Hemodynamically Unloading the Distal Pulmonary Circulation in Pulmonary Hypertension: A Modeling Study.
Hemodynamically Unloading the Distal Pulmonary Circulation in Pulmonary Hypertension: A Modeling Study.
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肺动脉高压中远端肺循环的血流动力学卸载：建模研究。
DOI：
10.1115/1.4051719
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Kheyfets,VitalyO
中科院分区：
文献类型：
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作者：
Walter,Rachelle;Hunter,Kendall;Stenmark,Kurt;Kheyfets,VitalyO
肺动脉高压（PH）是一种进行性疾病，其特征在于肺动脉（PA）阻抗的阻力性和反应性逐渐增加。先前在PH啮齿动物模型中的研究表明，降低左肺中的血流动力学负荷（通过束缚左PA）可逆转这种重塑现象。然而，对肺循环单侧进行绑扎不是一种可行的临床选择，因此-使用计算机模拟建模-我们评价了是否可以通过用顺应性合成PA替换近端脉管系统来重建绑扎效果。我们通过将近端脉管系统的一维模型与零维线传输模型结合到第12代，开发了肺循环的计算模型。使用该模型，我们进行了四次模拟：（1）对照;（2）PH;（3）左PA狭窄的PH;以及（4）近端血管顺应性恢复到对照水平的PH。模拟显示，与PH相关的血管变化导致远端循环中的脉压（PP）、最大压力（、最大壁面剪切应力（WSS）和最大周向应力（相对于对照）增加。对左肺动脉结扎可降低左肺血流动力学应力的测量值，但可增加右肺血流动力学应力的测量值。此外，左PA条带增加了无功PA阻抗。然而，将近端PA顺应性恢复到对照水平同时降低了两肺中血流动力学应力的所有测量值，并将反应性PA阻抗恢复到正常水平。总之，如果未来的体内研究支持血流动力学卸载作为PH的有效治疗方法的想法，则可以通过用顺应性假体置换近端PA来手术实现，并且它将具有减少反应性右心室后负荷的额外益处。
Pulmonary hypertension (PH) is a progressive disease that is characterized by a gradual increase in both resistive and reactive pulmonary arterial (PA) impedance. Previous studies in a rodent model of PH have shown that reducing the hemodynamic load in the left lung (by banding the left PA) reverses this remodeling phenomenon. However, banding a single side of the pulmonary circulation is not a viable clinical option, so-using in silico modeling–we evaluated if the banding effect can be recreated by replacing the proximal vasculature with a compliant synthetic PA. We developed a computational model of the pulmonary circulation by combining a one-dimensional model of the proximal vasculature with a zero-dimensional line transmission model to the 12th generation. Using this model, we performed four simulations: (1) Control; (2) PH; (3) PH with a stenosis in the left PA; and (4) PH with proximal vessel compliance returned to Control levels. Simulations revealed that vascular changes associated with PH result in an increase in pulse pressure (PP), maximum pressure (, maximum wall shear stress (WSS), and maximum circumferential stress (relative to controls, in the distal circulation. Banding the left PA reduced these measurements of hemodynamic stress in the left lung, but increases them in the right lung. Furthermore, left PA banding increased reactive PA impedance. However, returning the proximal PA compliance to Control levels simultaneously decreased all measures of hemodynamic stress in both lungs, and returned reactive PA impedance to normal levels. In conclusion, if future in vivo studies support the idea of hemodynamic unloading as an effective therapy for PH, this can be surgically achieved by replacing the proximal PA with a compliant prosthesis, and it will have the added benefit of reducing reactive right ventricular afterload.