Interpretation of an aneurysm.
Interpretation of an aneurysm.
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动脉瘤的解释。
DOI：
10.1093/eurheartj/ehv276
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发表时间：
2015-09
影响因子：
39.3
通讯作者：
舒先红
中科院分区：
文献类型：
--
作者：
汪咏莳;吴擘颋;Markl, Michael;舒先红
一位51岁女性因意外发现主动脉窦动脉瘤（SVA）而被转诊至我院。多层计算机断层扫描和心血管磁共振成像（CMR）很好地描述了76× 43 mm的右室上腔静脉蔓延到右心室流出道（图A）。进行了动脉瘤切除沿着和主动脉根部瓣膜置换术（图B），术后1个月的随访CMR证实主动脉根部形态和血流恢复（图C和D;在线补充材料，视频S1）。时间分辨三维相位对比（4D flow）技术显示动脉瘤和主动脉的动态3D血流特征。流速流线显示，在收缩早期，在右主动脉窦畸形开口处，主动脉流出道出现偏心收缩期射流分支，以1.5 m/s的峰值速度将血液导向动脉瘤后壁，并演变为左旋向下涡流，向前流动为16 mL/循环（图E-H）。在收缩中期和晚期，在动脉瘤的上部完全形成螺旋流模式，并随着低速漩涡逐渐填充整个动脉瘤而延伸到舒张期（在线补充材料，视频S2）。动脉瘤内高度不均匀的血流分布提供了独特的Vantage位置，以更好地了解其各种并发症谱的发病机制，包括扩张、破裂和血栓形成。血流定量显示主动脉血流和峰值速度因异常涡流重新定向至动脉瘤而受损，两者在手术后均显著增加至年龄、性别和BSA匹配的健康志愿者水平（图I和J）。
A 51-year-old female was referred to our institution for an accidentally found sinus of valsalva aneurysm (SVA). Multi-slice computer tomography and cardiovascular magnetic resonance imaging (CMR) well depicted a 76× 43 mm right SVA sprawling over right ventricular outflow tract (Panel A). Aneurysm resection along with valvesparing aortic root replacement was performed (Panel B), and the follow-up CMR 1 month after surgery confirmed restoration of aortic root morphology and blood flow (Panels C and D; Supplementary material online, Video S1). Timeresolved three-dimensional phase contrast (4D flow) technique visualized dynamic 3D flow features of both the aneurysm and aorta. Flow velocity streamlines demonstrated an eccentric systolic flow jet branching from the main aortic outflow during early systole at the misshaped opening of right sinus of valsalva, directing blood towards the posterior wall of the aneurysm with a peak velocity of 1.5 m/s, and evolving into a left-handed downward vortex with a forward flow of 16 mL/cycle (Panels E–H). A resulting helix flow pattern was fully developed at the upper portion of the aneurysm during mid and late systole, and extended into diastolic phases as low-velocity swirls gradually filling the entire aneurysm (Supplementary material online, Video S2). The highly uneven flow distribution within the aneurysm provided unique vantage points to better understand the pathogenesis of its diverse complication spectrum including expansion, rupture, and thrombosis. Flow quantification revealed impairment in aortic flow and peak velocity via aberrant vortex redirected into the aneurysm, both of which markedly increased after surgery to the level of an age-, gender-, and BSA-matched health volunteer (Panels I and J).