应用TEE数据源的左心耳3D模型开口参数指导LAmbreTM封堵器型号选择

目的探讨左心耳开口的多个解剖参数与术中最终置入心房颤动(以下简称房颤)患者体内的LAmbre TM封堵器型号之间的关系。方法选取在我院成功进行左心耳LAmbre TM封堵的23例房颤患者,应用交互式医学影像控制系统软件对其左心耳3D经食管超声心动图(TEE)医学数字成像和通信容积数据进行阈值分割等操作,重建左心耳3D模型,测量左心耳开口最大径、周长及面积,并与手术最终选择封堵器型号进行相关性分析。将与封堵器固定盘大小相关性较好的前15例患者的左心耳开口参数与所选择封堵器大小进行线性回归分析。抽取术中更换封堵器2例患者,制作左心耳3D打印模型,并进行体外封堵器释放试验。结果成功对23例房颤患者的左心耳超声容积数据进行后处理,并获取了包括左心耳开口形态在内的5个开口参数。左心耳开口最大径、面积及周长与相应LAmbre TM封堵器固定盘大小的相关性较好(r=0.85、0.74、0.89,均P0.01)。以与封堵器固定盘大小相关性较好的前15例房颤患者的左心耳开口最大径及周长作为预测变量,封堵器型号为因变量,建立的回归方程分别为:封堵器固定盘最大径预测值=11.22+0.71×开口最大径;封堵器固定盘周长预测值=12.71+1.06×开口周长。通过对左心耳开口参数的综合评估,体外试验中成功封堵了所抽取的2例患者的左心耳模型,且所选择的封堵器与手术最终应用的型号一致。结论综合分析左心耳3D模型开口解剖参数可以更好地指导LAmbre TM封堵器型号的选择。

A study of choosing occluder size of LAmbreTM using the parameters of left atrial appendage orifice from 3D model based on TEE data

Objective This study aimed to explore the relationship between the parameters of the LAA orifice based on three-dimensional transesophageal echocardiography (3D TEE) data and the final decive size of LAmbreTM. Methods We retrospectively analyzed ultrasound 3D DICOM data from 23 patients who underwent LAA occlusion with the LAmbreTM occluder. The volume images of LAA were acquired by the post-processing of Mimics software. The parameters of the LAA orifice were measured and evaluated. Two cases of LAA who had been replaced occluders during LAA occlusion were printed, and simulation operations were carried out on these models. Results The data of 23 patients were successfully post-treated and five parameters of the LAA orifice were obtained. Correlation between the maximal width, area and perimeter measurements and the closure disk of the LAmbreTM device were r=0.85, P=0.000, r=0.74, P=0.000, r=0.89, P= 0.000, respectively. By comprehensive analysis of the LAA orifice parameters, the two occluders finally used for simulation were selected, which had the same size as the occluder chosen for the actual procedure, and were inserted into 3D printing models with a near perfect fit. Conclusions Comprehensive analysis of the anatomical parameters of the LAA orifice by ultrasound 3D DICOM data may better guide the choice of optimal device size LAmbreTM.