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主动脉瓣狭窄患者围手术期主动脉血流动力学变化:前瞻性系列 4D-Flow MRI 研究。

Perioperative Hemodynamic Changes in the Thoracic Aorta in Patients With Aortic Valve Stenosis: A Prospective Serial 4D-Flow MRI Study.

机构信息

Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.

Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.

出版信息

Semin Thorac Cardiovasc Surg. 2020 Spring;32(1):25-34. doi: 10.1053/j.semtcvs.2019.07.006. Epub 2019 Jul 16.

Abstract

This study investigated hemodynamic changes in the thoracic aorta and aortic arch branches before and after aortic valve replacement (AVR) by 4D-flow MRI in patients with aortic valve stenosis (AS). Thoracic 4D-flow MRI was performed in 10 AS patients before and after AVR (mean 27 ± 1.9 days). Fifteen aortic planes and 3 aortic arch branches planes were set to evaluate the mean volume flow rate in each plane during a cardiac cycle and the angle between the main flow direction in a specified plane and the axial direction of the aorta. We also focused on the distribution and magnitude of helicity density to evaluate the flow complexity. A significant increase in the volume flow rate after AVR was found in the ascending aorta (before 59.2 ± 8.7 mL/s vs after 77.3 ± 6.2 mL/s, P < 0.05) and the aortic arch branches (before 26.5 ± 2.8 mL/s vs after 35.8 ± 3.3 mL/s, P < 0.001). The flow angle significantly decreased in the ascending aorta (before 39.2 ± 2.7 degree vs after 25.2 ± 1.7°, P < 0.0001) and the arch aorta (before 19.3 ± 2.0 degree vs after 13.4 ± 0.9°, P < 0.001). The volume flow rate in the ascending aorta and the arch branches increased within 1 month after AVR, showing an increased blood supply to the upper body, including to the brain. The postoperative change was accompanied with an increased blood flow in the ascending aorta and a decreased flow complexity proximal to the arch branches.

摘要

本研究通过 4D-flow MRI 研究了主动脉瓣狭窄(AS)患者主动脉瓣置换(AVR)前后胸主动脉和主动脉弓分支的血流动力学变化。对 10 例 AS 患者进行了胸 4D-flow MRI 检查,分别在 AVR 前后(平均 27±1.9 天)进行。设置了 15 个主动脉平面和 3 个主动脉弓分支平面,以评估每个平面在心动周期内的平均容积流量和指定平面内主流动方向与主动脉轴向之间的夹角。我们还重点关注螺旋密度的分布和大小,以评估血流复杂性。AVR 后,升主动脉(术前 59.2±8.7mL/s 对术后 77.3±6.2mL/s,P<0.05)和主动脉弓分支(术前 26.5±2.8mL/s 对术后 35.8±3.3mL/s,P<0.001)的容积流量明显增加。升主动脉(术前 39.2±2.7 度对术后 25.2±1.7°,P<0.0001)和弓状主动脉(术前 19.3±2.0 度对术后 13.4±0.9°,P<0.001)的血流角度明显减小。AVR 后 1 个月内,升主动脉和弓状分支的容积流量增加,表明向包括大脑在内的上半身的血液供应增加。术后变化伴随着升主动脉血流量增加和弓状分支近端血流复杂性降低。

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