Aortic root dynamics and surgery: from craft to science
Aortic root dynamics and surgery: from craft to science
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DOI：
10.1098/rstb.2007.2124
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发表时间：
2007-08-29
影响因子：
6.3
通讯作者：
Miller, D. Craig
中科院分区：
文献类型：
--
作者：
Cheng, Allen;Dagum, Paul;Miller, D. Craig
自世纪以列奥纳多达芬奇的研究开始以来，在整个心动周期中主动脉根的精确结构和功能动力学一直困扰着研究者。过去50年的实验工作大大有助于我们目前对主动脉根部动力学的理解。在这篇文章中，我们回顾和总结了相关的结构分析，使用不透射线的标记和声测晶体，关于主动脉根三维变形和描述主动脉根动力学在整个心动周期的细节。然后，我们比较不同的研究之间的数据，并讨论了负责的主动脉根部变形的模式，包括血流动力学，解剖和时间的决定因素，这些变形的机制。主动脉根部变形的这些模式紧密耦合，以最大化射血，优化跨瓣射血血液动力学，并且可能最重要的是通过最佳舒张负荷分担和最小化整个心动周期的跨瓣湍流来减少主动脉瓣尖上的应力。这种对主动脉根部力学和生理学的更全面的理解将有助于改进内科和外科治疗方法、增强治疗决策和更好地对患者进行干预后护理。随着对主动脉根部生理学的更好理解，未来对主动脉瓣修复和置换的研究应考虑主动脉根部动力学的综合结构和功能不对称性，以最大限度地减少主动脉瓣尖上的应力，以防止过早的结构性瓣膜退化。
Since the fifteenth century beginning with Leonardo da Vinci's studies, the precise structure and functional dynamics of the aortic root throughout the cardiac cycle continues to elude investigators. The last five decades of experimental work have contributed substantially to our current understanding of aortic root dynamics. In this article, we review and summarize the relevant structural analyses, using radiopaque markers and sonomicrometric crystals, concerning aortic root three-dimensional deformations and describe aortic root dynamics in detail throughout the cardiac cycle. We then compare data between different studies and discuss the mechanisms responsible for the modes of aortic root deformation, including the haemodynamics, anatomical and temporal determinants of those deformations. These modes of aortic root deformation are closely coupled to maximize ejection, optimize transvalvular ejection haemodynamics and-perhaps most importantly-reduce stress on the aortic valve cusps by optimal diastolic load sharing and minimizing transvalvular turbulence throughout the cardiac cycle. This more comprehensive understanding of aortic root mechanics and physiology will contribute to improved medical and surgical treatment methods' enhanced therapeutic decision making and better post-intervention care of patients. With a better understanding of aortic root physiology, future research on aortic valve repair and replacement should take into account the integrated structural and functional asymmetry of aortic root dynamics to minimize stress on the aortic cusps in order to prevent premature structural valve deterioration.