冠状动脉瘤扩张性心肌缺血机理及其搭桥手术治疗的血流动力学研究

冠状动脉瘤是冠状动脉发生局部或弥漫性扩张，管径超过正常冠状动脉直径2倍以上的病变，是一种罕见、病灶性强、致死率高的心血管疾病。其临床表现为右冠好发，症状与冠状动脉狭窄性心肌缺血无异，临床治疗采用与治疗冠状动脉狭窄相同的搭桥手术。揭示冠状动脉瘤右冠好发的病灶性、扩张性心肌缺血不同于狭窄性心肌缺血的血流动力学机理，具有理论创新意义；明确冠状动脉瘤搭桥术不同于冠状动脉狭窄搭桥术的血流动力学指征，对冠状动脉瘤的临床治疗决策具有理论指导价值。本项目拟采用几何多尺度、流-固耦合血流动力学数值模拟和体外模型实验的方法，研究左右冠状动脉的血流动力学差异，阐明冠状动脉瘤右冠好发的血流动力学机理；研究冠状动脉瘤局部扩张的异常血流动力学，揭示涡漩、血液滞留以及巨型动脉瘤“窃血”的血流动力学级联效应，阐明冠状动脉瘤扩张性心肌缺血的血流动力学机理；研究冠状动脉瘤搭桥手术的血流动力学，为临床手术决策提供理论依据。

The coronary aneurysm is the local or diffuse dilatation of coronary artery with diameter 2 times larger than the normal coronary artery. It is a kind of rare and focal coronary disease with high mortality. It may cause the myocardial ischemia as same as the coronary stenosis. Thus, the same surgery as used in coronary stenosis treatment, the coronary artery bypass grafting, is also adopted to deal with coronary aneurysm in clinics. In the present study, the geometrical multiscale hemodynamic simulation and in vitro experimental method will be used to reveal the focal characteristic of coronary aneurysm, the different mechanism of myocardial ischemia resulted from coronary aneurysm, and the hemodynamics of coronary aneurysm bypass grafting. Firstly, the hemodynamic difference between the left and right coronary artery will be studied to find out the reason why the coronary aneurysm is prone to the right coronary artery. Secondly, the abnormal hemodynamics in the coronary aneurysm will be studied in details to discover cascade progress of vortex, flow stagnation and the blood theft in huge aneurysm, so that the reason for myocardial ischemia caused by coronary aneurysm will be elucidated. Finally, the hemodynamics of the bypass grafting for the coronary aneurysm will be studied to help the surgical decision making in clinics from the view of hemodynamic optimization.