患者データから自施設で作製した中空立体模型を用いた，成人動脈管開存の経皮的閉鎖術シミュレーション

Koichi Kataoka; 片岡功一; Masaaki Kawada; 河田政明; Daisuke Matsubara; 松原大輔; Kensuke Oka; 岡健介; Shun Suzuki; 鈴木峻; Takaomi Minami; 南孝臣; Yasushi Imai; 今井靖

doi:10.20599/jjpic.2.14

患者データから自施設で作製した中空立体模型を用いた，成人動脈管開存の経皮的閉鎖術シミュレーションSimulation using patient-specific hollow three-dimensional models for percutaneous closure of patent ductus arteriosus in adult

片岡功一^1,2,3，河田政明^1,3,4，松原大輔²，岡健介²，鈴木峻²，南孝臣²，今井靖³Koichi Kataoka^1,2,3, Masaaki Kawada^1,3,4, Daisuke Matsubara², Kensuke Oka², Shun Suzuki², Takaomi Minami², Yasushi Imai³

¹ 自治医科大学とちぎ子ども医療センター小児手術・集中治療部Pediatric Operating Suite and Intensive Care Unit, Jichi Children’s Medical Center Tochigi ◇ Tochigi, Japan

² 自治医科大学小児科Department of Pediatrics, Jichi Medical University ◇ Tochigi, Japan

³ 自治医科大学成人先天性心疾患センターAdult Congenital Heart Disease Center, Jichi Medical University ◇ Tochigi, Japan

⁴ 自治医科大学とちぎ子ども医療センター小児・先天性心臓血管外科Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi ◇ Tochigi, Japan

受付日：2017年6月12日Received: June 12, 2017

受理日：2017年7月6日Accepted: July 6, 2017

発行日：2017年8月31日Published: August 31, 2017

【背景と目的】成人動脈管開存（PDA）の経皮的閉鎖術において，留置時の閉鎖栓の形状を正確に予測することは困難である．患者データから作製した中空立体模型を用いた，成人PDAの経皮的閉鎖術シミュレーションの有用性を検討する．

【対象と方法】対象は成人PDA4症例．年齢は54～75歳，Krichenko分類はE 3症例，D1症例であった．CT画像データから3Dプリンターで造形した実体模型を元に透明シリコーン製中空模型を作製し，AMPLATZER™ Duct OccluderおよびAMPLATZER™ Vascular Plug IIの留置形状をシミュレーションして閉鎖術に臨んだ．

【結果】中空模型の作製時間は3日，作製費用は約1万円であった．留置した閉鎖栓は良好に透見でき，手にとって様々な角度から観察することで，最適な閉鎖栓を選択しえた．

【考察と結論】透明シリコーン製中空立体模型はPDAの経皮的閉鎖術シミュレーターとして優れ，特に成人症例で有用性が高い．

Background and Objective: It is challenging to accurately predict the shape and stability of occlusion devices during percutaneous closure of patent ductus arteriosus (PDA) in adults. In this study, we evaluate the utility of percutaneous closure simulation of PDA in adults using patient-specific hollow three-dimensional (3D) models created from computed tomography data.

Methods: The study was conducted on four adult patients with PDA, whose age ranged from 54 to 75 years. While three were type E as per the Krichenko classification, one was type D. We created a transparent silicone hollow model using a solid model, which was printed by a personal 3D printer from contrast-enhanced multidetector computed tomography data, as a mold. All processes were carried out at our institution. Before actually performing percutaneous closure of PDA, we simulated procedures using these models and investigated the shape and stability of AMPLATZER™ Duct Occluder/AMPLATZER™ Vascular Plug deployed in them.

Results: Briefly, the time and cost required to create a hollow 3D model were about 3 days and 10,000 Japanese Yen, respectively. It was very easy to recognize the shape and stability of deployed devices in these models because the devices were clearly visible from outside. In fact, these models could be picked up by hands and observed from various angles, which was helpful in selecting optimum devices for closure.

Conclusions: The transparent silicone hollow models are an excellent simulator of percutaneous closure of PDA, especially in adults.

Key words: simulation; three-dimensional printing; patent ductus arteriosus; percutaneous closure; adult

Journal of JCIC

原著Original Article

患者データから自施設で作製した中空立体模型を用いた，成人動脈管開存の経皮的閉鎖術シミュレーションSimulation using patient-specific hollow three-dimensional models for percutaneous closure of patent ductus arteriosus in adult