个体化计算机流体模型评估经导管二尖瓣缘对缘修复装置对二尖瓣反流超声定量分析的影响

Evaluating the impact of transcatheter mitral valve edge-to-edge repair devices on the assessment of mitral valve regurgitation by echocardiography based on individualized computer fluid models

目的使用计算机流体力学(CFD)技术探索经导管二尖瓣缘对缘修复(TEER)装置对术后二尖瓣反流血流会聚的影响,探寻TEER术后准确测量二尖瓣有效反流口面积(EROA)的解决方案。方法回顾性分析2020年1月至2023年8月于武汉大学人民医院治疗的33例二尖瓣反流患者TEER术前心脏CT影像和术中三维经食管超声心动图(3DTEE)图像并进行多模态融合。使用该数据构建TEER术后包括TEER装置和去除TEER装置后的二尖瓣反流CFD模型。测量二尖瓣反流口中点到TEER装置的距离(D)。测量保留和去除TEER装置时的近端等流速面(PISA)半径(R),并据此计算出相应的EROA1和EROA2。计算EROA矫正因子(CC,CC=EROA2/EROA1)。结果共获得42组保留和去除TEER装置的轻度及以上二尖瓣残余反流的CFD模型和50组PISA。根据PISA与TEER装置的相对位置,共观察到4种PISA:1型,PISA远离TEER装置(D>R,14个),CC为0.93±0.07;2型,PISA紧邻TEER装置(D<R,31个),CC为0.65±0.10;3型,PISA位于TEER装置内部(3个),CC分别为1.81、2.72和1.06;4型,PISA位于两个TEER装置中间(2个),CC分别为0.30和0.31。1型和2型PISA的CC与D显著相关(r=0.828,P<0.001)。结论个体化CFD模型可以评估TEER装置对PISA的影响,1型和2型PISA可以使用基于超声数据的矫正系数减少或消除TEER装置对EROA计算的影响。

Objective To explore the impact of transcatheter edge-to-edge repair(TEER)devices on mitral valve regurgitant flow convergence post-procedure using computational fluid dynamics(CFD),and to seek solutions for accurately measuring effective regurgitant orifice area(EROA)after TEER.Methods Multimodal fusion was conducted based on preoperative cardiac CT images and intraoperative three-dimensional transesophageal echocardiography(3DTEE)of 33 patients with mitral valve regurgitation undergoing TEER at Renmin Hospital of Wuhan University from January 2020 to August 2023.Using this data,CFD models of mitral valve regurgitation post-TEER,including with and without the TEER device,were constructed.The distance(D)from the midpoint of the mitral regurgitation orifice to the TEER device was measured.The proximal isovelocity surfice area(PISA)radius with and without the TEER device was measured,and the corresponding EROA1 and EROA2 based on this was calculated.The EROA correction factor CC=EROA2/EROA1 was calculated.Results A total of 42 sets of CFD models with mild or greater residual mitral regurgitation,both with and without the TEER device,and 50 sets of PISA were obtained.Based on the relative position of PISA to the TEER device,four types of PISA were observed:Type 1:PISA away from the TEER device(D>R,14 cases),with a CC of 0.93±0.07;Type 2:PISA adjacent to the TEER device(D<R,31 cases),with a CC of 0.65±0.10;Type 3:PISA located inside the TEER device(3 cases),with CC of 1.81,2.72,and 1.06 respectively;Type 4:PISA located between two TEER devices(2 cases),with CC of 0.30 and 0.31 respectively.The CC of Type 1 and Type 2 PISA was significantly correlated with D(r=0.828,P<0.001).Conclusions Individualized CFD models can be used to assess the impact of TEER devices on PISA.Type 1 and Type 2 PISA can use correction coefficients based on ultrasonic data to reduce or eliminate the impact of TEER devices on the calculation of EROA.