Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China.
Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
J Thorac Cardiovasc Surg. 2021 Aug;162(2):e165-e176. doi: 10.1016/j.jtcvs.2020.02.034. Epub 2020 Feb 20.
In this study we aimed to propose a new computed tomography-based hemodynamic indicator to quantify the functional significance of aortic dissection and predict post intervention luminal remodeling.
Computational hemodynamics and 3D structural analyses were conducted in 51 patients with type B aortic dissection, at initial presentation and at approximately 1 month, 3 months, and 1 year post intervention. A functional index was proposed on the basis of luminal pressure difference. Statistical relationships between the proposed indicator and longitudinal luminal development were analyzed.
The computed luminal pressure difference (true lumen pressure minus false lumen pressure) varied overall from positive to negative along the aorta. The first balance position at which the pressure difference equals 0 was proposed as the functional indicator. A more distally located first balance position indicated better functional status. Implantation of stent graft distally shifted this balance position. Patients with the balance position shifted out of the dissected region (43%) presented the highest functional improvement after intervention; whereas those with the balance position shifted to the abdominal region (25%) showed unsatisfactory results. The magnitude of distal shifting of the first balance position at 3 months post intervention was statistically related to the subsequent true lumen expansion and false lumen reduction.
The first balance position of luminal pressure difference quantified the hemodynamic status of the dissected aorta. The magnitude of distal shifting of the balance position after intervention was associated with functional improvement and might be used predict longitudinal aortic remodeling.
本研究旨在提出一种新的基于计算机断层扫描的血流动力学指标，以量化主动脉夹层的功能意义，并预测介入治疗后管腔重塑。
对 51 例 B 型主动脉夹层患者在初次就诊时以及介入治疗后约 1 个月、3 个月和 1 年时进行计算血流动力学和 3D 结构分析。基于管腔压力差提出了一个功能指标。分析了所提出的指标与纵向管腔发育之间的统计关系。
计算出的管腔压力差（真腔压力减去假腔压力）总体上沿主动脉从正变负。将压力差等于 0 的第一个平衡位置作为功能指标。位置越靠近远端，功能状态越好。支架植入物的植入使这个平衡位置向远端移动。平衡位置移出夹层区域的患者（43%）在介入治疗后功能改善最大；而平衡位置移至腹部区域的患者（25%）则效果不理想。介入治疗后 3 个月时第一平衡位置的远端移位程度与随后的真腔扩张和假腔缩小有统计学关系。
管腔压力差的第一个平衡位置量化了夹层主动脉的血流动力学状态。介入治疗后平衡位置的远端移位程度与功能改善相关，可能用于预测纵向主动脉重塑。
