Role of aortic root motion in the pathogenesis of aortic dissection

Role of aortic root motion in the pathogenesis of aortic dissection
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DOI：
10.1161/01.cir.0000112569.27151.f7
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发表时间：
2004-02-17
期刊：
CIRCULATION
影响因子：
37.8
通讯作者：
Robicsek, F
Robicsek, F
中科院分区：
医学1区
文献类型：
--
作者：
Beller, CJ;Labrosse, MR;Robicsek, F

文献摘要

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背景：在心脏周期中，主动脉根部的向下运动可能是导致主动脉夹层中观察到的周向撕裂的原因。方法与结果：对40例心脏患者进行对比剂注射，建立主动脉根、弓和弓支的有限元模型，评估主动脉根位移和压力对主动脉壁应力的影响。主动脉根部轴向位移0 ~ 14mm。在主动脉不全患者中（22 +/- 13%的肾导管连接处直径对12 +/- 9%），其升高；在左心室运动不足患者中（10 +/- 9%的肾导管连接处直径对17 +/- 12%），其降低。由于主动脉根部位移导致的最大应力增加出现在中管交界处上方约2cm处，当8.9 mm的轴向位移加上120毫米汞柱的管压时，纵向应力增加了50%，达到0.32 Nmm（-2）。当压力载荷增加到180 mm Hg而不发生轴向位移时，观察到类似的结果。结论：主动脉根移位和高血压都会显著增加升主动脉的纵向应力。对于有夹层危险的高血压患者，监测主动脉根部运动可作为一个重要的危险因素。
Background - The downward movement of the aortic root during the cardiac cycle may be responsible for producing the circumferential tear observed in aortic dissections.Methods and Results - Contrast injections were investigated in 40 cardiac patients, and a finite element model of the aortic root, arch, and branches of the arch was built to assess the influence of aortic root displacement and pressure on the aortic wall stress. The axial displacement of the aortic root ranged from 0 to 14 mm. It was increased in patients with aortic insufficiency ( 22 +/- 13% of the sino-tubular junction diameter versus 12 +/- 9%) and reduced in patients with hypokinesis of the left ventricle ( 10 +/- 9% of sino-tubular junction versus 17 +/- 12%). The largest stress increase due to aortic root displacement was found approximately 2 cm above the sino- tubular junction, where the longitudinal stress increased by 50% to 0.32 Nmm(-2) when 8.9-mm axial displacement was applied in addition to 120-mm Hg luminal pressure. A similar result was observed when the pressure load was increased to 180 mm Hg without axial displacement.Conclusions - Both aortic root displacement and hypertension significantly increase the longitudinal stress in the ascending aorta. For patients with hypertension who are at risk of dissection, aortic root movement may be monitored as an important risk factor.