Pulmonary hepatic flow distribution in total cavopulmonary connections: extracardiac versus intracardiac.
Pulmonary hepatic flow distribution in total cavopulmonary connections: extracardiac versus intracardiac.
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DOI：
10.1016/j.jtcvs.2010.06.009
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发表时间：
2011-01
影响因子：
6
通讯作者：
Yoganathan, Ajit P.
中科院分区：
文献类型：
--
作者：
Dasi, Lakshmi P.;Whitehead, Kevin;Pekkan, Kerem;de Zelicourt, Diane;Sundareswaran, Kartik;Kanter, Kirk;Fogel, Mark A.;Yoganathan, Ajit P.
肺动静脉畸形 (PAVM) 可能发生在 Fontan 之后，并且被认为与肝静脉流出物不成比例的肺部分布有关。我们研究了总腔静脉-肺连接（TCPC）几何形状的影响以及心输出量（CO）增加对下腔静脉（IVC）返回肺部的分布的影响。对 10 名 Fontan 患者进行处理，其中 5 名具有心脏外 (EC) 结构，5 名具有心脏内 (IC) 结构，之前分析了 TCPC 的功率损耗，以计算下腔静脉返回肺部的分布（二阶精度）。在 IVC 偏移和 CO 流量分流的参数变化下对一种理想化 TCPC 进行了类似分析。理想化 TCPC 模型中 IVC 返回的流取决于 IVC 偏移幅度和 CO 流量分流比。对于患者特异性 TCPC，IVC 返回的优先流与 IC 型 TCPC 中的 CO 流量分流比成正比 (p < 0.0001)。 EC TCPC 中的优先流与 IVC 偏移相关 (p<0.05)，与 CO 流量分配无关。据推测，IC 中的增强混合可以解释对比结果。在 IC 中，锻炼往往会减少流向 LPA 的流，而对于 EC，锻炼往往会均衡流。 EC 和 IC TCPC 由于几何差异而形成对比的混合特性，因此具有本质上不同的流特性。 PA 直径和 IVC 偏移可以共同决定肝血流。
Pulmonary arteriovenous malformations (PAVMs) can occur after the Fontan and are believed to be associated with disproportionate pulmonary distribution of hepatic venous effluent. We studied the impact of total cavo-pulmonary connection (TCPC) geometry and the effect of increased cardiac output (CO) on distribution of inferior vena caval (IVC) return to the lungs. 10 Fontan patients – 5 with extra-cardiac (EC) and 5 with intra-cardiac (IC) configurations of the TCPC previously analyzed for power loss were processed for calculating the distribution of inferior vena caval return to the lungs (2nd order accuracy). One idealized TCPC was similarly analyzed under parametric variation of IVC offset and CO flow split Streaming of the IVC return in the idealized TCPC model was dependent on both IVC offset magnitude and CO flow split ratio. For patient-specific TCPCs, preferential streaming of the IVC return was directly proportional to CO flow split ratio in the IC type TCPCs (p < 0.0001). Preferential streaming in EC TCPCs correlated to the IVC offset (p<0.05) and did not correlate to CO flow split. Enhanced mixing in IC is speculated to explain the contrasting results. Exercising tends to reduce streaming towards LPA in IC, while for EC, exercising tends to equalize the streaming. EC and IC TCPCs have inherently different streaming characteristics due to contrasting mixing characteristics owing to their geometric differences. PA diameters and IVC offsets may together determine hepatic flow streaming.
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