Use of mathematic modeling to compare and predict hemodynamic effects of the modified Blalock-Taussig and right ventricle-pulmonary artery shunts for hypoplastic left heart syndrome
Use of mathematic modeling to compare and predict hemodynamic effects of the modified Blalock-Taussig and right ventricle-pulmonary artery shunts for hypoplastic left heart syndrome
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DOI：
10.1016/j.jtcvs.2007.04.078
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发表时间：
2008-08-01
影响因子：
6
通讯作者：
Dubini, Gabriele
中科院分区：
文献类型：
--
作者：
Bove, Edward L.;Migliavacca, Francesco;Dubini, Gabriele
目的：左心发育不良综合征的一期重建（诺伍德手术）可以采用改良的Blalock-Taussig分流术或右心室-肺动脉分流术。这两种方法都有一些固有的特点。方法：采用有限体积法建立了诺伍德手术的Blalock-Taussig分流术和右心室-肺动脉分流术的三维计算机模型。在Blalock-Taussig分流模型中使用3、3.5和4 mm的导管，而在右心室-肺动脉分流模型中使用4、5和6 mm的导管。两种模型中的液压网络（集总阻力、柔度、惯性和弹性）相同。采用多尺度方法将三维模型与流通网耦合。计算机模拟与术后导管数据进行了比较。结果：预测和观察数据之间有很好的相关性。右室-肺动脉分流术组主动脉舒张压升高，肺动脉压降低，Qp/Qs比值降低，冠状动脉灌注压升高。数学建模预测了右心室-肺动脉分流模型中的最小阻力血流，这与术后多普勒测量结果相关。右心室肺动脉分流表现出较低的中风工作和较高的机械效率（中风工作/总机械能）。结论：预测和观察数据之间的密切相关性支持使用数学建模的设计和评估的外科手术。在诺伍德手术的右心室-肺动脉分流改良中，系统性心室切开术的潜在损害作用尚未分析。
Objective: Stage one reconstruction (Norwood operation) for hypoplastic left heart syndrome can be performed with either a modified Blalock-Taussig shunt or a right ventricle-pulmonary artery shunt. Both methods have certain inherent characteristics. It is postulated that mathematic modeling could help elucidate these differences.Methods: Three-dimensional computer models of the Blalock-Taussig shunt and right ventricle-pulmonary artery shunt modifications of the Norwood operation were developed by using the finite volume method. Conduits of 3, 3.5, and 4 mm were used in the Blalock-Taussig shunt model, whereas conduits of 4, 5, and 6 mm were used in the right ventricle-pulmonary artery shunt model. The hydraulic nets (lumped resistances, compliances, inertances, and elastances) were identical in the 2 models. A multiscale approach was adopted to couple the 3-dimensional models with the circulation net. Computer simulations were compared with postoperative catheterization data.Results: Good correlation was found between predicted and observed data. For the right ventricle-pulmonary artery shunt modification, there was higher aortic diastolic pressure, decreased pulmonary artery pressure, lower Qp/Qs ratio, and higher coronary perfusion pressure. Mathematic modeling predicted minimal regurgitant flow in the right ventricle-pulmonary artery shunt model, which correlated with postoperative Doppler measurements. The right ventricle-pulmonary artery shunt demonstrated lower stroke work and a higher mechanical efficiency (stroke work/total mechanical energy).Conclusions: The close correlation between predicted and observed data supports the use of mathematic modeling in the design and assessment of surgical procedures. The potentially damaging effects of a systemic ventriculotomy in the right ventricle-pulmonary artery shunt modification of the Norwood operation have not been analyzed.