Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ward, Kyoto, 602-8566, Japan.
Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Sci Rep. 2023 Apr 20;13(1):6490. doi: 10.1038/s41598-023-33727-6.
Chronic thromboembolic pulmonary hypertension is caused by incomplete resolution and organization of thrombi. Blood flow dynamics are involved in thrombus formation; however, only a few studies have reported on pulmonary artery blood flow dynamics in patients with chronic thromboembolic pulmonary hypertension. Furthermore, the effects of treatment interventions on pulmonary artery blood flow dynamics are not fully understood. The aim of the study was to evaluate pulmonary artery blood flow dynamics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy and balloon pulmonary angioplasty, using computational fluid dynamics. We analyzed patient-specific pulmonary artery models of 10 patients with chronic thromboembolic pulmonary hypertension and three controls using computational fluid dynamics. In patients with chronic thromboembolic pulmonary hypertension, flow velocity and wall shear stress in the pulmonary arteries were significantly decreased, and the oscillatory shear index and blood stagnation volume were significantly increased than in controls. Pulmonary endarterectomy induced redistribution of pulmonary blood flow and improved blood flow dynamics in the pulmonary artery. Balloon pulmonary angioplasty improved pulmonary blood flow disturbance, decreased blood flow stagnation, and increased wall shear stress, leading to vasodilatation of the distal portion of the pulmonary artery following balloon pulmonary angioplasty treatment.
慢性血栓栓塞性肺动脉高压是由血栓不完全溶解和机化引起的。血流动力学参与血栓形成;然而,只有少数研究报道了慢性血栓栓塞性肺动脉高压患者的肺动脉血流动力学。此外,治疗干预对肺动脉血流动力学的影响尚不完全清楚。本研究旨在应用计算流体动力学评估慢性血栓栓塞性肺动脉高压患者在肺动脉内膜切除术和球囊肺动脉成形术前后的肺动脉血流动力学。我们使用计算流体动力学分析了 10 例慢性血栓栓塞性肺动脉高压患者和 3 例对照患者的特定肺动脉模型。与对照组相比,慢性血栓栓塞性肺动脉高压患者的肺动脉内血流速度和壁面切应力明显降低,振荡剪切指数和血液停滞量明显增加。肺动脉内膜切除术引起肺血流重新分布,改善肺动脉血流动力学。球囊肺动脉成形术改善了肺动脉血流紊乱,减少了血流停滞,增加了壁面切应力,导致球囊肺动脉成形术后肺动脉远端血管扩张。