Multi-Band Surgery for Repaired Tetralogy of Fallot Patients With Reduced Right Ventricle Ejection Fraction: A Pilot Study
Multi-Band Surgery for Repaired Tetralogy of Fallot Patients With Reduced Right Ventricle Ejection Fraction: A Pilot Study
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多带手术修复右心室射血分数降低的法洛四联症患者：一项初步研究
DOI：
10.3389/fphys.2020.00198
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发表时间：
2020-03
影响因子：
4
通讯作者：
Tang Dalin
中科院分区：
文献类型：
--
作者：
Yu Han;del Nido Pedro J.;Geva Tal;Yang Chun;Wu Zheyang;Rathod Rahul H.;Huang Xueying;Billiar Kristen L.;Tang Dalin
右心室功能衰竭是修复性法洛四联症（TOF）患者最常见的症状之一。目前的手术治疗方法包括肺动脉瓣置换术（PVR），其术后结果好坏参半。提出了一种新的PVR手术策略，使用主动收缩带来改善PVR后的预后。为了代替在真实患者身上测试危险的外科手术，使用基于患者特异性心脏磁共振（CMR）数据的生物力学心室模型进行计算模拟（虚拟手术），以测试具有主动收缩带的PVR手术的可行性。试验了不同的束带组合和插入选择，以确定最佳的手术设计。方法对1例经知情同意的TOF患者（男，23岁）进行心脏磁共振检查。我们建立了21个有限元模型，并按照既定的程序进行求解，以研究扎带手术的结果。材料模型采用非线性各向异性Mooney-Rivlin模型。模拟了5种不同的频带插入方案（3种不同频带位置的单频带模型、1种不同频带位置的单频带模型、1种不同频带位置的单频带模型和1种不同频带位置的模型）。测试三种收缩率（10、15、20%）和被动收缩率（0%）。左室射血分数作为心功能指标。结果收缩20%的三波段模型右心室射血分数从基线的37.38%提高到41.58%，绝对提高4.20%。其他4种收缩率为20%的波段模型右心室射血分数分别为39.70、39.45、40.70%（两波段）和39.17%。21种模型的RV平均应力和应变值差异不大（5-11%）。结论本初步研究表明，三频带收缩率为20%的模型可使右心室射血分数绝对改善4.20%，具有临床意义。被动弹性带导致右心室射血分数降低。在进行临床试验之前，建模结果和手术策略需要通过多患者研究和动物实验进一步发展和验证。需要组织再生技术来生产收缩带的材料。
Introduction Right ventricle (RV) failure is one of the most common symptoms among patients with repaired tetralogy of Fallot (TOF). The current surgery treatment approach including pulmonary valve replacement (PVR) showed mixed post-surgery outcomes. A novel PVR surgical strategy using active contracting bands is proposed to improve the post-PVR outcome. In lieu of testing the risky surgical procedures on real patients, computational simulations (virtual surgery) using biomechanical ventricle models based on patient-specific cardiac magnetic resonance (CMR) data were performed to test the feasibility of the PVR procedures with active contracting bands. Different band combination and insertion options were tested to identify optimal surgery designs. Method Cardiac magnetic resonance data were obtained from one TOF patient (male, age 23) whose informed consent was obtained. A total of 21 finite element models were constructed and solved following our established procedures to investigate the outcomes of the band insertion surgery. The non-linear anisotropic Mooney–Rivlin model was used as the material model. Five different band insertion plans were simulated (three single band models with different band locations, one model with two bands, and one model with three bands). Three band contraction ratios (10, 15, and 20%) and passive bands (0% contraction ratio) were tested. RV ejection fraction was used as the measure for cardiac function. Results The RV ejection fraction from the three-band model with 20% contraction increased to 41.58% from the baseline of 37.38%, a 4.20% absolute improvement. The RV ejection fractions from the other four band models with 20% contraction rate were 39.70, 39.45, and 40.70% (two-band) and 39.17%, respectively. The mean RV stress and strain values from all of the 21 models showed only modest differences (5–11%). Conclusion This pilot study demonstrated that the three-band model with 20% band contraction ratio led to 4.20% absolute improvement in the RV ejection fraction, which is considered as clinically significant. The passive elastic bands led to the reduction of the RV ejection fractions. The modeling results and surgical strategy need to be further developed and validated by a multi-patient study and animal experiments before clinical trial could become possible. Tissue regeneration techniques are needed to produce materials for the contracting bands.
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DOI：
10.1016/b978-0-12-801238-3.99945-8
发表时间：
2019-01-01
期刊：
ENCYCLOPEDIA OF BIOMEDICAL ENGINEERING, VOL 2
影响因子：
--
作者：
Chan, Rachel W.;Lau, Justin Y. C.;Lau, Angus Z.
通讯作者：
Lau, Angus Z.
DOI：
10.1115/1.2913339
发表时间：
2008-08
期刊：
Journal of biomechanical engineering
影响因子：
--
作者：
Tang D;Yang C;Geva T;Del Nido PJ
通讯作者：
Del Nido PJ
影响因子：
37.8
作者：
Geva T;Gauvreau K;Powell AJ;Cecchin F;Rhodes J;Geva J;del Nido P
通讯作者：
del Nido P
使用具有不同零负荷舒张期和收缩期形态的基于 MRI 的模型对法洛四联症患者进行患者特异性体内右心室材料参数估计
影响因子：
3.5
作者：
Yu H;Del Nido PJ;Geva T;Yang C;Tang A;Wu Z;Rathod RH;Huang X;Billiar KL;Tang D
通讯作者：
Tang D
来自多板计算机断层扫描图像的三尖瓣变形的有限元分析。
影响因子：
3.8
作者：
Kong F;Pham T;Martin C;McKay R;Primiano C;Hashim S;Kodali S;Sun W
通讯作者：
Sun W