Ascending aortic curvature as an independent risk factor for type A dissection, and ascending aortic aneurysm formation: a mathematical model
Ascending aortic curvature as an independent risk factor for type A dissection, and ascending aortic aneurysm formation: a mathematical model
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DOI：
10.1016/j.ejcts.2008.02.029
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发表时间：
2008-06-01
影响因子：
3.4
通讯作者：
Poole, Robert J.
中科院分区：
文献类型：
--
作者：
Poultis, Michael R.;Warwick, Richard;Poole, Robert J.
目的：建立一个数学模型来证明，除了高血压、二叶式主动脉瓣、升主动脉瘤和马凡氏综合征等主动脉内膜组织异常之外，升主动脉曲率也是 A 型夹层的独立危险因素。方法：利用牛顿第三运动定律进行稳态一维流动分析。评估了五种不同的临床情况：（1）主动脉曲率的影响； (2) β-受体阻滞剂的影响，(3) 患者体型的影响，(4) 马凡主动脉上的力，以及 (5) 主动脉夹层入口瓣的部位。结果：主动脉曲率使升主动脉上施加的力增加了 10 倍以上。与收缩压为 120 mmHg 的患者相比，尽管主动脉直径较小且心输出量较低，但主动脉弯曲会导致收缩压为 80 mmHg 的患者对主动脉施加更大的力。在正常直径的主动脉中，与主动脉曲率相比，β-受体阻滞剂的影响最小。主动脉曲率可能有助于解释为什么正常直径的主动脉可以夹层，并且入口撕裂的点可能是可预测的。主动脉曲率对马凡氏综合征患者主动脉施加的力有重大影响。结论：对于作用在主动脉壁上的力而言，主动脉曲率比主动脉直径、血压、心输出量、β受体阻滞剂的使用和患者体型更重要。这可以解释为什么一些升主动脉直径正常、患有或不患有马凡氏综合征的患者会出现 A 型夹层和动脉瘤。主动脉曲率也可能有助于解释急性 A 型夹层中入口撕裂的部位。需要进一步的临床研究来验证这项研究的发现。 (C) 2008 年欧洲心胸外科协会。由 Elsevier B.V. 出版。保留所有权利。
Objective: To develop a mathematical model to demonstrate that ascending aortic curvature is an independent risk factor for type A dissections, in addition to hypertension, bicuspid aortic valve, aneurysm of ascending aorta, and intrinsic aortic tissue abnormalities, like Marfan's syndrome. Methods: A steady state one-dimensional flow analysis was performed, utilising Newton's third taw of motion. Five different clinical scenarios were evaluated: (1) effect of aortic curvature; (2) effect of beta-blockers, (3) effect of patient size, (4) forces on a Marfan's aorta, and (5) site of entry flap in aortic dissection. Results: Aortic curvature increases the forces exerted on the ascending aorta by a factor of over 10-fold. Aortic curvature can cause patients with a systolic blood pressure of 80 mmHg to have greater forces exerted on their aorta despite smaller diameters and lower cardiac outputs, than patients with systolic blood pressures of 120 mmHg. In normal diameter aortas, beta-blockers have minimal effect compared with aortic curvature. Aortic curvature may help to explain why normal diameter aortas can dissect, and also that the point of the entry tear may be potentially predictable. Aortic curvature has major effects on the forces exerted on the aorta in patients with Marfan's syndrome. Conclusions: Aortic curvature is relatively more important that aortic diameter, blood pressure, cardiac output, beta-blocker use, and patient size with regard to the force acting on the aortic wall. This may explain why some patients with normal diameter ascending aortas with or without Marfan's syndrome develop type A dissections and aneurysms. Aortic curvature may also help to explain the site of entry tear in acute type A dissection. Further clinical study is needed to validate this study's finding. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.