Four-dimensional flow magnetic resonance imaging study to explain high prevalence of pulmonary vein stump thrombus after left upper lobectomy.
Four-dimensional flow magnetic resonance imaging study to explain high prevalence of pulmonary vein stump thrombus after left upper lobectomy.
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DOI：
10.21037/jtd-20-1606
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发表时间：
2020-10
影响因子：
2.5
通讯作者：
Sato M
中科院分区：
文献类型：
--
作者：
Umehara T;Takumi K;Ueda K;Tokunaga T;Harada-Takeda A;Suzuki S;Sato M
肺静脉（PV）残端血栓是脑梗死的已知来源，几乎仅在左上叶切除术后发生;然而，其机制仍不清楚。因此，我们评价了左心房的血流动力学与四维流动磁共振成像（4D-flow MRI），它可以同时描绘血流在三个位置和血流动力学的评价。对于右上叶（n=11）、右下叶（n=8）、左上叶（n=13）或左下叶（n = 8）中出现的癌症，基本上在肺叶切除术后7天进行4D-flow MRI。我们使用4D血流MRI评价了从同侧剩余肺静脉、切除的肺静脉残端和对侧肺静脉进入左心房的动态血液运动。有一些特征性的血流模式似乎可以促进或预防肺静脉残端血栓。与接受其他肺叶切除术的患者相比，接受左上肺叶切除术的患者的促进性血流模式明显更频繁，预防性血流模式明显更少。因此，静脉残端附近的血液湍流程度，如血液流动的变化程度所测量的，在接受左上叶切除术的患者中显著高于接受其他叶切除术的患者。我们的研究表明，左上叶切除术可能会通过左心房复杂的血流引起静脉残端附近的血液湍流，这可能会在静脉残端血栓的形成中发挥作用。需要进一步研究以确定静脉残端血栓高风险患者。
Pulmonary vein (PV) stump thrombus, a known source of cerebral infarction, develops almost exclusively after left upper lobectomy; however, the mechanism remains unclear. We therefore evaluated the hemodynamics in the left atrium with four-dimensional flow magnetic resonance imaging (4D-flow MRI), which enables the simultaneous depiction of blood flow at three locations and the evaluation of hemodynamics. 4D-flow MRI was basically performed 7 days after lobectomy for cancer arising in the right upper lobe (n=11), right lower lobe (n=8), left upper lobe (n=13), or left lower lobe (n=8). We evaluated dynamic blood movement from the ipsilateral remaining PV, the resected PV stump, and the contralateral PVs into the left atrium using 4D-flow MRI. There were some characteristic blood flow patterns that seemed to either promote or prevent PV stump thrombus. Promotive flow patterns were significantly more frequent and preventive flow patterns were significantly less frequent in patients who had undergone left upper lobectomy than in those who had undergone other lobectomy. Accordingly, the degree of blood turbulence near the vein stump, as measured by the extent of change in the blood movement, was significantly higher in patients who had undergone left upper lobectomy than in patients who had undergone other lobectomy. Our study revealed that left upper lobectomy likely causes blood turbulence near the vein stump through complicated blood streams in the left atrium, which can play a part in the development of vein stump thrombus. Further study to identify patients at high risk of vein stump thrombus is warranted.