Zhang Jun-Mei, Chua Leok Poh, Ghista Dhanjoo N, Zhou Tong-Ming, Tan Yong Seng
School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore.
Med Eng Phys. 2008 Mar;30(2):226-47. doi: 10.1016/j.medengphy.2007.02.004. Epub 2007 Apr 26.
Hemodynamics is widely believed to influence coronary artery bypass graft (CABG) stenosis. Although distal anastomosis has been extensively investigated, further studies on proximal anastomosis are still necessary, as the extent and initiation of the stenosis process may be influenced by the flow of the proximal anastomosis per se. Therefore, in this study, two models (i.e. 90 degrees and 135 degrees anastomotic models) were designed and constructed to simulate a proximal anastomosis of CABG for the left and right coronary arteries, respectively. Flow characteristics for these models were studied experimentally in order to validate the simulation results found earlier. PIV measurements were carried out on two Pyrex glass models, so that the disturbed flow (stagnation point, flow separation and vortex) found in both proximal anastomosis models using numerical simulation, could be verified. Consequently, a fair agreement between numerical and experimental data was observed in terms of flow characteristics, velocity profiles and wall shear stress (WSS) distributions under both steady and pulsatile flow conditions. The discrepancy was postulated to be due to the difference in detailed geometry of the physical and computational models, due to manufacturing limitations. It was not possible to reproduce the exact shape of the computational model when making the Pyrex glass model. The analysis of the hemodynamic parameters based on the numerical simulation study also suggested that the 135 degrees proximal anastomosis model would alleviate the potential of intimal thickening and/or atherosclerosis, more than that of a 90 degrees proximal anastomosis model, as it had a lower variation range of time-averaged WSS and the lower segmental average of WSSG.
人们普遍认为血流动力学影响冠状动脉旁路移植术(CABG)狭窄。尽管对远端吻合术已进行了广泛研究,但近端吻合术仍有必要进一步研究,因为狭窄过程的程度和起始可能受近端吻合术本身血流的影响。因此,在本研究中,设计并构建了两种模型(即90度和135度吻合模型),分别模拟左、右冠状动脉CABG的近端吻合术。对这些模型的血流特性进行了实验研究,以验证早期发现的模拟结果。在两个派热克斯玻璃模型上进行了粒子图像测速(PIV)测量,以便验证在数值模拟中两个近端吻合模型中发现的紊乱血流(驻点、流动分离和涡流)。因此,在稳定和脉动血流条件下,在血流特性、速度剖面和壁面剪应力(WSS)分布方面,数值和实验数据之间观察到了相当一致的结果。推测差异是由于物理模型和计算模型的详细几何形状不同,这是由于制造限制所致。制作派热克斯玻璃模型时,无法再现计算模型的确切形状。基于数值模拟研究的血流动力学参数分析还表明,135度近端吻合模型比90度近端吻合模型更能减轻内膜增厚和/或动脉粥样硬化的可能性,因为它的时间平均WSS变化范围较小,WSSG的节段平均值较低。