transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2022-9-2-81-94transmed-667Research ArticleКОМПЬЮТЕРНОЕ МОДЕЛИРОВАНИЕ И ЭПИДЕМИОЛОГИЧЕСКИЕ ИССЛЕДОВАНИЯCOMPUTER MODELING AND EPIDEMIOLOGYВысокоточная компьютерная сегментация аортального клапана и корня аортыHigh-precision computer segmentation of the aortic valve and aortic rootФилипповА. А.FilippovA. A.

Филиппов Алексей Александрович, младший научный сотрудник, врач сердечно-сосудистый хирург

Санкт-Петербург

Alexey A. Filippov, junior researcher, adult cardiovascular surgeon

Saint Petersburg

aleksei.filippov.chb@gmail.comhttps://orcid.org/0000-0002-7929-0594УспенскийВ. Е.UspenskiyV. E.

Успенский Владимир Евгеньевич, доцент кафедры сердечно-сосудистой хирургии, заведующий НИЛ заболеваний аорты и аортального клапана

ул. Аккуратова, д. 2, Санкт-Петербург, 197341

Vladimir E. Uspenskiy, Associate Professor of the Department of Cardiovascular Surgery, Head of the Research Laboratory of Aorta and Aortic Valve Diseases

Akkuratova str., 2, Saint Petersburg, 197341

uspenskiyv@yahoo.comhttps://orcid.org/0000-0002-2176-4611КаревЕ. А.KarevE. A.

Карев Егор Андреевич, врач функциональной диагностики, младший научный сотрудник

Санкт-Петербург

Egor A. Karev, doctor of functional diagnostics, junior researcher

Saint Petersburg

karevea@mail.ruКвиндтП. А.KvindtPavel A.

Квиндт Павел Александрович, младший научный сотрудник

Санкт-Петербург

Pavel A. Kvindt, junior researcher

Saint Petersburg

pakvindt@gmail.comПищугинА. С.PishchuginA. S.

Пищугин Александр Сергеевич, врач по рентгенэндоваскулярной диагностике и лечению

Санкт-Петербург

Alexander S. Pishchugin, doctor for X-ray endovascular diagnosis and treatment

Saint Petersburg

pischuginalexander@gmail.comhttps://orcid.org/0000-0002-0820-2913МалашичеваА. Б.MalashichevaA. B.

Малашичева Анна Борисовна, д.б.н., старший научный сотрудник

Санкт-Петербург

Anna B. Malashicheva, D.Sc., senior researcher

Saint Petersburg

amalashicheva@gmail.comТолпыгинД. С.TolpyginD. S.

Толпыгин Дмитрий Сергеевич, врач сердечно-сосудистый хирург

Санкт-Петербург

Dmitry S. Tolpygin, adult cardiovascular surgeon

Saint Petersburg

tolpygin_ds@almazovcentre.ruhttps://orcid.org/0000-0002-7817-3847МоисееваО. М.MoiseevaO. M.

Моисеева Ольга Михайловна, д.м.н., главный научный сотрудник, руководитель НИО некоронарогенных заболеваний сердца

Санкт-Петербург

Olga M. Moiseeva, D.Sc., Chief Researcher, Head of the Research Institute of Non-coronary Heart Diseases

Saint Petersburg

moiseeva_om@almazovcentre.ruГордеевМ. Л.GordeevM. L.

Гордеев Михаил Леонидович, д.м.н., профессор, главный научный сотрудник НИО кардиоторакальной хирургии, заведующий кафедрой сердечно-сосудистой хирургии

Санкт-Петербург

Mikhail L. Gordeev, D.Sc., Professor, Chief Researcher of the Research Department of Cardiothoracic Surgery, Head of the Department of Cardiovascular Surgery

Saint Petersburg

gordeev@almazovcentre.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian Federation202211062022928194Copyright © Филиппов А.А., Успенский В.Е., Карев Е.А., Квиндт П.А., Пищугин А.С., Малашичева А.Б., Толпыгин Д.С., Моисеева О.М., Гордеев М.Л., 20222022Филиппов А.А., Успенский В.Е., Карев Е.А., Квиндт П.А., Пищугин А.С., Малашичева А.Б., Толпыгин Д.С., Моисеева О.М., Гордеев М.Л.Filippov A.A., Uspenskiy V.E., Karev E.A., Kvindt P.A., Pishchugin A.S., Malashicheva A.B., Tolpygin D.S., Moiseeva O.M., Gordeev M.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/667Актуальность

Актуальность. Клапаносберегающее протезирование корня аорты с реимплантацией аортального клапана — активно развивающийся метод лечения аневризмы восходящей аорты. Улучшение результатов этого метода неразрывно связано с пониманием связей исходных функциональных и планиметрических характеристик клапанно-аортального комплекса, технических аспектов процедуры реимплантации и полученных результатов.

Цель

Цель. Поиск и анализ ранее малоизученных факторов — планиметрических характеристик аортального клапана и корня аорты.

Материалы и методы

Материалы и методы. Высокоточная оценка планиметрии аортальных створок требует прецизионных методов визуализации и последующих построений виртуальных трехмерных реконструкций. Создание высокоточных реконструкций стало возможно благодаря внедрению в клиническую практику специализированных сред автоматизированного проектирования. В связи с технической сложностью ни один из известных методов ранее не использовался для точного измерения всех структур корня аорты у большой группы пациентов. Нерешенными задачами остаются упрощение, ускорение построения реконструкции, а также масштабирование этой методики.

Результаты

Результаты. Основным итогом данной работы стало создание алгоритма сегментации корня аорты и построения высокоточной трехмерной реконструкции аортального клапана, а также практическая реализация алгоритма определения основных его планиметрических параметров с возможностью масштабирования на большую группу пациентов.

Заключение

Заключение. Метод позволяет построить высокоточную трехмерную реконструкцию внутренних структур корня аорты в течение нескольких часов и представляет ценность как для определения тактики и технических особенностей оперативного лечения пациента, так и для изучения влияния анатомии корня аорты на развитие рецидива аортальной недостаточности после клапаносберегающей операции.

Background

Background. Valve-sparing aortic root replacement with aortic valve reimplantation is a rapidly developing method of treatment of ascending aortic aneurysm. The improvement of the results of this method is inextricably linked with the understanding of the relationships between the initial functional and planimetric characteristics of the valvular-aortic complex, the technical aspects of the reimplantation procedure and the results obtained.

Objective

Objective. To search and analyze previously little-studied factors — the planimetric characteristics of the aortic valve and the aortic root.

Design and methods

Design and methods. High-precision assessment of the planimetry of the aortic flaps requires precision visualization methods and subsequent creation of virtual three-dimensional models. The creation of high-precision reconstructions became possible due to the introduction of specialized computer-aided design environments into clinical practice. Due to the technical complexity, none of the known methods has previously been used to accurately measure all the structures of the aortic root in a large group of patients. Simplification, acceleration of reconstruction construction, as well as scaling of this technique remain unresolved tasks.

Results

Results. The main result of this work is the development of an algorithm of segmentation of the aortic root and the construction of a high-precision three-dimensional model of the aortic valve, as well as the practical implementation of an algorithm for determining main planimetric parameters of the aortic root with the possibility of scaling to a large group of patients.

Conclusion

Conclusion. The method makes it possible to construct a high-precision three-dimensional reconstruction of the internal structures of the aortic root within a few hours and is valuable both for determining the tactics and technical features of surgical treatment of the patient, and for studying the effect of the anatomy of the aortic root on the development of recurrence of aortic insufficiency after valve-sparing surgery.

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The authors declare that there are no conflicts of interest present.