3D打印技术在先天性主动脉瓣疾病诊治中的应用

Application of three-dimensional printing technology in treatment of pediatric congenital aortic valve diseases

目的:探讨应用3D打印技术制作主动脉瓣疾病患儿的主动脉根部模型的可行性,并分析其在术前诊断、评估及拟定手术方案中的应用价值。方法:选取河南人民医院儿童心脏中心2017年6月至2020年2月,收治的25例(男性14例、女性11例)先天性主动脉瓣疾病患者,以64排CT为数据源,制作主动脉根部模型,与超声测量值应用对比较配评估心脏模型的相关性和精准度;分别使用3D打印模型和心脏超声对患者进行诊断分型等,并与术中结果对比,评估两种方式的准确率的一致性程度;选取同时期18例未做3D打印并在我院行手术治疗的主动脉瓣疾病患儿作为对照组,比较两组的手术时间和升主动脉阻断时间结果:3D心脏模型具有较高的相关性(r=0.95),能精准反映主动脉根部结构;判断解剖结构诊断,Kappa=0.779,具有较好的一致性;3D打印组和对照组的手术时间比较(t=1.5,P=0.145),两组手术时间差异,无统计学意义,两组升主动脉阻断时间比较(t=2.2,P=0.033),3D打印组较对照组(非打印组)升主动脉阻断时间缩短。结论:3D打印心脏瓣膜模型能够清楚的显示主动脉瓣膜畸形,提高对心脏心内空间解剖结构的认识,对先天性主动脉瓣疾病的诊治有一定的临床应用价值。

Objective:To explore the feasibility of 3 D printing for the aortic root model of children with aortic valve disease,and to analyze its application value in preoperative diagnosis,evaluation and surgical planning.Methods:Select children in henan province people’s hospital heart center in June 2017 to February 2020 were 25 cases(male 14,female 11),patients with congenital aortic valve disease with 64 row CTA as data source,application paired t-test and Pearson correlation analysis,evaluate the relevance and accuracy of the model.The 3 D printed model and echocardiography were respectively used to classify the patients and make the surgical plan,and compared with the intraoperative diagnosis,to evaluate the consistency of the accuracy of the two method.Eighteen children with aortic valve disease who had not received 3 D printing and received surgical treatment in our hospital during the same period were selected as the control group,and the operative time and the occlusion time of the ascending aorta were compared between the two groups Result:The 3 D heart model has a high correlation(Pearson coefficient>0.95),which can accurately reflect the aortic root structure.The anatomical structure diagnosis was determined by Kappa=0.779,showing good consistency.Compared with the control group(t=1.5,P=0.145),the operation time difference between the two groups was not statistically significant;compared with the control group(t=2.2,P=0.033),the operation time of the 3 D printing group was shorter than that of the control group(non-printing group).Conclusions:The 3 D-printed heart valve model can clearly show aortic valve malformations,improve the understanding of the intracardiac anatomical structure of the heart,contribute to the preoperative diagnosis and the formulation of surgical plans,and have certain clinical application value for the diagnosis and treatment of congenital aortic valve disease.