Total cavopulmonary connection flow with functional left pulmonary artery stenosis - Angioplasty and fenestration in vitro
Total cavopulmonary connection flow with functional left pulmonary artery stenosis - Angioplasty and fenestration in vitro
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DOI：
10.1161/circulationaha.104.530931
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发表时间：
2005-11-22
期刊：
影响因子：
37.8
通讯作者：
Yoganathan, AP
中科院分区：
文献类型：
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作者：
Pekkan, K;Kitajima, HD;Yoganathan, AP
背景 - 在我们的全腔肺动脉连接 (TCPC) 多中心研究中，观察到一组患有长段左肺动脉 (LPA) 狭窄的患者 (35%)。临床上公认的 LPA 狭窄的有害影响激发了在 3 维患者特异性和理想化 TCPC 通路内进行计算流体动力学模拟研究。本研究的目的是量化和评估 LPA 狭窄对血流动力学的影响，并判断旨在治疗的介入策略。 方法和结果 - 在相等的血管肺阻力下进行模拟，对离散狭窄 (DS) 和具有不同阻塞程度（0% 至 80%）的弥漫性长段发育不全进行建模。研究了开窗尺寸为 2 至 6 毫米、心房压力为 4 至 14 毫米汞柱的模型。研究了患者特异性、DS 为 85% 的心外 TCPC 的原始配置，以及在计算机介质中将 LPA 扩张至 0% 狭窄的虚拟手术后的情况。随着阻塞的减少，性能指数呈指数级提高（R-2 > 0.99）。弥漫性长节段发育不全在肺灌注和心脏能量损失方面比 DS 严重约 50%。对显示 85% DS 狭窄的 3 维 Fontan 解剖结构进行虚拟血管成形术，左肺灌注增加 61%，心脏能量耗散减少 50%。开窗 4 毫米后，与 80% DS 病例相比，TCPC 挡板压力下降约 10%，左肺灌注减少约 8%。结论 - DS < 60% 和弥漫性长节段发育不全 < 40% 可以被认为是可以忍受的，因为两者仅导致左肺灌注减少 12%。与血管成形术相反，开窗术（从右向左分流）可降低 TCPC 压力，但代价是左右肺灌注减少。这些结果表明，Fontan 之前的计算流体动力学模拟对于确定 LPA 狭窄的血流动力学意义和干预的潜在益处可能很有价值。
Background - In our multicenter study of the total cavopulmonary connection (TCPC), a cohort of patients with long-segment left pulmonary artery (LPA) stenosis was observed (35%). The clinically recognized detrimental effects of LPA stenosis motivated a computational fluid dynamic simulation study within 3-dimensional patient-specific and idealized TCPC pathways. The goal of this study was to quantify and evaluate the hemodynamic impact of LPA stenosis and to judge interventional strategies aimed at treating it.Methods and Results - Simulations were conducted at equal vascular lung resistance, modeling both discrete stenosis (DS) and diffuse long-segment hypoplasia with varying degrees of obstruction (0% to 80%). Models having fenestrations of 2 to 6 mm and atrium pressures of 4 to 14 mm Hg were explored. A patient-specific, extracardiac TCPC with 85% DS was studied in its original configuration and after virtual surgery that dilated the LPA to 0% stenosis in the computer medium. Performance indices improved exponentially (R-2 > 0.99) with decreasing obstruction. Diffuse long-segment hypoplasia was approximate to 50% more severe with regard to lung perfusion and cardiac energy loss than DS. Virtual angioplasty performed on the 3-dimensional Fontan anatomy exhibiting an 85% DS stenosis produced a 61% increase in left lung perfusion and a 50% decrease in cardiac energy dissipation. After 4-mm fenestration, TCPC baffle pressure dropped by approximate to 10% and left lung perfusion decreased by approximate to 8% compared with the 80% DS case.Conclusions - DS < 60% and diffuse long-segment hypoplasia < 40% could be considered tolerable because both resulted in only a 12% decrease in left lung perfusion. In contrast to angioplasty, a fenestration (right-to-left shunt) reduced TCPC pressure at the cost of decreased left and right lung perfusion. These results suggest that pre-Fontan computational fluid dynamic simulation may be valuable for determining both the hemodynamic significance of LPA stenosis and the potential benefits of intervention.