Di Molfetta A, Pilati M, Gagliardi M G, Fresiello L, Amodeo A, Cristofaletti A, Pongiglione G, Ferrari G
Cardiovascular Engineering - Institute of Clinical Physiology-CNR, Rome, Italy.
Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Med Eng Phys. 2015 Sep;37(9):898-904. doi: 10.1016/j.medengphy.2015.04.012. Epub 2015 Jul 26.
The results of Hybrid procedure (HP) for the hypoplastic left heart syndrome (HLHS) depend on several variables: pulmonary artery banding tightness (PAB), atrial septal defect size (ASD) and patent ductus arteriosus stent size (PDA). A HP complication could be the aortic coarctaction (CoAo). The reverse Blalock-Taussig shunt (RevBT) placement was proposed to avoid CoAo effects. This work aims at developing a lumped parameter model (LPM) to investigate the effects of the different variables on HP haemodynamics. A preliminary verification was performed collecting measurements on a newborn HLHS patient to calculate LPM input parameters to reproduce patient's baseline. Results suggest that haemodynamics is affected by ASD (ASD: 0.15-0.55 cm, pulmonary to systemic flow ratio Qp/Qs: 0.73-1, cardiac output (CO): 1-1.5 l/min and ventricular stroke work SW: 336-577 ml mmHg) and by the PAB diameter (PAB: 0.07-0.2 cm, Qp/Qs: 0.46-2.1, CO: 1.3-1.6 l/min and SW: 591-535 ml mmHg). Haemodynamics was neither affected by RevBT diameter nor by PDA diameter higher than 0.2 cm. RevBT implantation does not change the HP haemodynamics, but it can make the CoAo effect negligible. LPM could be useful to support clinical decision in complex physiopathology and to calibrate and personalise the parameters that play a role on flow distribution.
用于治疗左心发育不全综合征（HLHS）的杂交手术（HP）结果取决于几个变量：肺动脉环缩紧度（PAB）、房间隔缺损大小（ASD）和动脉导管未闭支架大小（PDA）。HP的一种并发症可能是主动脉缩窄（CoAo）。有人提出放置反向布莱洛克 - 陶西格分流术（RevBT）以避免CoAo的影响。这项工作旨在开发一个集总参数模型（LPM），以研究不同变量对HP血流动力学的影响。通过收集一名新生儿HLHS患者的测量数据进行初步验证，以计算LPM输入参数，从而再现患者的基线情况。结果表明，血流动力学受ASD（ASD：0.15 - 0.55厘米，肺循环与体循环血流量比值Qp/Qs：0.73 - 1，心输出量（CO）：1 - 1.5升/分钟，心室每搏功SW：336 - 577毫升·毫米汞柱）和PAB直径（PAB：0.07 - 0.2厘米，Qp/Qs：0.46 - 2.1，CO：1.3 - 1.6升/分钟，SW：591 - 535毫升·毫米汞柱）的影响。血流动力学既不受RevBT直径影响，也不受直径大于0.2厘米的PDA直径影响。RevBT植入不会改变HP的血流动力学，但它可以使CoAo的影响忽略不计。LPM有助于支持复杂病理生理学中的临床决策，并校准和个性化对血流分布起作用的参数。
