混合现实技术在法洛四联症术前评估中的应用

Application of mixed reality technology on preoperative evaluation of tetralogy of Fallot

背景法洛四联症是常见的复杂先天性心脏病之一,混合现实技术已广泛应用于许多医学学科,但在心脏病围术期评估方面的研究较少。目的探索混合现实技术在法洛四联症术前评估中的应用价值,提供临床应用证据。方法纳入2018年8月-2019年8月在解放军总医院第一医学中心心脏大血管外科就诊,经胸心脏超声诊断为法洛四联症的连续病例。术前行心脏CT血管造影后重建心脏三维(3D)模型,并使用Hololens(Microsoft,USA)混合现实设备获取室间隔缺损的位置、形状和大小。将混合现实技术及超声测量的室间隔缺损大小分别与术中探查所得实际室间隔缺损大小进行比较。结果共有32例连续病例纳入研究。心脏超声、混合现实3D模型测得室间隔缺损长径与实际室间隔缺损长径依次为(13.44±3.25)mm,(17.19±2.29)mm和(18.75±3.82)mm,组间差异均有统计学意义(P<0.001);混合现实3D模型示短径[(14.69±2.02)mm vs(14.31±3.11)mm,P=0.788]和估算面积[(203±54)mm2 vs(217±80)mm2,P=0.691]与术中实际室间隔缺损的差异均无统计学意义(P>0.05)。重建单个混合现实图像平均用时38.6 min。结论混合现实技术可以准确提供法洛四联症中室间隔缺损的位置、形状和大小,帮助医生更好地了解心内外结构,为法洛四联症的术前评估提供了新方法。

Background Tetralogy of Fallot(TOF)is one of the common complex congenital heart diseases.Although mixed reality technology has been widely used in many medical fields,few researches have been reported in the perioperative evaluation of the heart disease.Objective To explore the value of mixed reality technology in the preoperative evaluation of TOF and provide evidences for clinical application.Methods Consecutive cases admitted to the First Medical Center,Chinese PLA General Hospital from August 2018 to August 2019 with a diagnosis of TOF by echocardiography were enrolled.The three dimensional cardiac model was reconstructed after preoperative cardiac CT angiography,and the location,shape and size of the ventricular septal defect(VSD)were obtained using a Hololens(Microsoft,USA)mixed reality device.The sizes of VSD measured by mixed reality three-dimensional(3D)model,echocardiography,and actually measured intraoperatively were compared.Results A total of 32 patients were enrolled in the study.The diameters of VSD measured by echocardiography,mixed reality 3D model,and actual VSD were(13.44±3.25)mm,([17.19±2.29]mm,and(18.75±3.82)mm,with significant differences between the groups(P<0.001).However,there were no differences in short diameters([14.69±2.02]mm vs[14.31±3.11]mm,P=0.788)and estimated area([203±54]mm^(2) vs[217±80]mm^(2),P=0.691)between mixed reality 3D model and actual VSD.The average time to reconstruct a single mixed reality image was 38.6 minutes.Conclusion Mixed reality technology can provide accurate location,shape and size of VSD in TOF,which can help surgeons better understand the internal and external structures of the heart,thus providing a new approach to the preoperative evaluation of TOF.