术前使用左心耳3D模型及左心耳封堵体外模拟治疗心房颤动患者的疗效

摘要 目的：探讨术前使用左心耳3D模型及左心耳封堵体外模拟治疗心房颤动患者的疗效。方法：回顾性选择2021年1月至2022年10月来我院诊治的心房颤动患者，对照组行经食管超声心动图检查、心脏CT造影检查及左心耳封堵术。观察组行经食管超声心动图检查、心脏CT造影检查、基于心脏CT造影数据打印左心耳3D模型、应用3D打印模型进行左心耳封堵体外模拟演练及左心耳封堵术，对比两组相关指标。结果：两组经食管超声心动图检查左心耳各径线对比无差异（P>0.05）。两组经CT检查左心耳各径线对比无差异（P>0.05）。两组封堵器固定大小对比有差异（P<0.05）。术后经食管超声心动图检查发现，观察组术后3个月及12个月血流通过封堵器几率高于对照组，但组间对比无差异（P>0.05）。术后3个月及12个月时，两组的左心房内径降低，且同时间点观察组较对照组（P<0.05）；两组术后3个月及12个月时左心室内径对比无差异（P>0.05）。观察组的封堵器型号匹配率较对照组高，手术操作时间、X线曝光量、造影剂使用量、封堵器术中释放次数较对照组低（P<0.05），观察组的残余分流及手术并发症较对照组低，但组间对比无差异（P>0.05）。观察组术后3个月封堵器位置、有无残腔及不良心血管事件与对照组相比无差异（P>0.05），术后12个月，封堵器位置良好率较对照组低（P<0.05），其余两组间对比无差异（P>0.05）。结论：术前使用左心耳3D模型及左心耳封堵体外模拟可提高心房颤动患者的疗效。

The 3D Model of the Left Atrial Appendage and the Occlusion of the Left Atrial Appendage Were Used to Simulate the Effect of Atrial Fibrillation in Vitro

ABSTRACT Objective: To investigate the efficacy of preoperative left atrial appendage 3D model and left atrial appendage occlusion in vitro in the treatment of patients with atrial fibrillation. Methods: Patients with atrial fibrillation who came to our hospital from January 2021 to October 2022 were retrospectively selected, and the control group underwent transesophageal echocardiography, cardiac CT angiography and left auricular occlusion. In the observation group, transesophageal echocardiography, cardiac CT angiography, 3D model of the left heart ear was printed based on cardiac CT angiography data, and the 3D printed model was used to perform the in vitro simulation exercise of left ear occlusion and left ear occlusion, and the related indexes of the two groups were compared. Results: There was no difference between the left atrial appendage lines examined by transesophageal echocardiography (P>0.05). There was equal between the two groups (P>0.05). The fixed size comparison between the two blocking groups was different (P<0.05). Postoperative transesophageal echocardiography revealed that the probability of blood flow through the blocker was higher in the observation group than in the control group at 3 and 12 months postoperatively, but there was no difference between the groups (P>0.05). At 3 and 12 months postoperatively, the left atrial internal diameter decreased in both groups, and the observation group had a higher rate than the control group at the same time point (P<0.05); there was no difference in the left ventricular internal diameter between the two groups at 3 and 12 months postoperatively (P>0.05). The rate of blocker type matching was higher in the observation group than in the control group, and the operation time, X-ray exposure, contrast agent use, and intraoperative release of blocker were lower in the observation group than in the control group (P<0.05). Residual shunts and surgical complications were lower in the observation group than in the control group, but there was equal in the comparison between the groups (P>0.05). The position of occluder, residual space and adverse cardiovascular events at 3 and 12 months were lower than that of the control group. At 12 months after surgery, the good rate of occluder position was lower than that of the control group (P<0.05), and there was equal between the remaining two groups (P>0.05). Conclusion: Preoperative use of 3D model of left atrial appendage and in vitro simulation of left atrial appendage occlusion can improve the efficacy of patients with atrial fibrillation.