动脉导管对改良Blalock-Taussig分流术的血流动力学影响  

The hemodynamic effects of ductus arteriosus on modified Blalock-Taussig shunt

作　　者：熊吉文 孙琦[1] 刘锦纷[1,2] 胡立伟[2,3] 仝志荣 刘金龙 Xiong Jiwen;Sun Qi;Liu Jinfen;Hu Liwei;Tong Zhirong;Liu Jinlong(Department of Cardiothoracic Surgery,Shanghai Children’s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease,Shanghai Children’s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Diagnostic lmaging Center,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Institute of Pediatric Translational Medicine,Shanghai Children’s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,200127 [2]上海交通大学医学院附属上海儿童医学中心,上海结构性心脏病虚拟现实工程技术研究中心,200127 [3]上海交通大学医学院附属上海儿童医学中心影像诊断中心,200127 [4]上海交通大学医学院附属上海儿童医学中心,儿科转化医学研究所,200127

出　　处：《中华胸心血管外科杂志》2021年第3期154-158,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81870238,81970439);上海市科委国际学术合作交流项目(18410721400);上海市科委科技基金(17DZ2253100)。

摘　　要：目的通过计算流体力学分析关闭或保留动脉导管对改良Blalock-Taussig分流术后血流动力学的影响,为术前规划和术后血流动力学预测提供参考。方法基于患者个体化肺动脉闭锁合并动脉导管未闭的三维血管模型,通过计算机辅助设计对模型进行虚拟改良Blalock-Taussig分流术,保留或关闭动脉导管。利用计算血流动力学方法分析比较术前及虚拟术后的血流参数差异。结果保留动脉导管竞争性减少通过分流管的血流量,但肺血流量增加。通过分流管的血流与通过动脉导管的血流相互冲击,在肺动脉形成复杂湍流,具有低壁面切应力与高振荡剪切指数,可导致较高的流动能量损失。结论行改良Blalock-Taussig术时保留动脉导管将导致肺血流过多、体循环灌注不足、增加心脏负荷及心力衰竭风险,并不能降低潜在的血栓风险。Objective To investigate hemodynamic characteristics of the modified Blalock-Taussig shunt(MBTS)with the preservation or ligation of ductus arteriosus(DA)based on computational fluid dynamics(CFD),thus to help preoperative surgery design and postoperative prediction.Methods A patient with pulmonary atresia and patent ductus arteriosus was included.Patient-specific three-dimensional model was reconstructed and virtual surgeries of shunt insertion and ductus ligation or preservation were performed via computer-aided design(CAD).CFD was utilized to analyze hemodynamic parameters preoperatively and postoperatively based on patient-specific anatomy and physiologic data.Results The preservation of DA competitively reduced the shunt flow but increased total pulmonary perfusion.The shunt flow and ductal flow collided with each other,causing large and complicated turbulence in pulmonary artery where lower wall shear stress and higher oscillatory shear index were distributed,as well as higher energy loss.Conclusion The preservation of DA is riskier in hemodynamics which may lead to pulmonary over-perfusion,inadequate systemic perfusion and heavier cardiac burden,thus increasing the risk of heart failure and it seems to bring no benefit in terms of reducing risks of thrombosis.

关 键 词：改良BLALOCK-TAUSSIG分流术 动脉导管 计算血流动力学 虚拟手术 

分 类 号：R726.5[医药卫生—儿科]