The patient is 50-year-old man. He was admitted to our hospital with a strong back pain and diagnosed as an acute type B aortic dissection. On the second day of hospitalization, he developed symptoms of paraplegia, an...The patient is 50-year-old man. He was admitted to our hospital with a strong back pain and diagnosed as an acute type B aortic dissection. On the second day of hospitalization, he developed symptoms of paraplegia, and we considered TEVAR, but we were concerned that TEVAR intervention in the acute phase might worsen the dissection, so we first placed a cerebrospinal drainage (CSFD) device, which resulted in improvement of his symptoms. Thereafter, although his lower limb mobility was fine, he underwent thoracic stent graft aortic repair (TEVAR) in the subacute phase due to worsening ULP. The patient had a good postoperative course and was discharged home unassisted. The initial placement of CSFD was effective in reducing the incidence of paraplegia as a complication of TEVAR and in bringing the timing of TEVAR intervention from the acute phase to the subacute phase.展开更多
急性Stanford B型主动脉夹层(Acute Stanford type B Aortic Dissection, ATBAD)由于发病率和死亡率高,需要多学科方法评估、了解其特征、快速分类,进行药物控制、主动脉开窗术、腔内修复术等治疗。然而何时提供何种治疗方式最佳通常不...急性Stanford B型主动脉夹层(Acute Stanford type B Aortic Dissection, ATBAD)由于发病率和死亡率高,需要多学科方法评估、了解其特征、快速分类,进行药物控制、主动脉开窗术、腔内修复术等治疗。然而何时提供何种治疗方式最佳通常不明确。本文从单纯性、复杂性ATBAD的治疗上入手,对国内外最新治疗进展进行综述,以期对ATBAD患者提供更多获益。展开更多
Nowadays,cardiovascular disease has gradually become the number one killer of human health.The Stanford type-A aortic dissection is a relatively common cardiovascular disease with potential hazards.The disease is caus...Nowadays,cardiovascular disease has gradually become the number one killer of human health.The Stanford type-A aortic dissection is a relatively common cardiovascular disease with potential hazards.The disease is caused by a partialtearing of the aortic intima.Thoracic endovascular aortic repair(TEVAR)is one of the most effective treatment for type A aortic dissection and has been widely used clinically to achieve thrombosis and reduce pressure by covering the incision tear in the FL.However,the effect of entry tear location on type-A aortic dissection and the prognosis of TEVAR intervention are unclear.In this work,the hemodynamic effects of the type-A aortic dissection in different entry and covering entry tear position were mainly studied.It can provide a new method or idea in the field of the aortic dissection hemodynamics,which is of great significance to provide a basic theoretical research on the development of aortic dissection in the aspect of clinical judgment.Two type-A aortic dissection models with different entry tear positions(Model 1:the entry tear was located at the entrance of the ascending aorta,Model 2:the entry tear was located at the starting position of the descending aorta)were reconstructed according to the computed tomography(CT)images of the patients.In our study,the thoracic aortic endovascular repair was simulated by covering the entry tear(Model 3).Then,the semi-automatic adaptive technology HyperMeshl0.0(Altair HyperWorks,Troy,Ml,USA)mesh generator was used to generate the high-quality tetrahedral 3D mesh.To clarify the hemodynamic effects of entry tear and coverage in aortic blood flow pattern,the comparative study on the true lumen(TL)and false lumen(FL)blood flow patterns of three models were carried out numerically(the time-dependent pulsatile waveform of pressure boundary conditions used at the aortic inlet were consistent with Rapezzis’s work,time-dependent pulsatile waveform of velocity at the descending aorta outlet and the time-dependent pulsatile waveform of pressure at the brachiocephalic artery,left common carotid artery,and left subclavian artery were obtained from the work of Olufsenet et al).The velocity vector,flow ratio,pressure,time-average wall shear stress(TAWSS)and relative residence time(RRT)were calculated to evaluate the hemodynamic changes.The results of this work indicated that(Ⅰ)the velocity was higher at the entry tear in aorta entrance;(Ⅱ)the helical development