保留瓣根再植术后主动脉血流的4D血流特征。

Journal of visualized surgery Pub Date : 2018-05-09 eCollection Date: 2018-01-01 DOI:10.21037/jovs.2018.03.17
Nicola Galea, Filippo Piatti, Christopher Lau, Francesco Sturla, Luca Weltert, Iacopo Carbone, Ruggero De Paulis, Mario Gaudino, Leonard N Girardi
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引用次数: 11

摘要

保留瓣膜的主动脉根部置换术(VSRR)与再植技术是一种有效的替代方法,用于年轻患者的扩张根和保留尖,避免了终身抗凝或瓣膜变性的风险。为了保持主动脉根部的生理机能,新的带有解剖形状鼻窦的移植物已经被开发出来,这可以减少并发症的发生率并提高耐久性。然而,关于VSRR期间Valsalva窦的重建对长期预后的影响,仍然存在争议。新的四维血流技术利用其独特的能力,将根部的解剖学评估与主动脉血流的流体动力学评估结合起来,可以对移植物设计、瓣膜形态和三维血流特征之间的密切相互作用进行综合分析。早期的实验研究表明,移植物的形状如何影响主动脉根部的流动模式、旋涡的形成和下游流动的螺旋度;然而,这些发现的临床意义还有待阐明。从这些复杂的数据集的定性和定量分析中可以获得各种尚未开发的知识,可以更多地阐明在VSRR采用的众多手术技术和移植物中哪一种是最好的。非凡的潜力四维血流成像打开了新的无限视野,越来越多的病人量身定制的手术计划的角度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

4D flow characterization of aortic blood flow after valve sparing root reimplantation procedure.

4D flow characterization of aortic blood flow after valve sparing root reimplantation procedure.

4D flow characterization of aortic blood flow after valve sparing root reimplantation procedure.

4D flow characterization of aortic blood flow after valve sparing root reimplantation procedure.

Valve-sparing aortic root replacement (VSRR) with reimplantation technique is an effective alternative for young patients with dilated roots and preserved cusps, which avoids the risks of lifelong anticoagulation or valve degeneration. New grafts with anatomically-shaped sinuses have been developed in order to preserve aortic root physiology, which could decrease complication rates and improve durability. However, controversy remains regarding the effect of recreation of the sinuses of Valsalva during VSRR on long-term outcomes. The novel 4D flow technique, exploiting its unique ability to combine anatomical evaluation of the root with fluid-dynamic assessment of aortic flow, enables integrated analysis of the close interaction between graft design, valvular morphology and three-dimensional (3D) flow characteristics. Early experimental studies have shown how graft shape affects the aortic root flow pattern, formation of vortexes and helicity of downstream flow; however, the clinical significance of these findings is yet to be clarified. Various and still unexplored knowledge can be obtained from the qualitative and quantitative analysis of these complex datasets, that could shed more light on which is the best among myriad surgical techniques and grafts adopted in VSRR. The extraordinary potential 4D flow imaging opens new boundless horizons in the perspective of an increasingly patient-tailored surgical planning.

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