摘要目的:通过将左心耳3D模型置于体外动态流体中模拟左心耳封堵操作，评估术前模拟操作的准确性及应用价值。方法:回顾性分析2014年6月至2016年12月于武汉大学人民医院接受经导管左心耳封堵术的21例心房颤动患者的术前二维及三维经食管超声心动图(two/three-dimensional transesophagel echocardiography，2D/3D-TEE)图像，3D打印获取三种材料的左心耳模型，即硅胶－水凝胶左心耳模型、硅胶左心耳模型、Tangoplus左心耳模型，进行仿真度评估后置于体外动态流体系统中，模拟封堵操作并预测封堵器型号，分析其与术中最终使用的封堵器固定盘的相关性。根据21例患者术中2D/3D-TEE监测结果，获取封堵器压缩比，观察封堵器残余漏。再次将21例患者的左心耳模型置于体外动态流体中，使用与术中相同型号的封堵器模拟封堵操作，测量封堵器压缩比，观察封堵器残余漏，并与术中测值进行对比及相关性分析。结果:硅胶－水凝胶左心耳模型仿真度评分高于硅胶左心耳模型及Tangoplus左心耳模型。基于硅胶－水凝胶左心耳模型中封堵器固定盘内径与术中使用的封堵器固定盘内径相关性( r＝0.937， P<0.001)优于硅胶左心耳模型( r＝0.918， P<0.001)及Tangoplus左心耳模型( r＝0.895， P<0.001)。使用与术中相同型号的封堵器，硅胶－水凝胶左心耳模型中封堵器压缩比与术中封堵器压缩比差异无统计学意义( P＝0.908)。21例患者术中实际观察到7例封堵器残余漏，而硅胶－水凝胶左心耳模型中观察到4例，硅胶左心耳模型及Tangoplus左心耳模型中均观察到5例。 结论:基于硅胶－水凝胶左心耳模型建立左心耳封堵术前模拟系统有助于经皮左心耳封堵术前决策，模拟演练和术后效果评估。

abstractsObjective:To evaluate the accuracy and application value of the left atrial appendage(LAA) occlusion simulation in dynamic fluid in vitro based on left atrial appendage models. Methods:The preoperative two/three-dimensional transesophageal echocardiography(2D/3D-TEE) images of 21 patients with atrial fibrillation undergoing percutaneous LAA occlusion were retrospectively analyzed. LAA models with different materials (silicone-hydrogel LAA models, silicone LAA models and Tangoplus LAA models) were obtained by 3D printing. After simulation evaluation set models in a dynamic fluid system to simulate the occlusion operation, the type of occluder was predicted, the correlation between them and the final occluder used in the operation was analyzed.According to 2D/3D-TEE monitoring in 21 patients, the compression ratio of occluders was measured and the residual leakage around occluders was observed. With the same type occluder as in surgery, the compression ratio of occluders and residual leakage around the occluders in the three LAA models were observed and compared with intraoperative measurements, the descriptive and correlation analyses were conducted.Results:The simulation score of silicone-hydrogel LAA models was higher than those of silicone LAA models and Tangoplus LAA models. The occluder size in silicone-hydrogel LAA models was more correlated to the size used in the operation( r=0.937, P<0.001) than silicone LAA models ( r=0.918, P<0.001) and Tangoplus LAA models ( r=0.895, P<0.001). With the same size of occluder, there was no significant difference between the compression ratio of the occluder in silicone-hydrogel LAA models and intraoperative ( P=0.908). In 21 patients, 7 cases of residual leakage of occluder were observed during operation, while 4 cases were observed in silicone-hydrogel LAA, 5 cases were observed in silicone LAA models and 5 cases in Tangoplus LAA models. Conclusions:Preoperative simulation system of left atrial appendage occlusion based on silica gel-hydrogel model is helpful for preoperative decision-making, simulation exercise and post-operative evaluation of percutaneous left atrial appendage occlusion.