Berdajs Denis, Mosbahi Selim, Strano Francesco, Forro Zalan, Burki Marco, von Segesser Ludwig K
Department of Surgery and Anesthesiology, Cardiovascular Research, University Hospital Lausanne, Lausanne, Switzerland.
Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
Eur J Cardiothorac Surg. 2017 Mar 1;51(3):432-441. doi: 10.1093/ejcts/ezw347.
The aim was to evaluate the impact of the aortic valve reimplantation (David) and of the aortic root (AoR) remodelling (Yacoub) on the AoR haemodynamics.
In an experimental setup where the clinical scenario of Yacoub, ( n = 5, domestic pig) and of David ( n = 5, domestic pig) procedure was performed in each AoR, six high-fidelity (200 Hz) sonomicrometric crystals were implanted. Crystals were positioned at three commissures with their projection at the root base. In post-measurement processing 3D deformation of both AoR was determined and used for computed fluid dynamic modelling in order to evaluate pressure, velocity and shear stress profiles.
In David AoR: high pressure (> 150 mmHg) and low to moderate shear stress (0-30 Pa) were found from the period of isovolemic contraction to the closure of the aortic valve. At mid diastole pressure augmentation (> 120 mmHg) a low shear stress (0-10 Pa) was registered at the leaflets, three commissures, and intervalvular triangles. In Yacoub AoR: high pressure (110-130 mmHg) with moderate low shear stress (0-30 Pa) was only registered at isovolemic contraction.
The results show that haemodynamic conditions following a David procedure have a less favourable pattern as compared to a Yacoub AoR. In David AoR, high pressure and low shear stress are present during 2/3 of the cardiac cycle, whereas in Yacoub root, these conditions are present only for a short period of isovolemic contraction.
评估主动脉瓣再植入术（David术）和主动脉根部重塑术（Yacoub术）对主动脉根部血流动力学的影响。
在一个实验装置中，对每个主动脉根部分别实施Yacoub术（n = 5，家猪）和David术（n = 5，家猪）的临床场景，植入六颗高保真（200Hz）超声测微晶体。晶体置于三个瓣叶交接处，其投影位于根部基部。在测量后处理中，确定两个主动脉根部的三维变形，并用于计算流体动力学建模，以评估压力、速度和剪切应力分布。
在David术的主动脉根部：从等容收缩期到主动脉瓣关闭期间，发现高压（>150mmHg）和低至中度剪切应力（0 - 30Pa）。在舒张中期压力升高（>120mmHg）时，在瓣叶、三个瓣叶交接处和瓣间三角处记录到低剪切应力（0 - 10Pa）。在Yacoub术的主动脉根部：仅在等容收缩期记录到高压（110 - 130mmHg）和中度低剪切应力（0 - 30Pa）。
结果表明，与Yacoub术的主动脉根部相比，David术之后的血流动力学状况模式较差。在David术的主动脉根部，在心动周期的2/3时间内存在高压和低剪切应力，而在Yacoub术的主动脉根部，这些情况仅在等容收缩期的短时间内出现。
