Abstract

OBJECTIVES

We compared the effectiveness of virtual 3-dimensional (3D) models with 2-dimensional (2D) transthoracic echocardiography (TTE) for evaluating the anatomy of the interventricular septum (IVS) and abnormal muscle bundles (AMBs) in planning septal myectomy (SM).

METHODS

Between January 2017 and July 2020, 103 consecutive symptomatic patients with hypertrophic cardiomyopathy underwent 2D TTE and cardiovascular magnetic resonance imaging in 49 (47.6%) or computed tomography angiography in 54 (52.4%) patients with 3D IVS modelling for SM planning. We evaluated maximal IVS thickness and location, length and thickness of AMBs.

RESULTS

The mean maximal IVS thickness by 2D TTE was 7.3 [standard deviation (SD) 4.8] mm less than that based on the 3D model analysis: 21.4 (SD 3.7) vs 28.6 (SD 5.5) mm, respectively (P < 0.001, 95% confidence interval 6.4–8.2). The planned volume of ideal SM was larger than that of performed SM: 26.2 (18.4–39.4) vs 10.3 (7.4–12.8) cm³, respectively (P < 0.001). The sensitivity and specificity of 2D TTE in diagnosing AMBs were 36.9% and 95%, and those of cardiovascular magnetic resonance and computed tomography angiography with 3D modelling were 97.1% and 100% for cardiovascular magnetic resonance and 98% and 100% for computed tomography angiography, respectively. AMBs occurred in 84 (81.6%) patients. No patient required mitral valve replacement. The 30-day mortality was 1 patient. There were 4 late non-cardiac deaths (3.9%) within 18.1 (standard error 1.32) months.

CONCLUSIONS

Anatomical analysis of the IVS and AMBs based on their virtual 3D models is highly effective for SM planning.

中文翻译：

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室间隔肌切除术三维室间隔及异常肌束模型分析

摘要

目标

我们比较了虚拟 3 维 (3D) 模型与 2 维 (2D) 经胸超声心动图 (TTE) 的有效性，用于评估室间隔 (IVS) 和异常肌束 (AMB) 的解剖结构以计划进行间隔肌切除术 (SM) .

方法

在 2017 年 1 月至 2020 年 7 月期间，连续 103 名有症状的肥厚型心肌病患者接受了 49 名 (47.6%) 的 2D TTE 和心血管磁共振成像，或 54 名 (52.4%) 的 54 名 (52.4%) 患者接受了用于 SM 计划的 3D IVS 建模的计算机断层扫描血管造影。我们评估了 AMB 的最大 IVS 厚度和位置、长度和厚度。

结果

2D TTE 的平均最大 IVS 厚度比基于 3D 模型分析的值小 7.3 [标准偏差 (SD) 4.8] mm：分别为 21.4 (SD 3.7) 和 28.6 (SD 5.5) mm ( P  <  0.001, 95%置信区间 6.4-8.2）。理想 SM 的计划体积比已执行的 SM 大：分别为 26.2 (18.4–39.4) vs 10.3 (7.4–12.8) cm ³（P  < 0.001)。2D TTE 诊断 AMB 的敏感性和特异性分别为 36.9% 和 95%，心血管磁共振和 3D 建模的 CT 血管造影对心血管磁共振的敏感性和特异性分别为 97.1% 和 100%，对 CT 血管造影的敏感性和特异性分别为 98% 和 100% ， 分别。84 名 (81.6%) 患者发生 AMB。没有患者需要更换二尖瓣。30 天死亡率为 1 名患者。在 18.1 个月（标准误差 1.32）内有 4 例晚期非心脏死亡（3.9%）。

结论

基于虚拟 3D 模型的 IVS 和 AMB 的解剖分析对于 SM 规划非常有效。