Abstract：
OBJECTIVE: In this case report, the auxiliary role of deep learning and 3-dimensional printing technology in the perioperative period was discussed to guide transcatheter aortic valve replacement and coronary stent implantation simultaneously.
METHODS: A 68-year-old man had shortness of breath and chest tightness, accompanied by paroxysmal nocturnal dyspnea, 2 weeks before presenting at our hospital. Echocardiography results obtained in the outpatient department showed severe aortic stenosis combined with regurgitation and pleural effusion. The patient was first treated with closed thoracic drainage. After 800 mL of pleural effusion was collected, the patient\'s symptoms were relieved and he was admitted to the hospital. Preoperative transthoracic echocardiography showed severe bicuspid aortic valve stenosis combined with calcification and aortic regurgitation (mean pressure gradient, 42 mmHg). Preoperative computed tomography results showed a type I bicuspid aortic valve with severe eccentric calcification. The leaflet could be seen from the left coronary artery plane, which indicated an extremely high possibility of coronary obstruction. After preoperative imaging assessment, deep learning and 3-dimensional printing technology were used for evaluation and simulation. Guided transcatheter aortic valve replacement and a coronary stent implant were completed successfully. Postoperative digital subtraction angiography showed that the bioprosthesis and the chimney coronary stent were in ideal positions. Transesophageal echocardiography showed normal morphology without paravalvular regurgitation.
CONCLUSIONS: The perioperative guidance of deep learning and 3-dimensional printing are of great help for surgical strategy formulation in patients with severe bicuspid aortic valve stenosis with calcification and high-risk coronary obstruction.
METHODS: A 68-year-old man had shortness of breath and chest tightness, accompanied by paroxysmal nocturnal dyspnea, 2 weeks before presenting at our hospital. Echocardiography results obtained in the outpatient department showed severe aortic stenosis combined with regurgitation and pleural effusion. The patient was first treated with closed thoracic drainage. After 800 mL of pleural effusion was collected, the patient\'s symptoms were relieved and he was admitted to the hospital. Preoperative transthoracic echocardiography showed severe bicuspid aortic valve stenosis combined with calcification and aortic regurgitation (mean pressure gradient, 42 mmHg). Preoperative computed tomography results showed a type I bicuspid aortic valve with severe eccentric calcification. The leaflet could be seen from the left coronary artery plane, which indicated an extremely high possibility of coronary obstruction. After preoperative imaging assessment, deep learning and 3-dimensional printing technology were used for evaluation and simulation. Guided transcatheter aortic valve replacement and a coronary stent implant were completed successfully. Postoperative digital subtraction angiography showed that the bioprosthesis and the chimney coronary stent were in ideal positions. Transesophageal echocardiography showed normal morphology without paravalvular regurgitation.
CONCLUSIONS: The perioperative guidance of deep learning and 3-dimensional printing are of great help for surgical strategy formulation in patients with severe bicuspid aortic valve stenosis with calcification and high-risk coronary obstruction.
摘要：
目的：在本案例报告中，探讨了深度学习和3D打印技术在围手术期的辅助作用，以同时指导经导管主动脉瓣置换术和冠状动脉支架植入术。
方法：一名68岁的男子出现呼吸急促和胸闷，伴有阵发性夜间呼吸困难，在我们医院就诊前两周。在门诊获得的超声心动图结果显示严重的主动脉瓣狭窄合并反流和胸腔积液。患者首先接受胸腔闭式引流治疗。收集胸腔积液800mL后,病人的症状得到缓解，他被送进医院。术前经胸超声心动图显示主动脉瓣严重二叶狭窄合并钙化和主动脉瓣反流（平均压力梯度，42mmHg）。术前计算机断层扫描结果显示I型二叶主动脉瓣伴严重偏心钙化。从左冠状动脉平面可以看到小叶，这表明冠状动脉阻塞的可能性极高。术前影像学评估后，使用深度学习和三维打印技术进行评估和仿真。成功完成引导下经导管主动脉瓣置换术和冠状动脉支架植入。术后数字减影血管造影显示生物假体和烟囱冠状动脉支架处于理想位置。经食管超声心动图显示形态正常，无瓣膜旁反流。
结论：深度学习和3D打印的围手术期指导对重度主动脉瓣狭窄伴钙化和高危冠状动脉梗阻患者的手术策略制定有很大帮助。
方法：一名68岁的男子出现呼吸急促和胸闷，伴有阵发性夜间呼吸困难，在我们医院就诊前两周。在门诊获得的超声心动图结果显示严重的主动脉瓣狭窄合并反流和胸腔积液。患者首先接受胸腔闭式引流治疗。收集胸腔积液800mL后,病人的症状得到缓解，他被送进医院。术前经胸超声心动图显示主动脉瓣严重二叶狭窄合并钙化和主动脉瓣反流（平均压力梯度，42mmHg）。术前计算机断层扫描结果显示I型二叶主动脉瓣伴严重偏心钙化。从左冠状动脉平面可以看到小叶，这表明冠状动脉阻塞的可能性极高。术前影像学评估后，使用深度学习和三维打印技术进行评估和仿真。成功完成引导下经导管主动脉瓣置换术和冠状动脉支架植入。术后数字减影血管造影显示生物假体和烟囱冠状动脉支架处于理想位置。经食管超声心动图显示形态正常，无瓣膜旁反流。
结论：深度学习和3D打印的围手术期指导对重度主动脉瓣狭窄伴钙化和高危冠状动脉梗阻患者的手术策略制定有很大帮助。
