China University of Mining and Technology, No.1, Daxue Road, Xuzhou, Jiangsu, China; Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu, China.
The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Clin Biomech (Bristol). 2021 Feb;82:105256. doi: 10.1016/j.clinbiomech.2020.105256. Epub 2020 Dec 28.
This study aimed to adopt computational fluid dynamics to simulate the blood flow dynamics in inferior vena cava stenosis based on time-dependent patient-specific models of Budd-Chiari syndrome as well as a normal model. It could offer valuable references for a retrospective insight into the underlying mechanisms of Budd-Chiari syndrome pathogenesis as well as more accurate evaluation of postoperative efficacy.
Three-dimensional inferior vena cava models of Budd-Chiari syndrome patient-specific (preoperative and postoperative) and normal morphology model were reconstructed as per magnetic resonance images using Simpleware. Moreover, computational fluid dynamics of time-resolved inferior vena cava blood flow were simulated using actual patient-specific measurements to reflect time-dependent flow rates.
The assessment of the preoperative model revealed the dramatic variations of hemodynamic parameters of the stenotic inferior vena cava. Moreover, the comparison of the preoperative and postoperative models with the normal model as benchmark showed that postoperative hemodynamic parameters were markedly ameliorated via stenting, with the attenuation of overall velocity and wall shear stress, and the increase of pressure. However, the comparative analysis of the patient-specific simulations revealed that some postoperative hemodynamic profiles still bore some resemblance to the preoperative ones, indicating potential risks of restenosis.
Computational fluid dynamics simulation of time-resolved blood flow could reveal the tight correlation between the hemodynamic characteristics and the pathological mechanisms of inferior vena cava stenosis. Furthermore, such time-resolved hemodynamic profiles could provide a quantitative approach to diagnosis, operative regimen and postoperative evaluation of Budd-Chiari syndrome with inferior vena cava stenosis.
本研究旨在采用计算流体动力学方法，基于布加氏综合征的时间依赖性患者特定模型以及正常模型来模拟下腔静脉狭窄处的血流动力学。这可以为回顾性探讨布加氏综合征发病机制的潜在机制以及更准确地评估术后疗效提供有价值的参考。
使用 Simpleware 根据磁共振成像对布加氏综合征患者特定的（术前和术后）下腔静脉三维模型以及正常形态模型进行重建。此外，使用实际的患者特定测量值来模拟时间分辨下腔静脉血流的计算流体动力学，以反映时变流量。
术前模型的评估显示狭窄下腔静脉的血流动力学参数有明显变化。此外，将术前和术后模型与正常模型进行基准比较表明，支架置入术后血流动力学参数明显改善，整体速度和壁面切应力降低，压力增加。然而，对患者特定模拟的比较分析表明，一些术后血流动力学特征仍然与术前相似，表明存在再狭窄的潜在风险。
时间分辨血流的计算流体动力学模拟可以揭示下腔静脉狭窄的血流动力学特征与病理机制之间的紧密关联。此外，这种时间分辨的血流动力学特征可以为布加氏综合征伴下腔静脉狭窄的诊断、手术方案和术后评估提供定量方法。
