先天性心脏病相关性肺动脉高压血流动力学特异性研究

Hemodynamic Characteristics of Pulmonary Arterial Hypertension Related to Congenital Heart Disease

目的先天性心脏病相关性肺动脉高压(pulmonary arterial hypertension related to congenital heart disease,PAH-CHD)是肺动脉血流动力学异常所致的一种疾病。研究肺循环血流动力学特异性,有助于了解PAH-CHD发生发展的生物力学因素。方法对5例PAH-CHD患儿和5例无PAH(Non-PAH)的先天性心脏病患儿通过临床及影像资料收集,重建三维血管模型,利用计算流体动力学模拟肺动脉血液流动,对比分析肺动脉血流动力学相关速度流线、壁面剪切力(wall shear stress,WSS)及单位体表面积平均能量损失(·E)差异。结果血流动力学相关指标显示,PAH-CHD患儿左右肺动脉分支处流速和WSS明显升高,主肺动脉处WSS明显降低,·E呈显著增加趋势且与肺动脉直径及入口流量呈明显正相关。结论PAH-CHD患儿较Non-PAH患儿肺动脉分支处流速和WSS明显升高,主肺动脉WSS降低,·E增加,表明这些血流动力学因素与PAH-CHD密切相关,是临床评估PAH-CHD的潜在血流动力学指标。

Objective Hemodynamic disorder of the pulmonary artery(PA)is the main cause of pulmonary arterial hypertension related to congenital heart disease(PAH-CHD).To study the hemodynamic characteristics of PA,so as to understand biomechanical factors in the occurrence and development of PAH-CHD.Methods Clinical and imaging data were collected in five PAH-CHD patients and five matched controls(Non-PAH)to reconstruct subject-specific three-dimensional(3D)PA models.Computational fluid dynamics(CFD)was performed to compare the hemodynamic difference of flow patterns,wall shear stress(WSS)and normalized·energy loss(E)in the two groups.Results Hemodynamics-related parameters showed that the velocity and WSS were higher in the left and right PA branches of PAH-CHD patients,with significantly lower WSS in the main·PA.The E significantly increased in PAH-CHD patients and positively correlated with normalized PA diameter and inflow.Conclusions Compared with Non-PAH subjects,PAH-CHD patients have obviously higher velocity and·WSS in PA branches,lower WSS in main PA and greater E,indicating these hemodynamic parameters are related with the PAH-CHD,which can be used as potential biomechanical factors for the clinical evaluation of PAH-CHD.