UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom.
EuroIntervention. 2015 Oct;11(6):669-72. doi: 10.4244/EIJY15M09_03.
We report the application of patient-specific computational models to plan the treatment of complex aortic re-coarctation (rCoA) with a proximal aberrant right subclavian artery in a patient who had previously undergone bare metal stenting.
Clinically acquired images were used to set up patient-specific computational models for finite element (FE) and fluid dynamics (CFD) analyses. The 3D geometry was reconstructed from computed tomography and echocardiography images. Computer-generated deployment of a CP covered stent (NuMED, Hopkinton, NY, USA) at different diameters was tested using FE simulations. CFD analyses based on preoperative magnetic resonance flow measurements allowed assessment of rCoA pressure relief and right subclavian artery perfusion in the different scenarios. The simulations suggested an expansion diameter for the CP stent (8 zigs, length=28 mm) of between 16 and 18 mm to relieve the obstruction, cover the aneurysm and maintain satisfactory flow to the right subclavian artery. Following the modelling study, a 16 mm CP covered stent was successfully implanted.
Patient-specific models can be successfully used to plan re-stenting of complex rCoA, showing the benefits of integrating computational techniques into patient management.
我们报告了应用患者特异性计算模型来规划治疗复杂主动脉再狭窄（rCoA）伴近端异常右锁骨下动脉的病例，该患者曾接受过金属裸支架治疗。
使用临床获得的图像为有限元（FE）和流体动力学（CFD）分析建立患者特异性计算模型。从计算机断层扫描和超声心动图图像重建 3D 几何形状。使用 FE 模拟测试计算机生成的 CP 覆膜支架（NuMED，Hopkinton，NY，USA）在不同直径下的展开情况。基于术前磁共振流量测量的 CFD 分析允许评估不同情况下 rCoA 的减压和右锁骨下动脉灌注情况。模拟表明 CP 支架的扩张直径（8 个 Zig，长度=28mm）在 16 至 18mm 之间，以缓解阻塞、覆盖动脉瘤并保持右锁骨下动脉的满意血流。在模型研究之后，成功植入了 16mm CP 覆膜支架。
患者特异性模型可成功用于规划复杂 rCoA 的再支架治疗，显示了将计算技术集成到患者管理中的益处。