of the TL and FL might be related to the helical nature of aortic arch;(Ⅲ)the blood flow which passing the FL of Model 1,Model 2 and Model 3 in one cardiac cycle were approximately 26.63%,13.39%and 1%,respectively;(Ⅳ)the difference in intima wall pressure among the TL and FL was found varied a lot and shown a strong pulsation;(Ⅴ)the TAWSS distribution in TL and FL were quite different(the TAWSS in TL intima>8 Pa,the TAWSS in FL intima<4 Pa).In brief,the aortic morphology and location of the entry tear were found to have a significant effect on the hemodynamic of the aortic dissection.What’s more,we found that the risk of the aortic rupture could be higher if the position of entry tear is closer to the ascending aorta.By covering the entry tear to simulate TEVAR,the pressure of FL was reduced,which could provide some help for the treatment of early retrograde type-A dissection.展开更多
In this work,the hemodynamic effects of the type-A aortic dissection in different entry and covering entry tear positions were mainly studied.It provides a new method or idea in the field of the aortic dissection hemo...In this work,the hemodynamic effects of the type-A aortic dissection in different entry and covering entry tear positions were mainly studied.It provides a new method or idea in the field of the aortic dissection hemodynamics,and it is of profound significance to provide basic theoretical research on the development of aortic dissection in the aspect of clinical judgment.Two type-A aortic dissection models with different entry tear positions(Model 1:The entry tear was located at the entrance of the ascending aorta,Model 2:The entry tear was located at the starting position of the descending aorta)were reconstructed according to the computed tomography(CT)images of the patients.In our study,the thoracic aortic endovascular repair was simulated by covering the entry tear(Model 3).To clarify the hemodynamic effects of entry tear and coverage,the comparative study on the true lumen(TL)and false lumen(FL)blood flow patterns of three models were carried out numerically.The velocity vector,flow ratio,pressure,time-averaged wall shear stress(TAWSS)and relative residence time(RRT)were calculated to evaluate the hemodynamic changes.The results of this work indicated that(I)the velocity of entry tear at the aorta entrance was higher;(II)The helical development of the TL and FL might be related to the helical nature of aortic arch;(III)The blood flow which passing the FL of Model 1,Model 2 and Model 3 in one cardiac cycle were approximately 26.63%,13.39%and 1%,respectively;(IV)The difference in intima wall pressure of the TL and FL were showed a strong pulsation;(V)The TAWSS distribution in TL and FL were completely different(the TAWSS in TL intima>8 Pa,the TAWSS in FL intima<4 Pa).In brief,the aortic morphology and location of the entry tear were found to have a significant effect on the hemodynamics of the aortic dissection.In addition,the CFD method is used to obtain multi-dimensional hemodynamic information such as velocity field,pressure,TAWSS and RRT,which can help clinicians better understand the development of type-A aortic dissection and provide a theoretical basis for clinical treatment.展开更多
文摘The patient is 50-year-old man. He was admitted to our hospital with a strong back pain and diagnosed as an acute type B aortic dissection. On the second day of hospitalization, he developed symptoms of paraplegia, and we considered TEVAR, but we were concerned that TEVAR intervention in the acute phase might worsen the dissection, so we first placed a cerebrospinal drainage (CSFD) device, which resulted in improvement of his symptoms. Thereafter, although his lower limb mobility was fine, he underwent thoracic stent graft aortic repair (TEVAR) in the subacute phase due to worsening ULP. The patient had a good postoperative course and was discharged home unassisted. The initial placement of CSFD was effective in reducing the incidence of paraplegia as a complication of TEVAR and in bringing the timing of TEVAR intervention from the acute phase to the subacute phase.
