El-Nashar Hussam, Sabry Malak, Tseng Yuan-Tsan, Francis Nadine, Latif Najma, Parker Kim H, Moore James E, Yacoub Magdi H
Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt.
Department of Bioengineering, Imperial College London, London, United Kingdom.
Physiol Rev. 2024 Oct 1;104(4):1487-1532. doi: 10.1152/physrev.00038.2022. Epub 2023 Sep 21.
Whereas studying the aortic valve in isolation has facilitated the development of life-saving procedures and technologies, the dynamic interplay of the aortic valve and its surrounding structures is vital to preserving their function across the wide range of conditions encountered in an active lifestyle. Our view is that these structures should be viewed as an integrated functional unit, here referred to as the aortic valve apparatus (AVA). The coupling of the aortic valve and root, left ventricular outflow tract, and blood circulation is crucial for AVA's functions: unidirectional flow out of the left ventricle, coronary perfusion, reservoir function, and support of left ventricular function. In this review, we explore the multiscale biological and physical phenomena that underlie the simultaneous fulfillment of these functions. A brief overview of the tools used to investigate the AVA, such as medical imaging modalities, experimental methods, and computational modeling, specifically fluid-structure interaction (FSI) simulations, is included. Some pathologies affecting the AVA are explored, and insights are provided on treatments and interventions that aim to maintain quality of life. The concepts explained in this article support the idea of AVA being an integrated functional unit and help identify unanswered research questions. Incorporating phenomena through the molecular, micro, meso, and whole tissue scales is crucial for understanding the sophisticated normal functions and diseases of the AVA.
虽然孤立地研究主动脉瓣促进了挽救生命的手术和技术的发展,但主动脉瓣及其周围结构的动态相互作用对于在积极生活方式中遇到的各种情况下维持其功能至关重要。我们认为,这些结构应被视为一个整合的功能单元,在此称为主动脉瓣装置(AVA)。主动脉瓣与根部、左心室流出道和血液循环的耦合对于AVA的功能至关重要:左心室的单向流出、冠状动脉灌注、储器功能以及对左心室功能的支持。在这篇综述中,我们探讨了这些功能同时实现所基于的多尺度生物学和物理现象。还简要概述了用于研究AVA的工具,如医学成像模态、实验方法和计算建模,特别是流固耦合(FSI)模拟。探讨了一些影响AVA的病理情况,并提供了旨在维持生活质量的治疗和干预措施的见解。本文所解释的概念支持AVA作为一个整合功能单元的观点,并有助于确定未解决的研究问题。通过分子、微观、介观和全组织尺度纳入各种现象对于理解AVA复杂的正常功能和疾病至关重要。
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