保留瓣膜两种主动脉根部置换术的生物力学数值模拟  

Numerical Simulation of Biomechanics of Two Aortic Root Replacement Procedures with Valve Preservation

作　　者：王倩[1] 罗新锦 丘俊涛 胡圣懿 丁学超 杜田明 张艳萍[1] 侯倩文 乔爱科[1] WANG Qian;LUO Xinjin;QIU Juntao;HU Shengyi;DING Xuechao;DU Tianming;ZHANG Yanping;HOU Qianwen;QIAO Aike(College of Chemistry and Life Science,Beijing University of Technology,Beijing 100124,China;Department of Cardiovascular Surgery,National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China;State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]北京工业大学化学与生命科学学院,北京100124 [2]中国医学科学院阜外医院心血管外科,北京100037 [3]中国医学科学院阜外医院心血管疾病国家重点实验室,国家心血管病中心,北京100037

出　　处：《医用生物力学》2024年第4期691-698,共8页Journal of Medical Biomechanics

基　　金：中国医学科学院医学创新基金项目(2022-I2M-C&T-B-037);国家自然科学基金项目(12172018)。

摘　　要：目的阐释运用直筒型人工血管行保留主动脉瓣膜的主动脉根部改良重塑术和佛罗里达袖套术对新生主动脉根部生物力学的影响。方法采用CTA影像重建5例主动脉根部有限元模型,包括2例主动脉根部改良重塑术(A1、A2),2例佛罗里达袖套术(B1、B2)和1例无主动脉根部病变的对照组(C)。通过数值模拟获得血流和压力分布结果,评估主动脉根部的血流动力学差异。结果两种术式的患者和对照组收缩峰值的最大流速之间没有显著差异,但主动脉根部改良重塑术后的流速较为平缓,与对照组模型相近,而其主动脉内平均压力和壁面切应力趋于稳定。佛罗里达袖套术中,存在高速血流冲击血管壁,沿主动脉壁出现不同程度的壁面切应力和压力集中现象。结论保留瓣膜的主动脉根部手术后,新生主动脉根部的血流模式依赖于术后窦部几何形状的变化。观察到两种术式的血流状态均表现良好,但主动脉根部改良重塑术血流模式较佛罗里达袖套术更稳定。Objective To elucidate the influence of two procedures aortic root remodeling using a straight tubular artificial vessel while preserving the aortic valve and the Florida sleeve procedure on the biomechanics of the aortic root.Methods Five finite element models of the aortic root were reconstructed using computed tomography angiography images,including two cases of aortic root remodeling(A1 and A2),two cases of the Florida sleeve procedure(B1 and B2),and one control group without aortic root pathology(C).Numerical simulations were performed to obtain the blood flow and pressure distribution result to assess the differences in the hemodynamics of the aortic root.Results There were no significant differences in the peak systolic velocity 691 between the two procedures and the control.However,the flow velocity after aortic root remodeling was smoother,similar to the model of the control group,with a more stable average aortic pressure and wall shear stress.In the Florida sleeve procedure,high-speed blood flow affected the vessel wall,leading to various degrees of wall shear stress and pressure concentrations along the aortic wall.Conclusions After aortic root replacement with valve preservation,blood flow patterns in the reconstructed aortic root depended on postoperative changes in sinus geometry.Both surgical procedures showed favorable blood flow patterns;however,the flow pattern after aortic root remodeling was more stable than that after the Florida sleeve procedure.

关 键 词：主动脉根部改良重塑术 佛罗里达袖套术 直筒型人工血管 主动脉根部形态 计算流体力学 

分 类 号：R318.01[医药卫生—生物医学工程]