC Cardiovasc Interv,2019,12(23):2402-2412. DOI:10.1016/j.jcin.2019.06.015.
- [31] Wang DD,Guerrero M,Eng MH,et al. Alcohol septal ablation to prevent lef t ventricular outf low tract obstruction during transcatheter mitral valve replacement:first-in-man study[J].JACC Cardiovasc Interv,2019,12(13):1268-1279. DOI:10.1016/j.jcin.2019.02.034.
- [32] Bagur R,Cheung A,Chu MWA,et al. 3-dimensional-printed model for planning transcatheter mitral valve replacement[J].JACC Cardiovasc Interv,2018,11(8):812-813. DOI:10.1016/j.jcin.2017.10.049.
- [33] El Sabbagh A,Eleid MF,Matsumoto JM,et al. Three-dimensional prototyping for procedural simulation of transcatheter mitral valve replacement in patients with mitral annular calcifi cation[J].Catheter Cardiovasc Interv,2018,92(7):E537-E549. DOI:10.1002/ccd.27488.
- [34] Mao Y,Liu Y,Ma Y,et al. Mitral valve-in-valve implant of a balloonexpandable valve guided by 3-dimensional printing[J]. Front Cardiovasc Med,2022,9:894160. DOI:10.3389/fcvm.2022.894160.
- [35] Hammermeister K,Sethi GK,Henderson WG,et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve:final report of the Veterans Affairs randomized trial[J]. J Am Coll Cardiol,2000,36(4):1152-1158. DOI:10.1016/s0735-1097(00)00834-2.
- [36] Kinno M,Raissi SR,Olson KA,et al. Three-dimensional echocardiography in the evaluation and management of paravalvular regurgitation[J]. Echocardiography,2018,35(12):2056-2070.DOI:10.1111/echo.14194.
- [37] Hascoet S,Smolka G,Bagate F,et al. Multimodality imaging guidance for percutaneous paravalvular leak closure:Insights from the multi-centre FFPP register[J]. Arch Cardiovasc Dis,2018,111(6-7):421-431. DOI:10.1016/j.acvd.2018.05.001.
- [38] Eleid MF,Foley TA,Said SM,et al. Severe mitral annular calcification:multimodality imaging for therapeutic strategies and interventions[J]. JACC Cardiovasc Imaging,2016,9(11):1318-1337. DOI:10.1016/j.jcmg.2016.09.001.
- [39]徐亚鹏,王海山,杨夏燕,等.经导管二尖瓣置换产品设计开发及临床研究进展[J].中国介入心脏病学杂志,2022,30(10):791-796.DOI:10.3969/j.issn.1004-8812.2022.10.011.
- [40]马燕燕,刘洋,金屏,等.国产球囊扩张式瓣膜的临床应用初探[J].中国介入心脏病学杂志,2021,29(2):101-106. DOI:10.3969/j.issn.1004-8812.2021.02.010.