Computational fluid dynamic modelling to determine the hemodynamic effects of implanting a transcatheter mitral valve within the left ventricle
Computational fluid dynamic modelling to determine the hemodynamic effects of implanting a transcatheter mitral valve within the left ventricle
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计算流体动力学模型确定左心室内植入经导管二尖瓣的血流动力学效应
DOI：
10.1007/s10554-017-1276-y
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
De Vecchi A
中科院分区：
文献类型：
--
作者：
De Vecchi A
一名 85 岁男性因呼吸困难加剧就诊。超声心动图显示严重主动脉瓣狭窄、严重二尖瓣反流 (MR) 和左心室射血分数 32%。随后，他接受了使用 SAPIEN 3 瓣膜（Edwards Lifesciences，美国加利福尼亚州欧文市）的经导管主动脉瓣置换术 (TAVR)。鉴于残留的严重 MR，考虑进行经导管二尖瓣置换术 (TMVR)。这与在现有 TAVR 背景下引入左心室流出道 (LVOT) 梗阻的担忧有关 [1]。因此，进行多相心电图门控心脏 CT 进行几何（图 1）和计算流程评估。创建了两个计算流体动力学模型。第一个描述了手术前的血液动力学状态，而第二个描述了原位 TMVR 的模拟血液动力学状态（图 2，Mov. 1）。为了驱动血流模拟，将来自 CT 数据集的用于血流速度评估和心内膜壁运动跟踪的多普勒超声心动图数据纳入模型中。血流动力学模拟表明，TMVR 后 LVOT 面积减少 < 6%，峰值 LVOT 压力梯度为 6.8 mmHg，平均压力梯度为 2.95 mmHg。鉴于这些发现，使用美敦力 Intrepid 瓣膜（美敦力公司，明尼苏达州明尼阿波利斯市，美国）进行了 TMVR。 6 个月时，患者报告症状有所改善，超声心动图与计算模型显示出良好的一致性。术后 CT 扫描证实不存在 LVOT 梗阻（LVOT 面积减少 9%）（图 3）。尽管先进的成像技术可以定量描述患者当前的病理生理状态[1, 2]。他们无法预测心室对 TMVR 的反应。当前的报告展示了将成像数据与个性化计算流体动力学模型集成以将心室血流动力学模拟到新的临床工作流程中的实用性。预计随着心脏 CT 应用的扩大，与基础科学的进一步协调将会出现，从而能够针对其他复杂的临床问题提供解决方案和个性化的患者特定护理。
An 85-year-old man presented with increasing dyspnea. Echocardiography demonstrated severe aortic stenosis, severe mitral regurgitation (MR) and a left ventricular ejection fraction of 32%. He subsequently underwent transcatheter aortic valve replacement (TAVR) with a SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA). Given the residual severe MR a transcatheter mitral valve replacement (TMVR) was considered. This was associated with concerns as to introducing left ventricular outflow tract (LVOT) obstruction in the context of an existing TAVR [1]. Multiphase ECG-gated cardiac CT was therefore performed for geometric (Fig. 1) and computational flow evaluation. Two computational fluid-dynamic models were created. The first described the pre-procedural haemodynamic state whilst the second, the simulated haemodynamic state with proposed TMVR in situ (Fig. 2, Mov. 1). To drive the flow simulation the Doppler echocardiographic data for flow velocity assessment and endocardial wall motion tracking from CT dataset were incorporated into the model. The haemodynamic simulations suggested a< 6% reduction of the LVOT area following TMVR with a peak LVOT pressure gradient of 6.8 mmHg and a mean pressure gradient of 2.95 mmHg. Given these findings, TMVR with a Medtronic Intrepid valve (Medtronic Inc., Minneapolis, MN, USA) was performed. At 6-months the patient reported an improvement in symptoms with the echocardiogram showing good agreement with computational modelling. The post-procedural CT scan confirmed an absence of LVOT obstruction (9% LVOT area reduction)(Fig. 3). Although advanced imaging techniques can provide a quantitative description of the current pathophysiological state of a patient [1, 2]. they are unable to predict the ventricular response to TMVR. The current report demonstrates the utility of integrating imaging data with personalized Computational Fluid Dynamics models to simulate ventricular hemodynamics into a new clinical workstream. It is anticipated that as applications for cardiac CT expand, a further harmonisation with basic science with occur to enable solutions and personalised patient specific care to otherwise complex clinical problems.
用于经导管二尖瓣介入治疗的二尖瓣复合体的定量多层计算机断层扫描评估第 2 部分：功能性二尖瓣反流患者的几何测量。
DOI：
10.4244/eijy15m11_10
发表时间：
2016
期刊：
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
影响因子：
--
作者：
P. Thériault;M. Dorfmeister;D. Mylotte;A. Andalib;M. Spaziano;P. Blanke;G. Martucci;R. Lange;J. Leipsic;L. Bilodeau;N. Piazza
通讯作者：
N. Piazza
影响因子：
6.2
作者：
Theriault-Lauzier, Pascal;Mylotte, Darren;Piazza, Nicolo
通讯作者：
Piazza, Nicolo