先天性心脏病相关性肺动脉高压血流动力学特异性研究
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国家自然科学基金项目(81970439, 81771934, 81501558),上海市国际科技合作基金项目(18410721400),上海市科委科技基金(17DZ2253100),上海交通大学“交大之星”计划医工交叉研究基金(YG2019ZDA03)


Hemodynamic Characteristics of Pulmonary Arterial Hypertension Related to Congenital Heart Disease
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    摘要:

    目的 先天性心脏病相关性肺动脉高压(pulmonary arterial hypertension related to congenital heart disease, PAH-CHD)是肺动脉血流动力学异常所致的一种疾病。研究肺循环血流动力学特异性,有助于了解PAH-CHD发生发展的生物力学因素。方法 对5例PAH-CHD 患儿和5例无PAH(Non-PAH)的先天性心脏病患儿通过临床及影像资料收集,重建三维血管模型,利用计算流体动力学模拟肺动脉血液流动,对比分析肺动脉血流动力学相关速度流线、壁面剪切应力(wall shear stress, WSS)及单位体表面积平均能量损失(E·)差异。结果 血流动力学相关指标显示,PAH-CHD患儿左右肺动脉分支处流速和WSS明显升高,主肺动脉处WSS明显降低,E·呈显著增加趋势且与肺动脉直径及入口流量呈明显正相关。结论 PAH-CHD患儿较Non-PAH患儿肺动脉分支处流速和WSS明显升高,主肺动脉WSS降低,E·增加,表明这些血流动力学因素与PAH-CHD密切相关,是临床评估PAH-CHD的潜在血流动力学指标。

    Abstract:

    Objective Hemodynamic disorder of the pulmonary artery (PA) is the main cause of pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). To study the hemodynamic characteristics of PA, so as to understand biomechanical factors in the occurrence and development of PAH-CHD. Methods Clinical and imaging data were collected in five PAH-CHD patients and five matched controls (Non-PAH) to reconstruct subject-specific three-dimensional (3D) PA models. Computational fluid dynamics (CFD) was performed to compare the hemodynamic difference of flow patterns, wall shear stress (WSS) and normalized energy loss (E·) in the two groups. Results Hemodynamics-related parameters showed that the velocity and WSS were higher in the left and right PA branches of PAH-CHD patients, with significantly lower WSS in the main PA. The E· significantly increased in PAH-CHD patients and positively correlated with normalized PA diameter and inflow. Conclusions Compared with Non-PAH subjects, PAH-CHD patients have obviously higher velocity and WSS in PA branches, lower WSS in main PA and greater E·, indicating these hemodynamic parameters are related with the PAH-CHD, which can be used as potential biomechanical factors for the clinical evaluation of PAH-CHD.

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王丽平,刘金龙,张明杰,沈娟亚,仝志荣,徐卓明.先天性心脏病相关性肺动脉高压血流动力学特异性研究[J].医用生物力学,2020,35(3):276-283

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  • 收稿日期:2019-08-27
  • 最后修改日期:2019-10-08
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  • 在线发布日期: 2020-06-24
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