与年龄相关的Caval流量比率变化对肝脏流量分布在Fontan循环中的影响
Vijay Govindarajan1,2,3, Lauren Marshall1, Akshita Sahni1
1Departments of Cardiovascular Surgery (V.G., L.M., A.S., M.A.C., E.E.E., J.D., N.S.C., N.E.S., D.M.H., P.E.H., S.J.G., A.P., P.J.d.N.), Boston Children's Hospital, MA.
Circulation. Cardiovascular imaging
|April 3, 2024
概括
丰坦行动是"丰坦行动"
科学领域:
- 心血管外科心血管外科
- 儿童心脏病学 儿童心脏病学
- 生物医学工程 生物医学工程
背景情况:
- 芬坦手术是一种缓解性手术,用于单心室心脏缺陷.
- 实现平衡的肝流分布 (HFD) 对于预防病等并发症至关重要.
- HFD受到局部血液动力学的影响,这种动力学会随着年龄的增长而改变.
研究的目的:
- 评估与年龄相关的上腔静脉 (SVC) 和下腔静脉 (IVC) 流入的变化如何影响Fontan患者的HFD.
- 分析不同Fontan连接类型 (心外与侧面道) 对HFD随着时间的推移的影响.
主要方法:
- 从414名Fontan患者收集了SVC和IVC流量数据,以将SVC:IVC流量比与年龄相关联.
- 利用患者特定的计算流体动力学 (CFD) 建模在60名患者 (30名心脏外,30名侧面道) 中,年龄为3,8岁和15岁.
- 量化HFD及其与不同SVC:IVC流量比的关系.
主要成果:
- 在8岁左右,SVC:IVC流量比率发生了反转,这表明向下体流量占主导地位的转变.
- 由于与年龄相关的流量变化导致的HFD变化在心脏外不显著,但在侧面道队列中显著.
- 观察到IVC流量分布和HFD之间的正相关性,尽管它的强度随着年龄的增长而下降 (SVC:IVC比率从2到0.5).
结论:
- 与年龄相关的 caval 流入的变化对 Fontan 患者的长期 HFD 有显著的影响,特别是那些具有侧面道连接的患者.
- 了解随着时间的推移SVC:IVC比率的变化对于管理Fontan血动力学和改善患者结果至关重要.
- 这项研究提供了对Fontan生理学的定量见解,有助于临床决策和未来研究.
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