Blood flow energy loss: a predictor for the recovery of left ventricular function after bioprosthetic aortic valve replacement
Blood flow energy loss: a predictor for the recovery of left ventricular function after bioprosthetic aortic valve replacement
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DOI：
10.1093/icvts/ivab094
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发表时间：
2021-05-08
影响因子：
--
通讯作者：
Yaku, Hitoshi
中科院分区：
文献类型：
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作者：
Hohri, Yu;Itatani, Keiichi;Yaku, Hitoshi
提示：难以估计主动脉瓣置换术（AVR）后左心室（LV）功能的改善。本研究旨在评价能量损失（EL）是否可以预测AVR后的术后左室功能。方法：9例接受生物瓣膜AVR的患者入组本研究。5例患者使用猪心包假体，4例患者使用牛心包假体。主动脉血流模式进行可视化和EL和心输出量（CO）进行了测量，使用4维流动磁共振成像从LV到降主动脉; EL/CO的比率在提取的区域计算为总EL/CO ratio.RESULTS：与猪瓣膜，严重的螺旋流观察到在升主动脉在全收缩期。相比之下，牛心包瓣膜，在收缩早期观察到直的跨瓣主动脉血流，在收缩中期后，在升主动脉的大弯和小弯两侧出现2个大涡流。总EL/CO比值与主动脉瓣置换术后左室射血分数的改善密切相关（r = 0.74，P = 0.02）。总EL/CO比值是评价AVR术后左室射血分数改善的有价值的工具。优化总EL/CO比值有可能改善AVR后的血流动力学性能。
OBJECTIVES: It is difficult to estimate the improvement in left ventricular (LV) function after aortic valve replacement (AVR). The present study aimed to evaluate whether energy loss (EL) can predict the postoperative LV function after AVR.METHODS: Nine patients who underwent AVR with a bioprosthetic valve were enrolled in the present study. Porcine prostheses were used in 5 patients and bovine pericardial prostheses were used in 4 patients. The aortic flow pattern was visualized and EL and cardiac output (CO) were measured using 4-dimensional flow magnetic resonance imaging from the LV to the descending aorta; the EL/CO ratio in the extracted area was calculated as total EL/CO ratio.RESULTS: With a porcine valve, a severe helical flow was observed in the ascending aorta during the holosystolic phase. In contrast, with a bovine pericardial valve, straight transvalvular aortic flow was observed in the early systolic phase and 2 large vortical flows occurred on both sides of the greater and lesser curvature of the ascending aorta after the mid-systolic period. The total EL/CO ratio was strongly correlated with LV ejection fraction improvement after AVR (r = 0.74, P = 0.02).CONCLUSIONS: The aortic flow pattern is different between the porcine valve and bovine pericardial valve. The total EL/CO ratio is a valuable tool for evaluating the postoperative LV ejection fraction improvement after AVR. Optimization of total EL/CO ratio would have potential to improve haemodynamic performances after AVR.