Regional wall stress differences on tricuspid aortic valve-associated ascending aortic aneurysms.
Regional wall stress differences on tricuspid aortic valve-associated ascending aortic aneurysms.
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DOI：
10.1093/icvts/ivab269
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发表时间：
2022-06-01
影响因子：
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升胸主动脉瘤（aTAA）具有急性A型夹层的风险。选择性修复指南基于直径，但并发症通常发生在直径阈值以下。从生物力学上讲，当壁应力超过壁强度时可能发生夹层。动脉瘤壁应力可能更好地捕获夹层风险。我们的目的是通过解剖区域研究与三尖瓣主动脉瓣（TAV）相关的患者特异性aTAA壁应力。动脉瘤直径≥4.0 cm的患者接受计算机断层扫描血管造影。重建动脉瘤几何形状，并在考虑预应力的同时加载全身压力。进行有限元分析，以获得壁应力分布。在收缩期测定第99百分位纵向和周向应力。使用单向方差分析和事后Tukey HSD进行成对比较，比较区域之间的壁应力。动脉瘤（n = 204）上的峰值纵向壁应力分别为326 [标准差（SD）：61.7]，246（SD：63.4）和195（标清：主动脉窦、窦管连接处（STJ）和升主动脉（AscAo）分别为38.7 kPa，AscAo与双侧鼻窦（P < 0.001）及STJ（P < 0.001）之间差异有显著性。窦、STJ和AscAo的峰值周向壁应力分别为416（SD：85.1）、501（SD：119）和340（SD：57.6）kPa，AscAo与两个窦（P < 0.001）和STJ（P < 0.001）之间存在显著差异。主动脉根部的周向和纵向壁应力大于TAV动脉瘤患者的AscAo。相对于相应区域壁强度的动脉瘤壁应力大小和分布可以提高对特定患者中夹层风险更高的主动脉区域的理解。大多数胸升主动脉瘤（aTAA）是散发性的，与三尖瓣主动脉瓣（TAV）相关[1]。
Ascending thoracic aortic aneurysms (aTAAs) carry a risk of acute type A dissection. Elective repair guidelines are based on diameter, but complications often occur below diameter threshold. Biomechanically, dissection can occur when wall stress exceeds wall strength. Aneurysm wall stresses may better capture dissection risk. Our aim was to investigate patient-specific aTAA wall stresses associated with a tricuspid aortic valve (TAV) by anatomic region. Patients with aneurysm diameter ≥4.0 cm underwent computed tomography angiography. Aneurysm geometries were reconstructed and loaded to systemic pressure while taking prestress into account. Finite element analyses were conducted to obtain wall stress distributions. The 99th percentile longitudinal and circumferential stresses were determined at systole. Wall stresses between regions were compared using one-way analysis of variance with post hoc Tukey HSD for pairwise comparisons. Peak longitudinal wall stresses on aneurysms (n = 204) were 326 [standard deviation (SD): 61.7], 246 (SD: 63.4) and 195 (SD: 38.7) kPa in sinuses of Valsalva, sinotubular junction (STJ) and ascending aorta (AscAo), respectively, with significant differences between AscAo and both sinuses (P < 0.001) and STJ (P < 0.001). Peak circumferential wall stresses were 416 (SD: 85.1), 501 (SD: 119) and 340 (SD: 57.6) kPa for sinuses, STJ and AscAo, respectively, with significant differences between AscAo and both sinuses (P < 0.001) and STJ (P < 0.001). Circumferential and longitudinal wall stresses were greater in the aortic root than AscAo on aneurysm patients with a TAV. Aneurysm wall stress magnitudes and distribution relative to respective regional wall strength could improve understanding of aortic regions at greater risk of dissection in a particular patient. Most ascending thoracic aortic aneurysms (aTAAs) are sporadic and associated with a tricuspid aortic valve (TAV) [1].
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DOI：
10.1016/j.echo.2017.12.008
发表时间：
2018-05-01
影响因子：
6.5
作者：
Capoulade, Romain;Teoh, Jonathan G.;Hung, Judy
通讯作者：
Hung, Judy
影响因子：
4.6
作者：
Deveja, Rezar P.;Iliopoulos, Dimitrios C.;Sokolis, Dimitrios P.
通讯作者：
Sokolis, Dimitrios P.
影响因子：
24
作者：
Pape, Linda A.;Awais, Mazen;O'Gara, Patrick
通讯作者：
O'Gara, Patrick
影响因子：
4.6
作者：
Azadani, Ali N.;Chitsaz, Sam;Tseng, Elaine E.
通讯作者：
Tseng, Elaine E.
影响因子：
3.4
作者：
Beller, CJ;Labrosse, MR;Hagl, S
通讯作者：
Hagl, S