LI Jie,YIN Zhaofang,LIANG Fuyou.In vitro Experiment and Numerical Simulation-Based Study on Transient Hemodynamic Characteristics upon Balloon Deflation in Coronary Interventional Operation[J].Journal of medical biomechanics,2019,34(5):473-480
基于体外实验和数值仿真的冠脉介入手术中球囊去充盈瞬间的血流动力学研究
In vitro Experiment and Numerical Simulation-Based Study on Transient Hemodynamic Characteristics upon Balloon Deflation in Coronary Interventional Operation
Received:November 07, 2018  Revised:November 21, 2018
DOI:
Chinese key words:  冠脉介入手术  无复流  球囊去充盈  体外实验  数值模拟
English Key words:coronary interventional operation  no-reflow  balloon deflation  in vitro experiment  numerical simulation
Fund project:国家自然科学基金项目(81611530715,11832003),上海交通大学医工交叉研究基金(YG2016MS09)
Author NameAffiliation
LI Jie School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong Universit 
YIN Zhaofang Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine 
LIANG Fuyou School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong Universit 
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Chinese abstract:
      目的 研究冠脉介入手术中血流参数在球囊去充盈瞬间发生的动态变化,探讨球囊去充盈对术后无复流发生风险的潜在影响。方法 搭建体外实验装置,利用高速摄像机拍摄球囊变形过程和由染色剂标记的流场(流体介质为水),使用图像分析技术提取球囊变形参数,并估测球囊下游的流体流动速度;构建计算机仿真模型,导入实测的球囊变形数据,在多种灌注压和流体介质条件下模拟球囊去充盈过程。结果 球囊在去充盈过程中呈现显著的非线性变形特征。球囊下游流速的数值计算结果 与实测数据吻合良好,两者均显示流速随去充盈后的时间增长和灌注压升高而增大。数值计算进一步揭示,球囊下游流速在接近冠脉血流速度生理值时,球囊-管壁间隙流速和壁面剪应力分别达到其生理值的8~10倍和60~70倍。结论 球囊去充盈引起球囊-管壁间隙流体急剧加速和壁面剪应力异常升高,从而增大斑块、血栓碎屑剥离的风险。鉴于壁面剪应力的升高程度随灌注压升高而增大,在冠脉介入手术中采取术前降压或选择舒张期去充盈等措施可能有助于降低无复流的发生风险。
English abstract:
      Objective To investigate the transient hemodynamic changes during balloon deflation in coronary interventional operation, so as to explore the potential influence of balloon deflation on the occurrence of post-operative no-reflow. Methods An in vitro experimental apparatus was built, in which a high-speed camera was used to take snapshots of balloon deformation and flow field (marked by dyed water) during balloon deflation. Subsequently, image processing techniques were employed to derive the parameters of balloon deformation and estimate the flow velocity downstream from the balloon. A computer model of the experimental apparatus was constructed, with the incorporation of the measured balloon deformation data, to simulate the balloon deflation process under various perfusion pressure and fluid conditions. Results The balloon exhibited a highly nonlinear deformation behavior during deflation. The measured and simulated flow velocities downstream from the balloon were in reasonable agreement, both manifesting a monotonic increase with post-deflation time and perfusion pressure. Numerical simulations further revealed that when the flow velocity downstream from the balloon approached the physiological value of blood flow velocity in the coronary artery, the flow velocity in the balloon-vessel gap and wall shear stress (WSS) reached up to 8-10 times and 60-70 times of their physiological values, respectively. Conclusions Balloon deflation led to a sharp acceleration of flow in balloon-vessel gap and a concomitant abnormal rise in WSS, which might promote the stripping of plaque or thrombus flakes. In view of the fact that the balloon deflation-induced rise in WSS was augmented by the increase in perfusion pressure, taking strategies such as lowering pre-operative blood pressure or implementing balloon deflation during diastole in coronary interventional operation might help to reduce the risk of no-reflow.
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