Tear size and location impacts false lumen pressure in an ex vivo model of chronic type B aortic dissection
Tear size and location impacts false lumen pressure in an ex vivo model of chronic type B aortic dissection
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DOI：
10.1016/j.jvs.2007.11.059
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发表时间：
2008-04-01
影响因子：
4.3
通讯作者：
Eagle, Kim A.
中科院分区：
文献类型：
--
作者：
Tsai, Thomas T.;Schlicht, Marty S.;Eagle, Kim A.
背景B型主动脉夹层（TB-AD）患者的随访死亡率很高，3年时接近四分之一。死亡率增加的预测因素是假腔的部分血栓形成，可能堵塞远端撕裂。假腔内不同撕裂大小、位置和通畅性的血流动力学后果在很大程度上是未知的。我们研究了内膜撕裂大小、撕裂数量和位置对假腔压力的影响。在与脉动泵连接的慢性B型主动脉夹层离体模型中，同时测量真腔和假腔内的压力。实验在不同的解剖模型中进行，撕裂尺寸为6.4 mm和3.2 mm，配置如下;模型A：近端和远端撕裂模拟TB-AD患者最常见的血流动力学状态;模型B：仅近端撕裂模拟部分血栓形成和远端撕裂闭塞的患者;模型C：远端撕裂仅模拟通过覆膜支架近端密封的患者，具有持续的远端连通。为了比较模型之间的假腔舒张压，将所有模拟的假腔压力指数（FPI%）计算为FPI% =（假腔舒张压/真腔舒张压）X 100。模型A假腔收缩压略低于真腔，舒张压略高于真腔（DP 66.45 ± 0.16转Hg vs 66.20 ± 0.12转Hg，P
Background. Follow-up mortality is high in patients with type B aortic dissection (TB-AD) approaching one in four patients at 3 years. A predictor of increased mortality is partial thrombosis of the false lumen which may occlude distal tears. The hemodynamic consequences of differing tear size, location, and patency within the false lumen is largely unknown. We examined the impact of intimal tear size, tear number, and location on false lumen pressure.Methods. In an ex-vivo model of chronic type B aortic dissection connected to a pulsatile pump, simultaneous pressures were measured within the true and false lumen. Experiments were performed in different dissection models with tear sizes of 6.4 mm and 3.2 mm in the following configurations; model A: proximal and distal tear simulating the most common hemodynamic state in patients with TB-AD; model B: proximal tear only simulating patients with partial thrombosis and occlusion of distal tear; and model C: distal tear only simulating patients sealed proximally via a stent graft with persistent distal communication. To compare false lumen diastolic pressure between models, a false lumen pressure index (FPI%) was calculated for all simulations as FPI% = (false lumen diastolic pressure/true lumen diastolic pressure) X 100.Results. In model A, the systolic pressure was slightly lower in the false lumen compared with the true lumen while the diastolic pressure (DP) was slightly higher in the false lumen (DP 66.45 +/- 0.16 turn Hg vs 66.20 +/- 0.12 turn Hg, P