三维可视化技术模拟房间隔缺损介入治疗的临床研究

3D visualization for simulating percutaneous transcatheter closure of atrial septal defect： a pilot clinical study

目的探讨三维可视化技术模拟在房间隔缺损（ASD）介入治疗中的临床价值。方法应用超声三维体绘制显示ASD及缺损周边心内结构，同时运用三维建模技术绘制数字化仿真装置。对30例ASD介入术患儿仿真装置大小及装置下缘距房室瓣距离与实际所用房隔封堵装置各参数进行比较。结果三维可视化可显示患儿ASD的位置、形态、大小。仿真装置左心房面直径为（26．07±5．32）cm、右心房面直径为（22．13±5．31）cm，其距二尖瓣、三尖瓣距离分别为（5．76±2．39）和（8．25±2．40）cm，与实际所用Amplatzer封堵装置相应各参数[分别为（25．91±5．32）、（22．08±5．26）、（5．61±2．26）、（8．02±2．48）cm]之间差异无统计学意义（P〉0．05）。结论三维超声可视化作为一种无创性技术可在ASD封堵术前为介入治疗提供更详尽的缺损及装置信息，指导装置选择。

Objective To evaluate the clinical value of 3D visualization method for simulating percutaueous transcatheter closure of atrial septal defect （ASD）. Methods 3D volume render method was used for visualizing ASD and surrounding structures and 3D modeling method was applied for simulate the shape of occlusion device. The size and the distance between the lower edge of device and atria-ventricular valve of simulation occluder and actual selected atrial septal occluder （ASO） were compared in 30 patients underwent successful transcatheter closure of ASD. Results The location, geometry, size, extent of ASDs in children were displayed in 3D visualization. No significant difference was found between simulation occluder and ASO size measured from left atrium [ （26. 07 ±5.32） cm vs. （25.91 ±5.32） cm] and right atrium [ （22. 13 ±5. 31 ） cm vs. （22. 08± 5. 26） cm, all P 〉 O. 05 ]. The distances from simulation occluder to mitral valves [ （5.76±2. 39） cm] and to tricuspid valves [ （8.25±2. 40） cm] were similar as ASO to atria-ventricular valves [ （ 5.61± 2. 26） cm and （ 8.02 ±2. 48 ） era, respectively, all P 〉 0. 05 ]. Conclusions The simulating percutaneous transcatheter closure of ASD by 3D visualization technique could be a helpful noninvasive approach for ASO selection before the procedure of transcatheter occlusion of ASD.