经导管主动脉瓣置入术后椭圆形主动脉瓣环最大直径方向变化对升主动脉血流动力学的影响:一项基于血流动力学的研究  

Eff ects of change of the direction of the maximum diameter of oval aortic valve orifi ce on ascending aorta hemodynamics after transcatheter aortic valve implantation:a hemodynamic study

作　　者：宋攀 罗彩东[1] 王勇军 文军 戴闽[1] SONG Pan;LUO Cai-dong;WANG Yong-jun;WEN Jun;DAI Min(Department of Cardiology,Mianyang Central Hospital,Mianyang 621010,China)

机构地区：[1]绵阳市中心医院心内科,四川绵阳621010 [2]西南科技大学计算机科学与技术学院

出　　处：《中国介入心脏病学杂志》2023年第9期667-672,共6页Chinese Journal of Interventional Cardiology

基　　金：四川省医学科研青年创新课题项目(2021)(Q21075);四川省自然科学基金项目(青年科学基金项目,2022)(2022NSFSC1369)。

摘　　要：目的探讨经导管主动脉瓣置入术(TAVI)后椭圆形主动脉瓣环最大径线方向变化对升主动脉血流动力学的具体影响。方法纳入绵阳市中心医院4例患者的4个健康主动脉代表TAVI治疗后的主动脉。本研究通过血流动力学数值模拟,比较了3种不同瓣环形状(正常主动脉瓣环、Ⅰ型椭圆形和Ⅱ型椭圆形)对主动脉壁面剪切应力(WSS)及螺旋流度指标分布的影响,其中Ⅰ型椭圆形瓣环的长轴位于主动脉矢状面,Ⅱ型椭圆形瓣环的长轴与主动脉矢状面垂直。结果在螺旋流动方面,Ⅰ型椭圆形瓣环能明显改变螺旋流动的方向(P<0.001),而Ⅱ型椭圆形瓣环能显著增强螺旋流动度(P=0.020)。3组升主动脉时间平均壁面剪切应力(TAWSS)在极值、平均值比较,差异有统计学意义(P=0.010,P<0.001),而且在极值Ⅰ型椭圆形瓣环明显高于Ⅱ型椭圆形瓣环;降主动脉TAWSS在极值比较,差异有统计学意义(P=0.010),而且在Ⅰ型椭圆形瓣环明显低于Ⅱ型椭圆形瓣环。3组升主动脉振荡剪切系数(OSI)平均值上比较,差异有统计学意义(P=0.010),但在降主动脉OSI平均值上,Ⅰ型椭圆形瓣环明显高于圆形瓣环,但差异无统计学意义(P=0.080)。结论Ⅰ型椭圆形瓣环导致螺旋流结构转变为主动脉弓内侧的低速紊流模式,而Ⅱ型椭圆形瓣环保持螺旋流结构不变,但流速分布呈偏态。Ⅰ型瓣环更容易出现低TAWSS,并在区域内伴有高OSI。这些发现对于优化TAVI手术策略和指导后续患者管理具有重要价值。Objective To investigate the specifi c impact of the direction of the maximum diameter of the elliptical Aortic valve orifi ce on the hemodynamics of the Ascending aorta after Transcatheter aortic valve implantation(TAVI).Methods Through the numerical simulation of hemodynamics,this study compared the eff ects of three diff erent valve orifi ce shapes(circular,typeⅠoval and typeⅡoval)on the distribution of aortic wall Shear stress(WSS)and spiral flow index.Results There was a statistically signifi cant diff erence in the extreme and average values of time average wall shear stress(TAWSS)among the three groups of ascending aorta(P=0.010,P<0.001),and at the extreme value,typeⅠelliptical annulus was signifi cantly higher than typeⅡelliptical annulus.The TAWSS of the descending aorta showed statistically significant differences in extreme values(P=0.010),and was signifi cantly lower in typeⅠelliptical annulus than in typeⅡelliptical annulus.There was a statistically significant difference in the average OSI of the ascending aorta among the three groups(P=0.010),but in the average OSI of the descending aorta,the typeⅠelliptical valve annulus was signifi cantly higher than the circular valve annulus.The valve ring was shaped,but the diff erence was not statistically signifi cant(P=0.080).Conclusions TypeⅠelliptical orifi ce leads to the transformation of spiral flow structure into low-speed turbulent flow mode inside the Aortic arch,while typeⅡelliptical orifi ce keeps the spiral flow structure unchanged,but the velocity distribution is skewed.TypeⅠorifi ces are more prone to low TAWSS with high oscillatory Shear stress index(OSI)in the region.These fi ndings have signifi cant value in optimizing TAVI surgical strategies and guiding subsequent patient management.

关 键 词：经导管主动脉瓣置入术 主动脉瓣环 椭圆形 血流动力学 

分 类 号：R54[医药卫生—心血管疾病]