左心房血流患者特定模拟中的肺静脉血流分离效应。

Pulmonary vein flow split effects in patient-specific simulations of left atrial flow.

机构信息

Department of Mechanical, Thermal and Fluids Engineering, Universidad de Málaga, Málaga, Spain; Department of Aerospace Engineering, University Carlos III of Madrid, Leganés, Spain.

Institute of Fluid Mechanics and Heat Transfer, TU Wien, Vienna, Austria.

出版信息

Comput Biol Med. 2023 Sep;163:107128. doi: 10.1016/j.compbiomed.2023.107128. Epub 2023 Jun 12.

Abstract

Disruptions to left atrial (LA) blood flow, such as those caused by atrial fibrillation (AF), can lead to thrombosis in the left atrial appendage (LAA) and an increased risk of systemic embolism. LA hemodynamics are influenced by various factors, including LA anatomy and function, and pulmonary vein (PV) inflow conditions. In particular, the PV flow split can vary significantly among and within patients depending on multiple factors. In this study, we investigated how changes in PV flow split affect LA flow transport, focusing for the first time on blood stasis in the LAA, using a high-fidelity patient-specific computational fluid dynamics (CFD) model. We use an Immersed Boundary Method, simulating the flow in a fixed, uniform Cartesian mesh and imposing the movement of the LA walls with a moving Lagrangian mesh generated from 4D Computerized Tomography images. We analyzed LA anatomies from eight patients with varying atrial function, including three with AF and either a LAA thrombus or a history of Transient Ischemic Attacks (TIAs). Using four different flow splits (60/40% and 55/45% through right and left PVs, even flow rate, and same velocity through each PV), we found that flow patterns are sensitive to PV flow split variations, particularly in planes parallel to the mitral valve. Changes in PV flow split also had a significant impact on blood stasis and could contribute to increased risk for thrombosis inside the LAA, particularly in patients with AF and previous LAA thrombus or a history of TIAs. Our study highlights the importance of considering patient-specific PV flow split variations when assessing LA hemodynamics and identifying patients at increased risk for thrombosis and stroke. This knowledge is relevant to planning clinical procedures such as AF ablation or the implementation of LAA occluders.

摘要

左心房(LA)血流的紊乱,如由心房颤动(AF)引起的紊乱,可能导致左心耳(LAA)血栓形成和全身性栓塞风险增加。LA 血液动力学受到多种因素的影响,包括 LA 解剖结构和功能以及肺静脉(PV)流入条件。特别是,PV 血流分流在不同患者之间和同一患者内会因多种因素而有很大差异。在这项研究中,我们研究了 PV 血流分流的变化如何影响 LA 血流输送,首次关注 LAA 中的血液停滞,使用高保真的患者特定计算流体动力学(CFD)模型。我们使用浸入边界法,在固定的均匀笛卡尔网格中模拟流动,并使用从 4D 计算机断层扫描图像生成的移动拉格朗日网格来施加 LA 壁的运动。我们分析了来自 8 名具有不同心房功能的患者的 LA 解剖结构,包括 3 名患有 AF 且 LAA 有血栓或短暂性脑缺血发作(TIA)病史的患者。使用四种不同的血流分流(右和左 PV 之间为 60/40%和 55/45%,等流量比,以及每个 PV 的相同流速),我们发现血流模式对 PV 血流分流变化非常敏感,特别是在与二尖瓣平行的平面上。PV 血流分流的变化也对血液停滞有重大影响,并可能导致 LAA 内血栓形成风险增加,特别是在患有 AF 且 LAA 有血栓或 TIA 病史的患者中。我们的研究强调了在评估 LA 血液动力学和识别血栓形成和中风风险增加的患者时,考虑患者特定的 PV 血流分流变化的重要性。这一知识与规划临床程序(如 AF 消融术或 LAA 封堵器的实施)有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e458/10529707/50539dc98b55/nihms-1916788-f0001.jpg

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