Apicoaortic conduit and cerebral perfusion in mixed aortic valve disease: a computational analysis.
Apicoaortic conduit and cerebral perfusion in mixed aortic valve disease: a computational analysis.
复制标题
混合主动脉瓣疾病中的顶主动脉导管和脑灌注：计算分析。
DOI：
10.1093/icvts/ivt379
复制
发表时间：
2013
影响因子：
--
通讯作者：
A. Renzulli
中科院分区：
文献类型：
--
作者：
G. Fragomeni;M. Rossi;F. Condemi;R. Mazzitelli;G. Serraino;A. Renzulli
目标
主动脉瓣尖管道的复兴引起了人们对这种不适合传统瓣膜置换术的严重主动脉瓣狭窄的替代治疗的新兴趣。然而，对主动脉瓣尖管道植入后主动脉上血管的灌注仍然存在疑问，特别是当严重的主动脉瓣狭窄伴主动脉瓣关闭不全时。本研究的目的是评价混合性主动脉瓣疾病患者在主动脉瓣尖管道植入术前后主动脉上血管（无名动脉、左颈动脉和左锁骨下动脉）的灌注。
方法
我们从一位患有严重主动脉瓣狭窄和轻度主动脉瓣关闭不全并接受主动脉瓣管道植入术的真实的患者的数据出发，创建了一个计算模型，其中严重主动脉瓣狭窄与不同程度的主动脉瓣关闭不全（轻度、中度和中度）相关。
结果
共分析了6种组合。在所有模拟中，伴随的主动脉瓣关闭不全越严重，通过主动脉上血管的血流减少越多。与植入前混合主动脉瓣疾病的相同组合相比，主动脉瓣管道植入后，每个主动脉瓣上血管的中位输出量绝对增加。有趣的是，来自降主动脉中管道的逆行血流极少，并且不会促进主动脉上血管输出量的改善。
结论
计算分析表明，即使在混合性主动脉瓣疾病的情况下，心尖主动脉导管对脑灌注也具有保护作用，而不是盗血现象。
OBJECTIVES
The revival of the apicoaortic conduit has attracted new interest in this alternative treatment for severe aortic stenosis unsuitable for conventional valve replacement. However, doubts still exist about the perfusion of the epiaortic vessels after apicoaortic conduit implantation, especially when severe aortic stenosis is associated with aortic valve insufficiency. The aim of the study was to evaluate the perfusion of the epiaortic vessels (innominate artery, left carotid artery and left subclavian artery) in cases of mixed aortic valve disease before and after apicoaortic conduit implantation.
METHODS
Starting from the data of a real patient with severe aortic stenosis and mild aortic insufficiency who underwent apicoaortic conduit implantation, we created a computational model where severe aortic valve stenosis was associated with different grades of aortic insufficiency (mild, medium and moderate).
RESULTS
A total of six combinations were analysed. In all simulations, the more severe the concomitant aortic insufficiency, the more the flow through the epiaortic vessels was diminished. After apicoaortic conduit implantation, there was an absolute augmentation of the median output in each epiaortic vessel compared with the same combination of mixed aortic valve disease before implantation. Interestingly, retrograde flow from the conduit in the descending aorta was minimal and did not contribute to the improved output of the epiaortic vessels.
CONCLUSIONS
The computational analysis suggested a protective effect, rather than steal phenomenon, of the apicoaortic conduit towards the cerebral perfusion, even in cases of mixed aortic valve disease.