论文标题

单个心室患者主动脉重建的计算研究

A computational study of aortic reconstruction in single ventricle patients

论文作者

Taylor-LaPole, Alyssa M., Colebank, Mitchel J., Weigand, Justin D., Olufsen, Mette S., Puelz, Charles

论文摘要

患有左心脏综合征(HLHS)的患者出生于左心脏欠发达的患者。他们通常会接受一系列手术,导致单个心室生理学称为Fontan循环。尽管这些患者通常能够生存到成年初期,但他们有医疗并发症的风险,部分原因是他们的心脏输出率低,这导致大脑和肠道灌注不足。虽然临床成像数据可以提供对成像区域内心血管功能的详细见解,但很难将这些数据用于评估身体其余部分的缺陷并导致血压动态。本文中使用的患者的数据包括三维,磁共振血管造影(MRA),时间分辨相对比心脏磁共振图像(4D-MRI)和血压计血压测量值。 4D-MRI图像提供了对成像区域内血管中速度和流动的详细见解,但是它们无法预测体内其余部分的流动,也无法提供血压值。为了解决这些局限性,本研究将MRA,4D-MRI和压力数据与1D流体动力学模型相结合,以预测主要全身动脉的血液动力学,包括大脑和肠管脉管系统。为了研究手术后的效果,我们将HLHS患者的模拟与匹配的对照患者的模拟进行了比较,该患者具有双出口右心室(DORV)生理学和天然主动脉的模拟。我们的结果表明,HLHS患者在大脑中具有高血压压力,并且流向肠道。波强度分析表明,HLHS患者在光直立的运动条件下具有不规则的循环功能,并且预测壁剪应力低于正常,这表明HLHS患者可能患有高血压。

Patients with hypoplastic left heart syndrome (HLHS) are born with an underdeveloped left heart. They typically receive a sequence of surgeries that result in a single ventricle physiology called the Fontan circulation. While these patients usually survive into early adulthood, they are at risk for medical complications, partially due to their lower than normal cardiac output, which leads to insufficient cerebral and gut perfusion. While clinical imaging data can provide detailed insight into cardiovascular function within the imaged region, it is difficult to use this data for assessing deficiencies in the rest of the body and for deriving blood pressure dynamics. Data from patients used in this paper include three dimensional, magnetic resonance angiograms (MRA), time-resolved phase contrast cardiac magnetic resonance images (4D-MRI) and sphygmomanometer blood pressure measurements. The 4D-MRI images provide detailed insight into velocity and flow in vessels within the imaged region, but they cannot predict flow in the rest of the body, nor do they provide values of blood pressure. To remedy these limitations, this study combines the MRA, 4D-MRI, and pressure data with 1D fluid dynamics models to predict hemodynamics in the major systemic arteries, including the cerebral and gut vasculature. To study effects post-surgery we compare simulations for an HLHS patient with simulations for a matched control patient that has double outlet right ventricle (DORV) physiology with a native aorta. Our results show that the HLHS patient has hypertensive pressures in the brain as well as reduced flow to the gut. Wave-intensity analysis suggests that the HLHS patient has irregular circulatory function during light upright exercise conditions and that predicted wall-shear stresses are lower than normal, suggesting the HLHS patient may have hypertension.

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