Ex Vivo Modeling of Atrioventricular Valve Mechanics in Single Ventricle Physiology.
Ex Vivo Modeling of Atrioventricular Valve Mechanics in Single Ventricle Physiology.
复制标题
单心室生理学中房室瓣力学的离体建模。
DOI：
10.1007/s10439-023-03178-1
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发表时间：
2023
影响因子：
3.8
通讯作者：
Ma,MichaelR
中科院分区：
文献类型：
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作者：
Moye,StephenC;Kidambi,Sumanth;Lee,JamesY;Cowles,TeaghanH;Gilligan-Steinberg,ShaneD;Bryan,AmeliaY;Wilkerson,Rob;Woo,YJoseph;Ma,MichaelR
单心室生理学（SVP）用于描述任何无法支持独立肺循环和体循环的先天性心脏病。目前的治疗策略依赖于一系列姑息手术，最终导致Fontan生理学，其依赖于单个功能心室提供体循环，同时被动地通过肺循环引导静脉回流。尽管早期死亡率显著降低，但房室瓣（AVV）返流的存在是这些患者心力衰竭的关键预测因素。我们试图评价SVP生理学中与AVV相关的生物力学变化。将左心室和右心室缝合到患者衍生的3D打印支架上，并安装到能够再现诺伍德、格伦、丰坦和晚期丰坦生理学的anex体内系统心脏模拟器中。我们发现，与后叶和间隔叶相比，三尖瓣前叶的最大力、平均力和最大拉力升高。在生理学之间，相对于Glenn、Fontan和晚期Fontan生理学，诺伍德生理学中的最大拉力最大。这些对比趋势表明，单心室AVV失效的长期和短期机制不同，AVV干预应考虑瓣叶和生理学之间力分布的不对称性。
Single ventricle physiology (SVP) is used to describe any congenital heart lesion that is unable to support independent pulmonary and systemic circulations. Current treatment strategies rely on a series of palliation surgeries that culminate in the Fontan physiology, which relies on the single functioning ventricle to provide systemic circulation while passively routing venous return through the pulmonary circulation. Despite significant reductions in early mortality, the presence of atrioventricular valve (AVV) regurgitation is a key predictor of heart failure in these patients. We sought to evaluate the biomechanical changes associated with the AVV in SVP physiologies. Left and right ventricles were sutured onto patient-derived 3D-printed mounts and mounted into anex vivosystemic heart simulator capable of reproducing Norwood, Glenn, Fontan and Late Fontan physiologies. We found that the tricuspid anterior leaflet experienced elevated maximum force, average force, and maximum yank compared to the posterior and septal leaflets. Between physiologies, maximum yank was greatest in the Norwood physiology relative to the Glenn, Fontan, and Late Fontan physiologies. These contrasting trends suggest that long- and short-term mechanics of AVV failure in single ventricle differ and that AVV interventions should account for asymmetries in force profiles between leaflets and physiologies.