The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise
The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise
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DOI：
10.1152/ajpheart.00628.2008
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发表时间：
2008-12-01
影响因子：
4.8
通讯作者：
Yoganathan, Ajit P.
中科院分区：
文献类型：
--
作者：
Sundareswaran, Kartik S.;Pekkan, Kerem;Yoganathan, Ajit P.
总腔肺连接阻力：对静息和运动时单心室血流动力学有显着影响。 Am J Physiol Heart Circ Physiol 295：H2427-H2435，2008。首次发表于 2008 年 10 月 17 日； doi:10.1152/ajpheart.00628.2008.-关于全腔肺连接 (TCPC) 对单心室 (SV) 循环中静息和运动血流动力学的影响知之甚少。本研究的目的是使用 SV 循环的集总参数模型来阐明这一机制。肺血管阻力 (1.96 +/- 0.80 WU) 和全身血管阻力 (18.4 +/- 7.2 WU) 是从 40 名 TCPC 患者的导管插入数据中获得的。 TCPC 阻力 (0.39 +/- 0.26 WU) 是通过对 MRI (n = 16) 重建的解剖学精确三维模型进行计算流体动力学模拟来确定的。这些参数用于 SV 循环的集总参数模型，以研究静息和运动条件下 TCPC 阻力对 SV 血流动力学的影响。使用双心室模型进行比较。对于双心室循环，心输出量 (CO) 对 TCPC 阻力的依赖性可以忽略不计（灵敏度 = -0.064 1.min(-1).WU-1），但对于 SV 循环则不然（灵敏度 = -0.88 1.min(-1).WU-1）。 SV 随心率增加 CO 的能力也严重降低。在模拟心率为 150 次/分钟时，与阻力最低（50%）且循环正常（119%）的 SV 患者相比，阻力最高（1.08 WU）的 SV 患者 CO 增加量（20.5%）显着较低。这是由于与 SV 循环相关的后负荷增加 (+ 35%) 和前负荷减少 (- 12%)。总之，TCPC 阻力对 SV 生理学患者的静息血流动力学和运动能力有显着影响。
The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise. Am J Physiol Heart Circ Physiol 295: H2427-H2435, 2008. First published October 17, 2008; doi:10.1152/ajpheart.00628.2008.-Little is known about the impact of the total cavopulmonary connection (TCPC) on resting and exercise hemodynamics in a single ventricle (SV) circulation. The aim of this study was to elucidate this mechanism using a lumped parameter model of the SV circulation. Pulmonary vascular resistance (1.96 +/- 0.80 WU) and systemic vascular resistances (18.4 +/- 7.2 WU) were obtained from catheterization data on 40 patients with a TCPC. TCPC resistances (0.39 +/- 0.26 WU) were established using computational fluid dynamic simulations conducted on anatomically accurate three-dimensional models reconstructed from MRI (n = 16). These parameters were used in a lumped parameter model of the SV circulation to investigate the impact of TCPC resistance on SV hemodynamics under resting and exercise conditions. A biventricular model was used for comparison. For a biventricular circulation, the cardiac output ( CO) dependence on TCPC resistance was negligible (sensitivity = -0.064 1.min(-1).WU-1) but not for the SV circulation (sensitivity = -0.88 1.min(-1).WU-1). The capacity to increase CO with heart rate was also severely reduced for the SV. At a simulated heart rate of 150 beats/min, the SV patient with the highest resistance (1.08 WU) had a significantly lower increase in CO (20.5%) compared with the SV patient with the lowest resistance (50%) and normal circulation (119%). This was due to the increased afterload (+ 35%) and decreased preload (- 12%) associated with the SV circulation. In conclusion, TCPC resistance has a significant impact on resting hemodynamics and the exercise capacity of patients with a SV physiology.