Pulmonary vein flow split effects in patient-specific simulations of left atrial flow.
Pulmonary vein flow split effects in patient-specific simulations of left atrial flow.
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DOI：
10.1016/j.compbiomed.2023.107128
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发表时间：
2023-09
影响因子：
7.7
通讯作者：
中科院分区：
文献类型：
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作者：
左心房（LA）血流中断，如房颤（AF）引起的血流中断，可导致左心耳（LAA）血栓形成，并增加全身性栓塞的风险。LA血流动力学受多种因素影响，包括LA解剖结构和功能以及肺静脉（PV）流入条件。具体而言，取决于多个因素，患者之间和患者内的PV分流可能显著不同。在这项研究中，我们研究了肺静脉分流的变化如何影响左心房血流传输，首次使用高保真患者特定计算流体动力学（CFD）模型关注左心耳的血瘀。我们使用浸没边界法，在一个固定的，均匀的笛卡尔网格中模拟流动，并利用从4D计算机断层扫描图像生成的移动拉格朗日网格来施加LA壁的运动。我们分析了8例心房功能不同的患者的左心房解剖结构，其中3例患有房颤，并且有左心耳血栓或短暂性脑缺血发作（TIA）病史。使用四种不同的流量分配（通过右侧和左侧肺静脉的60/40%和55/45%，流速均匀，并且通过每个肺静脉的速度相同），我们发现流量模式对肺静脉流量分配变化敏感，特别是在平行于肺静脉的平面中。二尖瓣。肺静脉分流的变化也对血液淤滞有显著影响，并可能导致左心耳内血栓形成的风险增加，特别是在AF和既往左心耳血栓或TIA病史的患者中。我们的研究强调了在评估左心房血流动力学和识别血栓形成和卒中风险增加的患者时，考虑患者特异性肺静脉分流变化的重要性。这些知识与计划临床手术相关，例如AF消融或LAA封堵器的实施。
Disruptions to left atrial (LA) blood flow, such as those caused by atrial fibrillation (AF), can lead to thrombosis in the left atrial appendage (LAA) and an increased risk of systemic embolism. LA hemodynamics are influenced by various factors, including LA anatomy and function, and pulmonary vein (PV) inflow conditions. In particular, the PV flow split can vary significantly among and within patients depending on multiple factors. In this study, we investigated how changes in PV flow split affect LA flow transport, focusing for the first time on blood stasis in the LAA, using a high-fidelity patient-specific computational fluid dynamics (CFD) model. We use an Immersed Boundary Method, simulating the flow in a fixed, uniform Cartesian mesh and imposing the movement of the LA walls with a moving Lagrangian mesh generated from 4D Computerized Tomography images. We analyzed LA anatomies from eight patients with varying atrial function, including three with AF and either a LAA thrombus or a history of Transient Ischemic Attacks (TIAs). Using four different flow splits (60/40% and 55/45% through right and left PVs, even flow rate, and same velocity through each PV), we found that flow patterns are sensitive to PV flow split variations, particularly in planes parallel to the mitral valve. Changes in PV flow split also had a significant impact on blood stasis and could contribute to increased risk for thrombosis inside the LAA, particularly in patients with AF and previous LAA thrombus or a history of TIAs. Our study highlights the importance of considering patient-specific PV flow split variations when assessing LA hemodynamics and identifying patients at increased risk for thrombosis and stroke. This knowledge is relevant to planning clinical procedures such as AF ablation or the implementation of LAA occluders.
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DOI：
10.1002/cnm.3100
发表时间：
2018-08-01
影响因子：
2.1
作者：
Garcia-Isla, Guadalupe;Luis Olivares, Andy;Camara, Oscar
通讯作者：
Camara, Oscar
DOI：
10.1002/cnm.3254
发表时间：
2019-11-01
影响因子：
2.1
作者：
Feng, Liuyang;Gao, Hao;Luo, Xiaoyu
通讯作者：
Luo, Xiaoyu
影响因子：
3.6
作者：
Bosi GM;Cook A;Rai R;Menezes LJ;Schievano S;Torii R;Burriesci G Burriesci
通讯作者：
Burriesci G Burriesci
影响因子：
37.8
作者：
Chen LY;Chung MK;Allen LA;Ezekowitz M;Furie KL;McCabe P;Noseworthy PA;Perez MV;Turakhia MP;American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Stroke Council
通讯作者：
American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Stroke Council
影响因子：
4.4
作者：
Cheng, CP;Herfkens, RJ;Feinstein, JA
通讯作者：
Feinstein, JA