Fragmentation of Different Calcification Growth Patterns in Bicuspid Valves During Balloon Valvuloplasty Procedure.
Fragmentation of Different Calcification Growth Patterns in Bicuspid Valves During Balloon Valvuloplasty Procedure.
复制标题
球囊瓣膜成形术过程中二尖瓣不同钙化生长模式的破碎。
DOI：
10.1007/s10439-022-03115-8
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发表时间：
2023
影响因子：
3.8
通讯作者：
Haj-Ali,Rami
中科院分区：
文献类型：
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作者：
Morany,Adi;Lavon,Karin;Halevi,Rotem;Haj-Ali,Nora;Bluestein,Danny;Raanani,Ehud;Hamdan,Ashraf;Haj-Ali,Rami
本研究主要研究二尖瓣钙化的CT表现和钙化途径，以及球囊瓣膜成形术中钙化沉积的特殊几何形状对钙化的影响。为了达到这一目标，我们采用了一种新型的反向钙化技术，该技术可以根据CT扫描预测导致当前状态的钙化进程，并应用于n= 的26例二尖瓣患者。两种主要钙化类型的1型二尖瓣：不对称和对称的部分或全部弧形和环状。随后，引入了钙化碎裂生物力学模型来研究经导管主动脉瓣置换术前的球囊瓣膜成形术，以实现更好的设备扩张。为了实现这一目标，我们对6个典型的二尖瓣狭窄的钙化类型进行了研究。结果表明，钙沉积层的几何形状对裂纹的萌生有显著影响。全圆形或部分圆形沉积具有较强的抗碎裂能力，基本保持完好，但弧形沉积导致瓶颈区出现多条裂隙。所提出的生物力学计算模型可以帮助评估钙化碎裂模式，以改进二尖瓣狭窄患者的治疗方法，特别是对于标签外的经导管主动脉瓣置换术。
This study focuses on the calcification development and routes of type-1 bicuspid aortic valves based on CT scans and the effect of the unique geometrical shapes of calcium deposits on their fragmentation under balloon valvuloplasty procedures. Towards this goal, the novel Reverse Calcification Technique (RCT), which can predict the calcification progression leading to the current state based on CT scans, is utilized forn= 26 bicuspid aortic valves patients. Two main calcification patterns of type-1 bicuspid aortic valves were identified; asymmetric and symmetric with either partial or full arcs and circles. Subsequently, a calcification fragmentation biomechanical model was introduced to study the balloon valvuloplasty procedure prior to transcatheter aortic valve replacement implantation that allows better device expansion. To achieve this goal, six representative stenotic bicuspid aortic valves of different calcification patterns were investigated. It was found that the distinct geometrical shape of the calcium deposits had a significant effect on the cracks' initiations. Full or partial circle deposits had stronger resistance to fragmentation and mainly remained intact, yet, arc-shaped pattern deposits resulted in multiple cracks in bottleneck regions. The proposed biomechanical computational models could help assess calcification fragmentation patterns toward improving treatment approaches in stenotic bicuspid aortic valve patients, particularly for the off-label use of transcatheter aortic valve replacement.