Image-based modeling of hemodynamics in coronary artery aneurysms caused by Kawasaki disease.
Image-based modeling of hemodynamics in coronary artery aneurysms caused by Kawasaki disease.
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DOI：
10.1007/s10237-011-0361-8
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发表时间：
2012-07
影响因子：
3.5
通讯作者：
Marsden AL
中科院分区：
文献类型：
--
作者：
Sengupta D;Kahn AM;Burns JC;Sankaran S;Shadden SC;Marsden AL
川崎病（KD）是儿童获得性心脏病的主要原因。一部分KD患者在冠状动脉中出现动脉瘤，导致血栓形成和心肌梗死的风险增加。目前，指导这些患者治疗的临床数据有限，且这些动脉瘤的血流动力学影响尚不清楚。我们应用患者特异性模型系统地量化由KD引起的冠状动脉动脉瘤的血流动力学和壁剪切应力。我们利用多探测器计算机断层扫描（CT）获得的解剖学数据，对一名3岁时患有KD的10岁男性受试者的动脉瘤血流动力学进行了建模。以本研究对象为模型，将改变后的血流动力学与重建的正常冠状动脉解剖进行比较。使用鲁棒有限元框架的计算机模拟用于量化冠状动脉中随时间变化的剪切应力和颗粒轨迹。我们使用生理下游边界条件来解释心脏收缩性和微循环。冠状动脉近端动脉瘤的存在导致血流再循环，动脉瘤内壁面剪切应力降低，动脉瘤颈部壁面剪切应力梯度高。KD受试者的壁面剪应力（2.95 ~ 3.81 dynes/sq cm）比正常对照模型（17.10 ~ 27.15 dynes/sq cm）低一个数量级。颗粒停留时间明显增加，KD受试者需要5个心周期才能完全清除动脉瘤区域，而正常模型的相应区域仅需要1.3个心周期。在这项由KD引起的冠状动脉瘤血流动力学的新定量研究中，我们记录了与血栓形成风险增加相关的明显异常血流模式。该方法有可能进一步深入了解动脉瘤在KD中的影响，并有助于对患者进行风险分层，以便进行适当的医疗和手术干预。
Kawasaki Disease (KD) is the leading cause of acquired pediatric heart disease. A subset of KD patients develops aneurysms in the coronary arteries, leading to increased risk of thrombosis and myocardial infarction. Currently, there are limited clinical data to guide the management of these patients, and the hemodynamic effects of these aneurysms are unknown. We applied patient-specific modeling to systematically quantify hemodynamics and wall shear stress in coronary arteries with aneurysms caused by KD. We modeled the hemodynamics in the aneurysms using anatomic data obtained by multi-detector computed tomography (CT) in a 10-year-old male subject who suffered KD at age 3 years. The altered hemodynamics were compared to that of a reconstructed normal coronary anatomy using our subject as the model. Computer simulations using a robust finite element framework were used to quantify time-varying shear stresses and particle trajectories in the coronary arteries. We accounted for the cardiac contractility and the microcirculation using physiologic downstream boundary conditions. The presence of aneurysms in the proximal coronary artery leads to flow recirculation, reduced wall shear stress within the aneurysm, and high wall shear stress gradients at the neck of the aneurysm. The wall shear stress in the KD subject (2.95–3.81 dynes/sq cm) was an order of magnitude lower than the normal control model (17.10–27.15 dynes/sq cm). Particle residence times were significantly higher, taking 5 cardiac cycles to fully clear from the aneurysmal regions in the KD subject compared to only 1.3 cardiac cycles from the corresponding regions of the normal model. In this novel quantitative study of hemodynamics in coronary aneurysms caused by KD, we documented markedly abnormal flow patterns that are associated with increased risk of thrombosis. This methodology has the potential to provide further insights into the effects of aneurysms in KD and to help risk stratify patients for appropriate medical and surgical interventions.
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影响因子：
37.8
作者：
Dewey, Frederick E.;Rosenthal, David;Ashley, Euan A.
通讯作者：
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影响因子：
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作者：
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作者：
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通讯作者：
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作者：
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