较薄的生物组织会导致主动脉心脏瓣膜置换术中的瓣叶飘动。

Thinner biological tissues induce leaflet flutter in aortic heart valve replacements.

机构信息

Department of Mechanical Engineering, Iowa State University, Ames, IA 50011.

Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712;

出版信息

Proc Natl Acad Sci U S A. 2020 Aug 11;117(32):19007-19016. doi: 10.1073/pnas.2002821117. Epub 2020 Jul 24.

Abstract

Valvular heart disease has recently become an increasing public health concern due to the high prevalence of valve degeneration in aging populations. For patients with severely impacted aortic valves that require replacement, catheter-based bioprosthetic valve deployment offers a minimally invasive treatment option that eliminates many of the risks associated with surgical valve replacement. Although recent percutaneous device advancements have incorporated thinner, more flexible biological tissues to streamline safer deployment through catheters, the impact of such tissues in the complex, mechanically demanding, and highly dynamic valvular system remains poorly understood. The present work utilized a validated computational fluid-structure interaction approach to isolate the behavior of thinner, more compliant aortic valve tissues in a physiologically realistic system. This computational study identified and quantified significant leaflet flutter induced by the use of thinner tissues that initiated blood flow disturbances and oscillatory leaflet strains. The aortic flow and valvular dynamics associated with these thinner valvular tissues have not been previously identified and provide essential information that can significantly advance fundamental knowledge about the cardiac system and support future medical device innovation. Considering the risks associated with such observed flutter phenomena, including blood damage and accelerated leaflet deterioration, this study demonstrates the potentially serious impact of introducing thinner, more flexible tissues into the cardiac system.

摘要

由于老龄化人口中心瓣膜退行性病变的高发率,瓣膜性心脏病最近成为日益受到关注的公共卫生问题。对于需要置换严重受损主动脉瓣的患者而言,经导管生物瓣置换术提供了一种微创治疗选择,可以消除与外科瓣膜置换相关的许多风险。尽管最近经皮器械的进步采用了更薄、更柔韧的生物组织,以通过导管实现更安全的输送,但此类组织在复杂、力学要求高且高度动态的瓣膜系统中的影响仍知之甚少。本研究采用了经过验证的计算流固耦合方法,以在生理上逼真的系统中隔离更薄、更顺应的主动脉瓣组织的行为。这项计算研究确定并量化了由于使用更薄的组织而引起的明显的瓣叶扑动,这导致了血流紊乱和瓣叶的振荡应变。这些较薄瓣膜组织相关的主动脉流动和瓣膜动力学以前尚未被识别,并提供了重要信息,可以极大地推进对心脏系统的基本认识,并支持未来的医疗设备创新。考虑到观察到的这种扑动现象相关的风险,包括血液损伤和瓣叶加速恶化,本研究表明,将更薄、更柔韧的组织引入心脏系统可能会产生严重影响。

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