Di Molfetta Arianna, Ferrari Gianfranco, Iacobelli Roberta, Filippelli Sergio, Amodeo Antonio
Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù.
Institute of Clinical Physiology, National Research Center, Rome, Italy.
Artif Organs. 2017 Jan;41(1):32-39. doi: 10.1111/aor.12859. Epub 2016 Dec 26.
The aim of this work is to develop and test a lumped parameter model of the cardiovascular system to simulate the concurrent use of pulsatile (PVAD) and continuous flow (CVAD) ventricular assist device (VAD) on Fontan patients. Echocardiographic and hemodynamic data of five Fontan patients were retrospectively collected and used to simulate the patients' baseline hemodynamics. Then, for each patient, the following assistance modality was simulated for the cavopulmonary and the single ventricle (SV): (a) CVAD for cavopulmonary assistance (RCF) and PVAD assisting the SV (LCF) (RPF + LCF), (b) CVAD assisting SV and PVAD for cavopulmonary assistance (LPF + RCF). The numerical model can well reproduce patients' baseline. The cardiac output increases more importantly in the LCF + RPF configuration (35 vs. 8%). Ventricular volume decreases more evidently in the configuration LCF + RPF (28 vs. 6%), atrial pressure decreases in the LCF + RPF modality (10%), while it slightly increases in the RCF + LPF modality. The pulmonary arterial pressure slightly decreases (increases) in the configuration RCF + LPF (LCF + RPF). Ventricular external work increases in both configurations because of the total increment of the cardiac output. However, artero-ventricular coupling improves in both configurations: RCF + LPF-14%, LCF + RPF-41%. The pulsatility index decreases (increases) by 8% (13.8%) in the configuration LCF + RPF (RCF + LPF). A model could permit us to simulate extreme physiological conditions of the implantation of both CF and PF VAD on the Fontan patient and could permit to choose the proper VAD on the base of patients' condition. The configuration LCF + RPF seems to maximize the hemodynamic benefits.
这项工作的目的是开发并测试一种心血管系统的集总参数模型，以模拟在Fontan患者中同时使用搏动性（PVAD）和连续流（CVAD）心室辅助装置（VAD）的情况。回顾性收集了五名Fontan患者的超声心动图和血流动力学数据，并用于模拟患者的基线血流动力学。然后，针对每名患者，对腔肺循环和单心室（SV）模拟以下辅助方式：（a）用于腔肺循环辅助的CVAD（RCF）和辅助SV的PVAD（LCF）（RPF + LCF），（b）辅助SV的CVAD和用于腔肺循环辅助的PVAD（LPF + RCF）。该数值模型能够很好地重现患者的基线情况。在心输出量方面，LCF + RPF配置的增加更为显著（35% 对 8%）。在LCF + RPF配置中，心室容积的减少更为明显（28% 对 6%），在LCF + RPF模式下心房压力降低（10%），而在RCF + LPF模式下略有增加。在RCF + LPF（LCF + RPF）配置中，肺动脉压力略有降低（升高）。由于心输出量的总体增加，两种配置下心室的外部功均增加。然而，两种配置下的动静脉耦合均得到改善：RCF + LPF为14%，LCF + RPF为41%。在LCF + RPF（RCF + LPF）配置中，搏动指数降低（升高）了8%（13.8%）。一个模型可以使我们模拟在Fontan患者中植入CF和PF VAD的极端生理状况，并可以根据患者情况选择合适的VAD。LCF + RPF配置似乎能使血流动力学益处最大化。
