Biomechanical Implications of Bicuspid Pulmonary Valve Dynamic Deformation in Patients with Repaired Tetralogy of Fallot

Q4 Biochemistry, Genetics and Molecular Biology

Molecular & Cellular Biomechanics Pub Date : 2019-02-21 DOI:10.32604/MCB.2019.05745

Caili Li, Jing Yao, Chun Yang, Di Xu, Liang Wang, D. Tang

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引用次数: 1

Abstract

Pulmonary valve stenosis (PVS) is one common post-operative problem in patients with tetralogy of Fallot (TOF) after repair. Congenital bicuspid pulmonary valve (BPV) is a condition of valvular stenosis, and the occurrence of congenital BPV is often associated with TOF. Compared with the biomechanical simulation model of the bicuspid aortic valve, the BPV is often neglected. In this study, we developed a dynamic biomechanical model of a simulated normal pulmonary root (PR) with tri-leaflet and a model of simulated PR with BPV in patients with repaired TOF in order to describe the effect of geometric structure with BPV on the stress and strain distribution. The geometry of PR included valvular leaflets, valsalva sinuses, inter leaflet triangle and annulus. Mechanical properties of PV leaflet were obtained from biaxial testing of human PV leaflet, and characterized by an anisotropic hyperelastic material model. Our model simulated complete cardiac cycles to observe valve leaflet dynamic stress/strain behaviors. Our results indicated that stress/strain distribution patterns of normal PV and the BPV were similar on pulmonary root and valve leaflets, but their values were different. When the valve was completely closed, maximum stresses were found leaflet attachment boundary, with their values at 17.1 kPa and 17.2 kPa respectively. When the valve was fully open, maximum stresses were found at the vicinity of commissures of sinus and leaflet, that is, near the annulus, with the values at 115.0 kPa and 143.0 kPa respectively. Compared with normal PR, the valve orifice area in the completely opened position in congenital BPV is significantly reduced. Our initial results demonstrated that geometrical variations with BPV may be a potential risk factor linked to occurrence of PVS in patients with repaired TOF. Computational models could be a useful tool in identifying possible linkage between valve disease development and biomechanical factors. Large-scale clinical studies are needed to validate these preliminary findings.

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修复法洛四联症患者双尖瓣动态变形的生物力学意义

肺动脉瓣狭窄(PVS)是法洛四联症(TOF)患者修复后常见的术后问题。先天性双尖瓣肺动脉瓣(BPV)是一种瓣膜狭窄的疾病，先天性双尖瓣肺动脉瓣的发生通常与TOF有关。与双尖瓣主动脉瓣的生物力学模拟模型相比，BPV常常被忽略。在本研究中，我们建立了三叶模拟正常肺动脉根(PR)的动态生物力学模型和修复性TOF患者模拟带BPV的PR模型，以描述带BPV的几何结构对应力和应变分布的影响。PR的几何形态包括瓣叶、瓣窦、瓣叶间三角形和瓣环。通过人体PV小叶的双轴测试获得PV小叶的力学性能，并采用各向异性超弹性材料模型表征。我们的模型模拟了完整的心脏周期，以观察瓣膜叶的动态应力/应变行为。结果表明，正常PV和BPV在肺根和瓣叶上的应力应变分布模式相似，但数值不同。当阀门完全关闭时，最大应力出现在小叶附着边界，分别为17.1 kPa和17.2 kPa。当瓣膜全开时，最大应力出现在鼻窦和小叶交界处附近，即环附近，应力值分别为115.0 kPa和143.0 kPa。与正常PR相比，先天性BPV完全打开位置的瓣口面积明显减少。我们的初步结果表明，BPV的几何变化可能是与修复TOF患者发生PVS相关的潜在危险因素。计算模型可能是识别瓣膜疾病发展与生物力学因素之间可能联系的有用工具。需要大规模的临床研究来验证这些初步发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Molecular & Cellular Biomechanics CELL BIOLOGYENGINEERING, BIOMEDICAL&-ENGINEERING, BIOMEDICAL

CiteScore

1.70

自引率

0.00%

发文量

期刊介绍： The field of biomechanics concerns with motion, deformation, and forces in biological systems. With the explosive progress in molecular biology, genomic engineering, bioimaging, and nanotechnology, there will be an ever-increasing generation of knowledge and information concerning the mechanobiology of genes, proteins, cells, tissues, and organs. Such information will bring new diagnostic tools, new therapeutic approaches, and new knowledge on ourselves and our interactions with our environment. It becomes apparent that biomechanics focusing on molecules, cells as well as tissues and organs is an important aspect of modern biomedical sciences. The aims of this journal are to facilitate the studies of the mechanics of biomolecules (including proteins, genes, cytoskeletons, etc.), cells (and their interactions with extracellular matrix), tissues and organs, the development of relevant advanced mathematical methods, and the discovery of biological secrets. As science concerns only with relative truth, we seek ideas that are state-of-the-art, which may be controversial, but stimulate and promote new ideas, new techniques, and new applications.