Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Ann Biomed Eng. 2024 Dec;52(12):3228-3239. doi: 10.1007/s10439-024-03587-w. Epub 2024 Aug 5.
To investigate the effect of changing systolic and diastolic blood pressures (SBP and DBP, respectively) on sinus flow and valvular and epicardial coronary flow dynamics after TAVR and SAVR.
SAPIEN 3 and Magna valves were deployed in an idealized aortic root model as part of a pulse duplicating left heart flow loop simulator. Different combinations of SBP and DBP were applied to the test setup and the resulting change in total coronary flow from baseline (120/60 mmHg), effective orifice area (EOA), and left ventricular (LV) workload, with each combination, was assessed. In addition, particle image velocimetry was used to assess the Laplacian of pressure ( ) in the sinus, coronary and main flow velocities, the energy dissipation rate (EDR) in the sinus and the LV workload.
This study shows that under an elevated SBP, there is an increase in the total coronary flow, EOA, LV workload, peak velocities downstream of the valve, , and EDR. With an elevated DBP, there was an increase in the total coronary flow and . However, EOA and LV workload decreased with an increase in DBP, and EDR increased with a decrease in DBP.
Blood pressure alters the hemodynamics in the sinus and downstream flow following aortic valve replacement, potentially influencing outcomes in some patients.
研究在 TAVR 和 SAVR 后改变收缩压和舒张压（分别为 SBP 和 DBP）对窦房结血流以及瓣叶和心外膜冠状血流动力学的影响。
SAPIEN 3 和 Magna 瓣膜作为脉动左心血流循环模拟器主动脉根部模型的一部分进行部署。将不同的 SBP 和 DBP 组合应用于测试设置，并评估总冠状动脉血流相对于基线（120/60mmHg）、有效开口面积（EOA）和左心室（LV）工作量的变化，以及每个组合。此外，粒子图像速度测量法用于评估窦房结、冠状动脉和主流速度中的压力拉普拉斯（ ）、窦房结和 LV 工作量中的能量耗散率（EDR）。
本研究表明，在 SBP 升高的情况下，总冠状动脉血流、EOA、LV 工作量、瓣下峰值速度、 和 EDR 增加。随着 DBP 的升高，总冠状动脉血流和 增加。然而，随着 DBP 的增加，EOA 和 LV 工作量减少，而 EDR 随着 DBP 的减少而增加。
血压改变主动脉瓣置换后窦房结和下游血流的血液动力学，可能会影响某些患者的结局。
