Imaging Institute and Heart & Vascular Institute, The Cleveland Clinic, Desk J-1 4, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Cardiovasc Transl Res. 2011 Aug;4(4):459-69. doi: 10.1007/s12265-011-9277-z. Epub 2011 Apr 12.
Valvular heart disease is a major cause of morbidity and mortality in developing and industrialized countries. For patients with advanced symptomatic disease, surgical open-heart valve replacement is an effective treatment, supported by long-term outcome data. More recently, less-invasive transcatheter approaches for valve replacement/implantation have been developed for patients that are not considered surgical candidates. An understanding of valvular and paravalvular anatomy and biomechanics is pivotal for the optimization of interventional valve procedures. Advanced imaging is increasingly used not only for clinical guidance but also for the design and further improvement of transcatheter valve systems. Computed tomography is particularly attractive because it acquires high-resolution volumetric data sets of the root including the leaflets and coronary artery ostia, with sufficient temporal resolution for multi-phasic analysis. These volumetric data sets allow subsequent 3-D and 4-D display, reconstruction in unlimited planes, and mathematical modeling. Computer modeling, specifically finite element analysis, of devices intended for implantation in the aortic root, allows for structural analysis of devices and modeling of the interaction between the device and cardiovascular anatomy. This paper will provide an overview of computer modeling of the aortic root and describe FEA approaches that could be applied to TAVI and have an impact on clinical practice and device design.
瓣膜性心脏病是发展中国家和工业化国家发病率和死亡率的主要原因。对于有晚期症状性疾病的患者，心脏直视手术瓣膜置换是一种有效的治疗方法，长期结果数据支持这一方法。最近，为不符合手术条件的患者开发了用于瓣膜置换/植入的微创经导管方法。了解瓣膜和瓣周解剖结构和生物力学对于优化介入瓣膜手术至关重要。先进的成像技术不仅越来越多地用于临床指导，也用于经导管瓣膜系统的设计和进一步改进。计算机断层扫描特别有吸引力，因为它可以获取包括瓣叶和冠状动脉开口在内的根部的高分辨率容积数据集，具有足够的时间分辨率进行多相位分析。这些容积数据集允许随后进行 3-D 和 4-D 显示、无限制平面的重建和数学建模。旨在植入主动脉根部的设备的计算机建模，特别是有限元分析，允许对设备进行结构分析，并对设备与心血管解剖结构之间的相互作用进行建模。本文将概述主动脉根部的计算机建模，并描述可应用于 TAVI 并对临床实践和设备设计产生影响的有限元分析方法。
