Quantitative assessment of paravalvular leakage after transcatheter aortic valve replacement using a patient-specific pulsatile flow model
Quantitative assessment of paravalvular leakage after transcatheter aortic valve replacement using a patient-specific pulsatile flow model
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DOI：
10.1016/j.ijcard.2017.11.106
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发表时间：
2018-05-01
影响因子：
3.5
通讯作者：
Iwasaki, Kiyotaka
中科院分区：
文献类型：
--
作者：
Tanaka, Yutaka;Saito, Shigeru;Iwasaki, Kiyotaka
背景：定量评估主动脉瓣置换术（TAVR）后的主动脉瓣返流（AR）仍然具有挑战性。我们开发了具有脉动流回路的患者特定解剖模型，并研究了TAVR.Methods后与AR相关的因素：基于使用23 mm SAPIEN XT进行经股动脉TAVR的6例患者的术前计算机断层扫描（CT）数据，开发了解剖学和机械等效的主动脉瓣模型。在平均主动脉压80 mm Hg下，复制TAVR术后两天内每位患者的前向血流和心率。使用电磁流量传感器测量每个模型在基础和附加条件下的瓣周漏（PVL）体积。使用micro-CT.Results：PVL体积在每个患者的具体模型是一致的，每个患者的PVL等级之间的经导管和主动脉瓣的不完全贴壁道进行检查，并受血流动力学条件。PVL和总返流量随平均主动脉压的增加而增加，而关闭容积无变化。与此相反，关闭容积随心率成比例增加，但PVL没有变化。最小横截面间隙与PVL体积呈正相关（r = 0.39，P = 0.02）。差距区域通常发生在原生commissure.Conclusions下的大体积钙化结节附近：PVL体积，这可能会受到血液动力学条件的影响，是显着相关的最小横截面之间的间隙面积的主动脉瓣环和支架框架。这些数据可能会提高我们对TAVR后PVL发生机制的理解。(C)2017作者出版社：Elsevier爱尔兰Ltd.
Background: Quantitative assessment of post-franscalheter aortic valve replacement (TAVR) aortic regurgitation (AR) remains challenging. We developed patient-specific anatomical models with pulsatile flow circuit and investigated factors associated with AR after TAVR.Methods: Based on pre-procedural computed tomography (CT) data of the six patients who underwent fransfemoral TAVR using a 23-mm SAPIEN XT, anatomically and mechanically equivalent aortic valve models were developed. Forward flow and heart rate of each patient in two days after TAVR were duplicated under mean aortic pressure of 80 mm Hg. Paravalvular leakage (PVL) volume in basal and additional conditions was measured for each model using an electromagnetic flow sensor. Incompletely apposed tract between the trans catheter and aortic valves was examined using a micro-CT.Results: PVL volume in each patient-specific model was consistent with each patient's PVL grade, and was affected by hemodynamic conditions. PVL and total regurgitation volume increased with the mean aortic pressure, whereas closing volume did not change. In contrast, closing volume increased proportionately with heart rate, but PVL did not change. The minimal cross-sectional gap had a positive correlation with the PVL volumes (r = 039, P = 0.02). The gap areas typically occurred in the vicinity of the bulky calcified nodules under the native commissure.Conclusions: PVL volume, which could be affected by hemodynamic conditions, was significantly associated with the minimal cross-sectional gap area between the aortic annulus and the stent frame. These data may improve our understanding of the mechanism of the occurrence of post-TAVR PVL. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.