Effects of blood flow dynamics on autologous pericardial degeneration in reconstructed pulmonary arteries
Effects of blood flow dynamics on autologous pericardial degeneration in reconstructed pulmonary arteries
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DOI：
10.1093/icvts/ivx293
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发表时间：
2018-02-01
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：
Kato, Nobuyasu;Yamagishi, Masaaki;Yaku, Hitoshi
目的：为明确自体心包异常变性的危险因素，在肺动脉闭锁和室间隔缺损时，采用自体心包和肺动脉主要侧支动脉重建肺动脉，并假设其血流湍流对内皮组织产生机械应力。根据6例患者在主要髂动脉侧支动脉单定位后拍摄的既往计算机断层扫描图像，为他们创建了患者特异性PA模型。建立了包括外周反射波、特征阻抗和自主调节系统在内的生理脉动流的计算流体动力学模型。根据模拟结果计算了流动流线、壁面切应力（WSS）和振荡剪切指数（OSI）。结果：生理性WSS高的部位异常改变较少。在重建的PA的吻合口处经常检测到过高的WSS，并且在心内修复期间在这些区域发现内膜增厚。高OSI和低WSS的区域在几个月内扩大了变化。其中1例患者右肺动脉矩形角吻合口处出现分离性涡流，血流动力学表现为高OSI、低WSS，心包异常增大.结论：血流引起的内皮应力可影响重建肺动脉自体心包及主要心肺侧枝动脉的退变.高OSI和低WSS可能会导致扩大或扩张，吻合口WSS过高可能会导致内膜增厚。
OBJECTIVES: To clarify the risk factors for abnormal degeneration of autologous pericardium, the mechanical stress on the endothelial tissue caused by turbulent blood flow in the pulmonary artery (PA) reconstructed with autologous pericardium and major aortopulmonary collateral arteries was assumed in pulmonary atresia and ventricular septal defect.METHODS: Patient-specific PA models were created for 6 patients based on their past computed tomography images taken after unifocalization of major aortopulmonary collateral arteries. Computational fluid dynamics models were created to simulate the physiological pulsatile flow including the peripheral reflection wave, characteristic impedance and autonomous regulation system. Flow streamline, wall shear stress (WSS) and the oscillatory shear index (OSI) were calculated from the simulated result. PA degeneration was evaluated with the computed tomography images before the intracardiac repair.RESULTS: Regions with physiological high WSS had fewer abnormal changes. Excessively high WSS was often detected at the anastomosis site of the reconstructed PA, and intimal thickening was found in these regions during intracardiac repair. Regions with high OSI and low WSS had dilated change within several months. In 1 patient, in particular, detached vortex flow occurred at the rectangular angle anastomosis site of the right PA in flow streamline, resulting in high OSI and low WSS with abnormal enlargement in the pericardium.CONCLUSIONS: Endothelial stress caused by blood flow would affect the degeneration of autologous pericardium and major aortopulmonary collateral arteries in the reconstructed PA. High OSI and low WSS might induce enlargement or dilatation, and excessively high WSS in the anastomosis site might induce intimal thickening.