经导管主动脉瓣置换术血流动力学体外实验研究

      In Vitro Experimental Study on Hemodynamics of Transcatheter Aortic Valve Replacement

      • 摘要: 基于CTA数据建立患者特异性的主动脉模型,采用改造后ViVitro脉动台的数字粒子图像测速(DPIV)试验方法,研究经导管主动脉瓣置换术(TAVR)术前和术后的主动脉血流动力学性能和流场特征。研究结果表明血流动力学参数与临床数据一致,验证了模型的准确性。从术前和术后有效开口面积(0.33 cm2和1.78 cm2)、平均跨瓣压差(58 mmHg和9 mmHg,1 mmHg=133.32 Pa)、返流百分比(52%和8%)、峰值流速(4.60 m/s和1.81 m/s)和流场分布(偏心射流和均匀射流)对比研究来看,TAVR术后的即刻有效性良好。从黏性切应力和雷诺切应力的角度,术前和术后患者特异性模型发生溶血和血栓问题的风险可能性低。该研究提供了一套可靠的用于主动脉流场的DPIV测试方法,从血流动力学性能和流场特征的角度为TAVR术式即刻和长期有效性提供生物力学依据,在临床诊断、术式治疗和远期评价等方面具有重要的应用价值。

         

        Abstract: The patient-specific aortic silicone model was established based on CTA data. The digital particle image velocimetry (DPIV) test method in the modified ViVitro pulsatile flow system was used to investigate the aortic hemodynamic performance and flow field characteristics before and after transcatheter aortic valve replacement (TAVR). The results showed that the hemodynamic parameters were consistent with the clinical data, which verified the accuracy of the model. From the comparative study of preoperative and postoperative effective orifice area (0.33 cm2 and 1.78 cm2), mean pressure difference (58 mmHg and 9 mmHg), percentage of regurgitation (52% and 8%), peak flow velocity (4.60 m/s and 1.81 m/s) and flow field distribution (eccentric jet and uniform jet), the immediate efficacy after TAVR is good. From the perspective of viscous shear stress and Reynolds shear stress, the risk of hemolysis and thrombotic problems was low in preoperative and postoperative patient-specific models. This study provides a set of reliable DPIV testing methods for aortic flow field, and provides biomechanical basis for the immediate and long-term effectiveness of TAVR from the perspective of hemodynamics and flow field characteristics. It has important application value in clinical diagnosis, surgical treatment and long-term evaluation.

         

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