The Study Of Preoperative Assessment Of Structural Heart Diseases By Three-dimensional Printing Models

Objective1.To investigate the feasibility and diagnostic value of preoperative real-time three-dimensional color Doppler transthoracic echocardiography(RT-3D-CDTTE)on the assessment of structural heart disease(SHD).2.To investigate the feasibility and diagnostic value of preoperative real-time three-dimensional color Doppler transthoracic echocardiography guided three dimensional printing model(RT-3D-CDTTE Guided 3DPM)on the assessment of SHD.3.To investigate the feasibility and diagnostic value of preoperative real-time three-dimensional color Doppler transesophageal echocardiography(RT-3D-CDTEE)on the assessment of SHD.4.To investigate the feasibility and diagnostic value of preoperative real-time three-dimensional color Doppler transesophageal echocardiography guided three dimensional printing model(RT-3D-CDTEE Guided 3DPM)on the guiding of left atrial appendage occlusion.5.To investigate the feasibility and diagnostic value of preoperative RT-3D-CDTEE and computed tomography(CT)guided three dimensional printing model(3DPM)on the guiding of left atrial appendage occlusion.6.To investigate the feasibility and diagnostic value of cardiac magnetic resonance imaging(CMRI)guided 3DPM on the assessment of SHD.Methods1.Two hundred and eleven patients were assessed preoperatively using RT-3D-CDTTE,compared to conventional two-dimensional color Doppler transthoracic echocardiography(2D-CDTTE),and took cardiovascular angiography and intraoperative findings as "Golden Standard" simultaneously.There are eighty one patients with SHD,including sixteen cases with mitral prolapse(of which twelve cases complicated with ruptured chordae)(MVP),sixteen cases with secondary atrial septal defect(ASD),fifteen cases with rheumatic mitral stenosis(RMS),eight cases with aortic stenosis(of which two case with bicuspid aortic valve)(AS),seven cases with partial endocardial cushion defect(PECD)and secondary ASD,seven cases with patent ductus arteriosus(PDA),two cases with tetralogy of Fallot(TOF),two cases with ventricular septal defect(VSD),one case with residual leakage after VSD repairment,two cases with mitral bioprosthesis valve paravalvular leakage,one case with Ebstein's anomaly,two cases with obstructive hypertrophic cardiomyopathy and two cases with pulmonary valve stenosis,One hundred and thirty patients without SHD were designed as negative control.2.One hundred and forty-four patients were assessed preoperatively using RT-3D-CDTTE Guided 3DPM,compared to conventional 3D-TTE,and took direct intraoperative findings as "Golden Standard" simultaneously.There are sixty two patients with SHD,including fourteen cases with MVP,twelve cases with PECD,twelve cases with secondary ASD,twelve cases with RMS,six cases with TOF,six cases with VSD,eighty-two patients without SHD were designed as negative control.3.One hundred and eleven patients were assessed preoperatively using RT-3D-CDTEE,compared to conventional 2D-CDTEE,and took cardiovascular angiography and intraoperative findings as "Golden Standard" simultaneously.There are thirty one patients with SHD,including six cases with MVP(of which two cases complicated with ruptured chordae),six cases with secondary ASD,five cases with RMS,three cases with AS(of which one case with bicuspid aortic valve),two cases with PECD and secondary ASD,two cases with PDA,one case with TOF,one case with VSD,one case with residual leakage after VSD repairment,one case with mitral bioprosthesis valve paravalvular leakage,one case with Ebstein's anomaly,one case with obstructive hypertrophic cardiomyopathy and one case with pulmonary valve stenosis,eighty patients without SHD were designed as negative control.4.The 3DPM guided by TEE was used to evaluate 8 patients requiring left atrial appendage occlusion,compared with conventional 2D-TEE and the final type of occluded umbrella.5.The 3D printing model was guided by TEE and CT.Preoperative assessment was performed on 8 patients requiring left atrial appendage occlusion,compared with conventional 2D-TEE and the final type of occluded umbrella.6.To evaluate the feasibility and causes of structural heart disease by a 3DPM guided by CMRI.Results1.The preoperative RT-3D-CDTTE displayed the three-dimensional structure and the hemodynamic status of SHD cardiac lesions clearly,which were consistent with cardiovascular angiography and intraoperative findings.2.RT-3D-CDTTE Guided 3DPM displayed the three-dimensional structure of SHD cardiac lesions clearly,which were consistent with intraoperative findings.3.The preoperative RT-3D-CDTEE displayed the three-dimensional structure and the hemodynamic status of SHD cardiac lesions clearly,which were consistent with cardiovascular angiography and intraoperative findings.4.The preoperative RT-3D-CDTEE Guided 3DPM displayed the three-dimensional structure of guiding of left atrial appendage occlusion cardiac lesions clearly,which were consistent with intraoperative findings.5.The three-dimensional structure of the left atrial appendage can be clearly displayed by the 3D model guided by TEE and CT.6.CMRI guided 3DPM assessment of SHD is currently technically difficult and requires time to overcome.Conclusion1.RT-3D-CDTTE provides essential information for the preoperative evaluation and decision of SHD.2.RT-3D-CDTTE Guided 3DPM provides essential information for the preoperative evaluation and decision of SHD.3.RT-3D-CDTEE provides essential information for the preoperative evaluation and decision of SHD.4.RT-3D-CDTEE Guided 3DPM provides essential information for the preoperative evaluation guiding of left atrial appendage occlusion.5.The 3D model guided by TEE and CT can provide important information for preoperative evaluation and decision making of left atrial appendage occlusion.6.At present,CMRI guided 3DPM is not feasible to assess SHD.