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基于常见临床数据集的复杂主动脉夹层的患者特异性血液动力学模拟。

Patient-specific haemodynamic simulations of complex aortic dissections informed by commonly available clinical datasets.

机构信息

Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK.

Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK.

出版信息

Med Eng Phys. 2019 Sep;71:45-55. doi: 10.1016/j.medengphy.2019.06.012. Epub 2019 Jun 27.

Abstract

Patient-specific computational fluid-dynamics (CFD) can assist the clinical decision-making process for Type-B aortic dissection (AD) by providing detailed information on the complex intra-aortic haemodynamics. This study presents a new approach for the implementation of personalised CFD models using non-invasive, and oftentimes minimal, datasets commonly collected for AD monitoring. An innovative way to account for arterial compliance in rigid-wall simulations using a lumped capacitor is introduced, and a parameter estimation strategy for boundary conditions calibration is proposed. The approach was tested on three complex cases of AD, and the results were successfully compared against invasive blood pressure measurements. Haemodynamic results (e.g. intraluminal pressures, flow partition between the lumina, wall shear-stress based indices) provided information that could not be obtained using imaging alone, providing insight into the state of the disease. It was noted that small tears in the distal intimal flap induce disturbed flow in both lumina. Moreover, oscillatory pressures across the intimal flap were often observed in proximity to the tears in the abdominal region, which could indicate a risk of dynamic obstruction of the true lumen. This study shows how combining commonly available clinical data with computational modelling can be a powerful tool to enhance clinical understanding of AD.

摘要

患者特异性计算流体动力学(CFD)可以通过提供关于复杂主动脉内血液动力学的详细信息,辅助 B 型主动脉夹层(AD)的临床决策过程。本研究提出了一种使用通常用于 AD 监测的非侵入性和最小数据集实现个性化 CFD 模型的新方法。引入了一种使用集中电容器在刚性壁模拟中考虑动脉顺应性的创新方法,并提出了边界条件校准的参数估计策略。该方法在三个复杂的 AD 病例中进行了测试,并成功地与侵入性血压测量结果进行了比较。血流动力学结果(例如管腔内压力、管腔之间的血流分配、基于壁切应力的指数)提供了仅凭成像无法获得的信息,深入了解了疾病的状况。注意到远端内膜瓣上的小撕裂会在两个管腔中引起紊乱的流动。此外,在腹部区域的撕裂附近经常观察到穿过内膜瓣的振荡压力,这可能表明真腔动态阻塞的风险。本研究表明,如何将常用的临床数据与计算模型相结合,可以成为增强对 AD 的临床理解的有力工具。

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