Mild anastomotic stenosis in patient-specific CABG model may enhance graft patency: a new hypothesis.
Mild anastomotic stenosis in patient-specific CABG model may enhance graft patency: a new hypothesis.
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DOI：
10.1371/journal.pone.0073769
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Kassab GS
中科院分区：
文献类型：
--
作者：
Huo Y;Luo T;Guccione JM;Teague SD;Tan W;Navia JA;Kassab GS
冠状动脉旁路移植术（CABG）吻合口血流形态复杂，可能影响血管的长期通畅。各种优化吻合设计的尝试并没有改善长期通畅。在这里，我们假设轻微的吻合口狭窄（狭窄面积约为40-60%）可能是适应性的，可以改善血流动力学条件，这可能有助于减缓动脉粥样硬化的进展。我们进一步假设狭窄的近端/远端部位有相反的变化，这可能是动脉粥样硬化从狭窄部位弥漫性扩张的危险因素。使用经过验证的分割软件包从计算机断层图像中提取出12个不同狭窄程度的患者特异性模型。采用三维有限元模型计算了包括壁面剪切应力（WSS）及其时空梯度（WSS梯度、WSSG和振荡剪切指数OSI）在内的流动模式。血流模拟结果表明，轻度吻合口狭窄显著增加了WSS (150dynes⋅cm−2)，降低了OSI(<0.02)，使得吻合口内血流动力学参数分布更加均匀，尽管近端/远端狭窄部位的WSS降低（<4 dynes⋅cm−2）。这些发现对移植物适应和长期通畅具有重要意义。
It is well known that flow patterns at the anastomosis of coronary artery bypass graft (CABG) are complex and may affect the long-term patency. Various attempts at optimal designs of anastomosis have not improved long-term patency. Here, we hypothesize that mild anastomotic stenosis (area stenosis of about 40–60%) may be adaptive to enhance the hemodynamic conditions, which may contribute to slower progression of atherosclerosis. We further hypothesize that proximal/distal sites to the stenosis have converse changes that may be a risk factor for the diffuse expansion of atherosclerosis from the site of stenosis. Twelve (12) patient-specific models with various stenotic degrees were extracted from computed tomography images using a validated segmentation software package. A 3-D finite element model was used to compute flow patterns including wall shear stress (WSS) and its spatial and temporal gradients (WSS gradient, WSSG, and oscillatory shear index, OSI). The flow simulations showed that mild anastomotic stenosis significantly increased WSS (>15 dynes⋅cm−2) and decreased OSI (<0.02) to result in a more uniform distribution of hemodynamic parameters inside anastomosis albeit proximal/distal sites to the stenosis have a decrease of WSS (<4 dynes⋅cm−2). These findings have significant implications for graft adaptation and long-term patency.
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DOI：
10.1152/ajpheart.00268.2009
发表时间：
2009-10-01
影响因子：
4.8
作者：
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通讯作者：
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影响因子：
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作者：
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DOI：
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发表时间：
1996-09-01
影响因子：
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作者：
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影响因子：
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DOI：
10.1016/j.ijheatmasstransfer.2004.01.021
发表时间：
2004-07-01
影响因子：
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作者：
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