文摘急性Stanford B型主动脉夹层(Acute Stanford type B Aortic Dissection, ATBAD)由于发病率和死亡率高,需要多学科方法评估、了解其特征、快速分类,进行药物控制、主动脉开窗术、腔内修复术等治疗。然而何时提供何种治疗方式最佳通常不明确。本文从单纯性、复杂性ATBAD的治疗上入手,对国内外最新治疗进展进行综述,以期对ATBAD患者提供更多获益。
基金funded by the National Natural Science Foundation of China ( 11602007,11572014, 11832003)Key research and development program ( 2017YFC0111104)New Talent ( 015000514118002)
文摘Nowadays,cardiovascular disease has gradually become the number one killer of human health.The Stanford type-A aortic dissection is a relatively common cardiovascular disease with potential hazards.The disease is caused by a partialtearing of the aortic intima.Thoracic endovascular aortic repair(TEVAR)is one of the most effective treatment for type A aortic dissection and has been widely used clinically to achieve thrombosis and reduce pressure by covering the incision tear in the FL.However,the effect of entry tear location on type-A aortic dissection and the prognosis of TEVAR intervention are unclear.In this work,the hemodynamic effects of the type-A aortic dissection in different entry and covering entry tear position were mainly studied.It can provide a new method or idea in the field of the aortic dissection hemodynamics,which is of great significance to provide a basic theoretical research on the development of aortic dissection in the aspect of clinical judgment.Two type-A aortic dissection models with different entry tear positions(Model 1:the entry tear was located at the entrance of the ascending aorta,Model 2:the entry tear was located at the starting position of the descending aorta)were reconstructed according to the computed tomography(CT)images of the patients.In our study,the thoracic aortic endovascular repair was simulated by covering the entry tear(Model 3).Then,the semi-automatic adaptive technology HyperMeshl0.0(Altair HyperWorks,Troy,Ml,USA)mesh generator was used to generate the high-quality tetrahedral 3D mesh.To clarify the hemodynamic effects of entry tear and coverage in aortic blood flow pattern,the comparative study on the true lumen(TL)and false lumen(FL)blood flow patterns of three models were carried out numerically(the time-dependent pulsatile waveform of pressure boundary conditions used at the aortic inlet were consistent with Rapezzis’s work,time-dependent pulsatile waveform of velocity at the descending aorta outlet and the time-dependent pulsatile waveform of pressure at the brachiocephalic artery,left common carotid artery,and left subclavian artery were obtained from the work of Olufsenet et al).The velocity vector,flow ratio,pressure,time-average wall shear stress(TAWSS)and relative residence time(RRT)were calculated to evaluate the hemodynamic changes.The results of this work indicated that(Ⅰ)the velocity was higher at the entry tear in aorta entrance;(Ⅱ)the helical development of the TL and FL might be related to the helical nature of aortic arch;(Ⅲ)the blood flow which passing the FL of Model 1,Model 2 and Model 3 in one cardiac cycle were approximately 26.63%,13.39%and 1%,respectively;(Ⅳ)the difference in intima wall pressure among the TL and FL was found varied a lot and shown a strong pulsation;(Ⅴ)the TAWSS distribution in TL and FL were quite different(the TAWSS in TL intima>8 Pa,the TAWSS in FL intima<4 Pa).In brief,the aortic morphology and location of the entry tear were found to have a significant effect on the hemodynamic of the aortic dissection.What’s more,we found that the risk of the aortic rupture could be higher if the position of entry tear is closer to the ascending aorta.By covering the entry tear to simulate TEVAR,the pressure of FL was reduced,which could provide some help for the treatment of early retrograde type-A dissection.
基金This study was partly funded by the National Natural Science Foundation of China(Grant Nos.11602007,11572014,11832003)the Key research and development program(2017YFC0111104),and New Talent(015000514118002).
文摘In this work,the hemodynamic effects of the type-A aortic dissection in different entry and covering entry tear positions were mainly studied.It provides a new method or idea in the field of the aortic dissection hemodynamics,and it is of profound significance to provide basic theoretical research on the development of aortic dissection in the aspect of clinical judgment.Two type-A aortic dissection models with different entry tear positions(Model 1:The entry tear was located at the entrance of the ascending aorta,Model 2:The entry tear was located at the starting position of the descending aorta)were reconstructed according to the computed tomography(CT)images of the patients.In our study,the thoracic aortic endovascular repair was simulated by covering the entry tear(Model 3).To clarify the hemodynamic effects of entry tear and coverage,the comparative study on the true lumen(TL)and false lumen(FL)blood flow patterns of three models were carried out numerically.The velocity vector,flow ratio,pressure,time-averaged wall shear stress(TAWSS)and relative residence time(RRT)were calculated to evaluate the hemodynamic changes.The results of this work indicated that(I)the velocity of entry tear at the aorta entrance was higher;(II)The helical development of the TL and FL might be related to the helical nature of aortic arch;(III)The blood flow which passing the FL of Model 1,Model 2 and Model 3 in one cardiac cycle were approximately 26.63%,13.39%and 1%,respectively;(IV)The difference in intima wall pressure of the TL and FL were showed a strong pulsation;(V)The TAWSS distribution in TL and FL were completely different(the TAWSS in TL intima>8 Pa,the TAWSS in FL intima<4 Pa).In brief,the aortic morphology and location of the entry tear were found to have a significant effect on the hemodynamics of the aortic dissection.In addition,the CFD method is used to obtain multi-dimensional hemodynamic information such as velocity field,pressure,TAWSS and RRT,which can help clinicians better understand the development of type-A aortic dissection and provide a theoretical basis for clinical treatment.
