A Computational Study of Dynamic Obstruction in Type B Aortic Dissection.
A Computational Study of Dynamic Obstruction in Type B Aortic Dissection.
复制标题
B 型主动脉夹层动态阻塞的计算研究。
DOI：
10.1115/1.4056355
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Figueroa,CA
中科院分区：
文献类型：
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作者：
Kim,T;vanBakel,PAJ;Nama,N;Burris,N;Patel,HJ;Williams,DM;Figueroa,CA
主动脉夹层的一个严重并发症是真腔动力性阻塞。动态阻塞导致灌注不良，即血液流向重要器官的阻塞。临床数据显示，中心血压升高会促进动力性梗阻。然而，高压导致热释光崩塌的机制还没有得到充分的研究和理解。在这里，我们开发了一个计算模型来研究动态阻塞中涉及的生物力学和血液动力学因素。我们假设TL和假腔（FL）之间相对较小的压力梯度足以使皮瓣移位并引起阻塞。建立了B型主动脉夹层的理想流固耦合模型。在平均心输出量下进行模拟，同时通过改变FL流出阻力来诱导血压的动态变化。随着FL阻力增加，中心主动脉压从95.7 mmHg增加到115.3 mmHg。在血压升高的同时，观察到皮瓣运动，导致TL塌陷，与临床结果一致。动态阻塞过程中TL和FL之间的最大压力梯度为4.5 mmHg，与我们的假设一致。此外，动态阻塞的最后阶段本质上是非常突然的，在我们的模拟中发生在短时间内（<1 s），与临床对这一戏剧性事件的理解一致。模拟还显示TL中的流量和压力响应于皮瓣运动而突然下降，与灌注不良的第一阶段一致。据我们所知，这项研究代表了第一个驱动主动脉夹层动态阻塞的潜在机制的计算分析。
A serious complication in aortic dissection is dynamic obstruction of the true lumen (TL). Dynamic obstruction results in malperfusion, a blockage of blood flow to a vital organ. Clinical data reveal that increases in central blood pressure promote dynamic obstruction. However, the mechanisms by which high pressures result in TL collapse are underexplored and poorly understood. Here, we developed a computational model to investigate biomechanical and hemodynamical factors involved in Dynamic obstruction. We hypothesize that relatively small pressure gradient between TL and false lumen (FL) are sufficient to displace the flap and induce obstruction. An idealized fluid–structure interaction model of type B aortic dissection was created. Simulations were performed under mean cardiac output while inducing dynamic changes in blood pressure by altering FL outflow resistance. As FL resistance increased, central aortic pressure increased from 95.7 to 115.3 mmHg. Concurrent with blood pressure increase, flap motion was observed, resulting in TL collapse, consistent with clinical findings. The maximum pressure gradient between TL and FL over the course of the dynamic obstruction was 4.5 mmHg, consistent with our hypothesis. Furthermore, the final stage of dynamic obstruction was very sudden in nature, occurring over a short time (<1 s) in our simulation, consistent with the clinical understanding of this dramatic event. Simulations also revealed sudden drops in flow and pressure in the TL in response to the flap motion, consistent with first stages of malperfusion. To our knowledge, this study represents the first computational analysis of potential mechanisms driving dynamic obstruction in aortic dissection.
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DOI：
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发表时间：
2003
期刊：
影响因子：
--
作者：
Yoon Lee;S. Shin
通讯作者：
S. Shin