流过机械心脏瓣膜的血小板活化

D. Bluestein, J. Jesty, A. Saltman, I. Krukenkamp, Krishnamurthy Suresh
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摘要

我们进行了体外和体内的数值研究,旨在量化流动通过机械心脏瓣膜(MHV)诱导的血小板的游离栓塞形成和促凝特性。通过St. Jude医疗MHV在主动脉位置进行脉动湍流模拟,研究瓣膜植入技术对瓣膜血栓栓塞电位的影响。一个错位的阀门,每隔一年缝合一次,通过阀孔的射流加速,产生更宽的涡流尾迹。血小板沿着湍流轨迹的剪切应力历史使血小板暴露在小叶周围升高的剪切应力下,导致它们被困在脱落的漩涡中。体外血小板研究通过将MHV安装在再循环循环回路中,通过xa因子测量血小板支持乙酰化人凝血酶原激活的能力,从而隔离血流诱导效应并量化血小板活性状态。血小板激活状态单调增加作为一个函数的再循环时间过去的阀门,作为测量凝血酶生成率在化验。最后,对植入MHV的绵羊进行了体内血小板活性状态测量,结果显示瓣膜植入后血小板活性明显增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Platelet Activation in Flow Past Mechanical Heart Valves
Numerical studies, in vitro, and in vivo measurements were conducted, aimed at quantifying free emboli formation and procoagulant properties of platelets induced by flow past mechanical heart valves (MHV). Pulsatile turbulent flow simulation was conducted past a St. Jude medical MHV in the aortic position, to study the effects of valve implantation technique on the thromboembolic potential of the valve. A misaligned valve with subannualarly sutured pledgets produced accelerating jet flow through the valve orifices and a wider wake of shed vortices. Shear stress histories of platelets along turbulent trajectories exposed the platelets to elevated shear stresses around the leaflets, leading them to entrapment within the shed vortices. In vitro platelet studies were conducted past the MHV mounted in a recirculation flow loop, by measuring the platelets ability to support the activation of acetylated human prothrombin by factor xa, which enables sequestering flow induced effects and quantification of the platelets activity state. The platelet activation state increased monotonically as a function of the recirculation time past the valve, as measured by the thrombin generation rates in the assay. Finally, platelet activity state measurements were conducted in vivo, from a sheep with an implanted MHV, showing marked increase of platelet activation after valve implantation.
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