Blood flow analysis of the aortic arch using computational fluid dynamicsaEuro
Blood flow analysis of the aortic arch using computational fluid dynamicsaEuro
复制标题
DOI：
10.1093/ejcts/ezv459
复制
发表时间：
2016-06-01
影响因子：
3.4
通讯作者：
Yaku, Hitoshi
中科院分区：
文献类型：
--
作者：
Numata, Satoshi;Itatani, Keiichi;Yaku, Hitoshi
为了获得关于主动脉疾病的预测信息，我们评估了主动脉弓内的血流如何受到胸主动脉瘤的影响。此外，为了揭示这些病例的最佳术中管理，我们使用计算流体动力学（CFD）检查了右锁骨下动脉（rSCA）灌注期间的血流。根据计算机断层扫描图像，采用六种不同的模式制作了患者特定的主动脉弓模型。采用有限体积法建立了模拟生理脉动流的CFD模型，包括外周反射波、特征阻抗和自主调节系统。计算一个心动周期内的血流模式、壁面切应力（WSS）和振荡剪切指数（OSI）。此外，在不同的灌注流量下，rSCA灌注过程中的流动流线进行了模拟。主动脉扩张引起的漩涡扰动流在一个扩张的空间，导致湍流不仅在动脉瘤内，而且在近端和/或远端正常的主动脉部分。在胸主动脉扩张的患者中，在收缩期存在螺旋形的螺旋流和周向涡旋。在患有弓状动脉瘤的患者中，动脉瘤内的湍流导致动脉瘤尖端的高OSI。在主动脉上支开口、窦管连接处、升主动脉后外侧和降主动脉近端小弯处检测到高OSI。rSCA灌注显示，右颈总动脉在整个心动周期中由来自rSCA的血流灌注。75%的血流来自rSCA，心脏血流仅在收缩高峰期的短时间内到达左颈总动脉和锁骨下动脉，扩张的主动脉导致主动脉弓内湍流，高OSI部位与急性主动脉夹层的最佳进入部位相似，提示机械应力与急性主动脉夹层的因果关系。rSCA插管可能对升主动脉斑块具有保护作用。
To obtain predictive information regarding aortic disease, we evaluated how blood flow inside the aortic arch was influenced by thoracic aortic aneurysms. In addition, to reveal the optimal intraoperative management in these cases, we examined blood flow during right subclavian arterial (rSCA) perfusion using computational fluid dynamics (CFD).Patient-specific models of the aortic arch were made with six different patterns based on the computed tomographic images. CFD models with finite volume methods were created to simulate the physiological pulsatile flow including the peripheral reflection wave, characteristic impedance and autonomous regulation system. Flow stream patterns, wall shear stress (WSS) and the oscillatory shear index (OSI) were calculated during one cardiac cycle. Furthermore, flow streamlines during rSCA perfusion were simulated under different perfusion flows.Aortic dilatation caused vortical disturbed flow in a dilated space, resulting in turbulent flow not only inside the aneurysm but also in the proximal and/or distal normal aortic portion. In patients with a dilated thoracic aorta, there was a helical spiral flow with a circumferential vortex in systole. In patients with an arch aneurysm, turbulent flow inside the aneurysm caused a high OSI at the tip of the aneurysm. A high OSI was detected at the orifice of the supra-aortic branches, sinotubular junction, posterior lateral side of the ascending aorta and lesser curvature of the proximal descending aorta. rSCA perfusion revealed that the right common carotid artery was perfused by blood flow from rSCA throughout the cardiac cycle. With 75% of the flow from the rSCA, blood flow from the heart reached the left common carotid and subclavian artery only during a short period during the peak of systole.A dilated aorta causes a turbulent flow pattern in the aortic arch. The high OSI site was similar to the favourite entry site for acute aortic dissection, indicating the causal relationship between mechanical stress and acute aortic dissection. rSCA cannulation might be cerebroprotective from ascending aortic plaque.