Deng Long, Huang Xueying, Yang Chun, Song Yunhu, Tang Dalin
a Department of Cardiac Surgery , Fuwai Hospital, Chinese Academy of Medical Sciences , Beijing , China.
b Fujian Provincial Key Laboratory of Mathematical Modeling and High-Performance Scientific Computation, School of Mathematical Sciences , Xiamen University , Xiamen , China.
Comput Methods Biomech Biomed Engin. 2018 Feb;21(3):255-263. doi: 10.1080/10255842.2018.1443215. Epub 2018 Feb 21.
Left ventricular outflow tract obstruction is observed in 70% of patients with hypertrophic cardiomyopathy, which occurs in about 1 of every 500 adults in the general population. It has been widely believed that the motion of the mitral valve, in particular, its systolic anterior motion (SAM), attributes significantly to such obstruction. For a better understanding of the mitral valve motion, a 3D patient-specific fluid-structure interaction model of the left ventricle from a patient with hypertrophic obstructive cardiomyopathy based on computed tomography (CT) scan images was proposed in this study. Displacement, structural stress, pressure, flow velocity and shear stress within the left ventricle and mitral valve were extracted to characterize their behavior. The maximum shear stress on mitral valve was 9.68 [Formula: see text]. The pressure on its posterior leaflet was higher than that on the anterior leaflet and the peak pressure on the mitral valve was 93.5 mm Hg which occurred at pre-SAM time. High angles of attack (54.3 ± 22.4°) were found in this patient. The methodology established in this study may have the potential to clarify the mechanisms of SAM and ultimately optimize surgical planning by comparing the mechanical results obtained from preoperative and postoperative models.
肥厚型心肌病患者中70%会出现左心室流出道梗阻，在普通人群中，每500名成年人中约有1人会发生这种情况。人们普遍认为，二尖瓣的运动，尤其是其收缩期前向运动（SAM），是造成这种梗阻的重要原因。为了更好地理解二尖瓣运动，本研究基于计算机断层扫描（CT）图像，提出了一种针对肥厚型梗阻性心肌病患者左心室的三维个体化流固耦合模型。提取左心室和二尖瓣内的位移、结构应力、压力、流速和剪应力，以表征其行为。二尖瓣上的最大剪应力为9.68[公式：见原文]。其后叶上的压力高于前叶，二尖瓣上的峰值压力为93.5毫米汞柱，出现在SAM前时刻。该患者的攻角较大（54.3±22.4°）。本研究建立的方法可能有潜力通过比较术前和术后模型获得的力学结果，阐明SAM的机制，并最终优化手术规划。
