Ouyang Da,He Peng,Pan Bo,et al.Fluid dynamics analysis and clinical application of three-dimensional reconstruction of aortic constriction[J].Journal of Clinical Pediatric Surgery,,():877-881.[doi:10.3760/cma.j.cn101785-202503023]
Fluid dynamics analysis and clinical application of three-dimensional reconstruction of aortic constriction
- Keywords:
- Aortic of Coarctation; Three-Dimensional Imaging; Computational Fluid Dynamics; Cardiology
- Abstract:
- Objective To explore the clinical role and significance of fluid dynamics analysis after three-dimensional reconstruction in the diagnosis and treatment of coarctation of the aorta (COA).Methods A retrospective analysis of the clinical data and imaging findings of 40 patients with COA (coarctation group) and 20 normal children (normal group) admitted from March 1,2017 to February 28,2021，combined with statistical methods and computational fluid dynamics (CFD) analysis to explore their clinical application potential.Results Pressure difference measured by CFD was (63.1±5.1) mmHg in narrowed group while pressure difference measured by preoperative ultrasound (64.1±5.2) mmHg.No statistically significant inter-group difference existed (P>0.05);Pressure difference measured by CFD was (4.4±1.0) mmHg in normal group and inter-group difference was statistically significant (P<0.01) as compared with CFD and ultrasound pressure difference in narrowed group.The relevant values fulfilled the clinical diagnostic criteria.CFD analysis based upon CTA three-dimensional reconstruction indicated that maximum pressure drop in narrowed section of narrowed group was >35 mmHg.Fluid vector diagram revealed a sharp pressure drop in narrowed section and pressure curve depicted a “a rapid drop over a short distance” characteristic;Pressure drop in the corresponding positions of normal group was <10 mmHg with a gentle change in pressure and no marked drop.Significant inter-group differences existed in hemodynamic characteristics.Conclusions CFD offers an excellent consistency with traditional imaging in the diagnosis of COA,providing richer hemodynamic information and achieving an accurate detection of aortic pressure changes at a lower cost and minimal trauma.It has comprehensive and systematic guiding significance for managing COA in children.
References:
[1] Karaosmanoglu AD,Khawaja RDA,Onur MR,et al.CT and MRI of aortic coarctation:pre-and postsurgical findings[J].AJR Am J Roentgenol,2015,204(3):W224-W233.DOI:10.2214/AJR.14.12529.
[2] Nigro G,Russo V,Rago A,et al.Heterogeneity of ventricular repolarization in newborns with severe aortic coarctation[J].Pediatr Cardiol,2012,33(2):302-306.DOI:10.1007/s00246-011-0132-4.
[3] Xu J,Zhao HL,Wang XY,et al.Accuracy,image quality,and radiation dose of prospectively ECG-triggered high-pitch dual-source CT angiography in infants and children with complex coarctation of the aorta[J].Acad Radiol,2014,21(10):1248-1254.DOI:10.1016/j.acra.2014.04.019.
[4] Baumgartner H,Bonhoeffer P,De Groot NMS,et al.ESC guidelines for the management of grown-up congenital heart disease (new version 2010)[J].Eur Heart J,2010,31(23):2915-2957.DOI:10.1093/eurheartj/ehq249.
[5] Singh S,Hakim FA,Sharma A,et al.Hypoplasia,pseudocoarctation and coarctation of the aorta-a systematic review[J].Heart Lung Circ,2015,24(2):110-118.DOI:10.1016/j.hlc.2014.08.006.
[6] Wu YH,Li JS,Wu C,et al.Diagnosis and surgical repair for coarctation of the aorta with intracardiac defects:a single center experience based on 93 infants[J].Front Pediatr,2020,8:49.DOI:10.3389/fped.2020.00049.
[7] Goubergrits L,Riesenkampff E,Yevtushenko P,et al.MRI-based computational fluid dynamics for diagnosis and treatment prediction:clinical validation study in patients with coarctation of aorta[J].J Magn Reson Imaging,2015,41(4):909-916.DOI:10.1002/jmri.24639.
[8] 毛乐.主动脉缩窄伴弓发育不良形态学及手术计算流体力学研究[D].上海:上海交通大学，2016.DOI:10.27307/d.cnki.gsjtu.2016.004857.Mao L.Study of morphologic and surgical computational fluid dynamics on aortic coarctation with hypoplastic aortic arch[D].Shanghai:Shanghai Jiaotong University,2016.DOI:10.27307/d.cnki.gsjtu.2016.004857.
[9] Vigneswaran TV,Bellsham-Revell HR,Chubb H,et al.Early postnatal echocardiography in neonates with a prenatal suspicion of coarctation of the aorta[J].Pediatr Cardiol,2020,41(4):772-780.DOI:10.1007/s00246-020-02310-5.
[10] Nie P,Wang X,Cheng Z,et al.The value of low-dose prospective ECG-gated dual-source CT angiography in the diagnosis of coarctation of the aorta in infants and children[J].Clin Radiol,2012,67(8):738-745.DOI:10.1016/j.crad.2011.12.007.
[11] ?i?li E,Kal?n S,Tuncer ON,et al.Comparison between nomograms used to define pediatric aortic arch hypoplasia:retrospective evaluation among patients less than 1 year old with coarctation of the aorta[J].Pediatr Cardiol,2019,40(6):1190-1198.DOI:10.1007/s00246-019-02130-2.
[12] Ladisa JF Jr,Taylor CA,Feinstein JA.Aortic coarctation:recent developments in experimental and computational methods to assess treatments for this simple condition[J].Prog Pediatr Cardiol,2010,30(1):45-49.DOI:10.1016/j.ppedcard.2010.09.0 06.
[13] Midulla M,Moreno R,Baali A,et al.Haemodynamic imaging of thoracic stent-grafts by computational fluid dynamics (CFD):presentation of a patient-specific method combining magnetic resonance imaging and numerical simulations[J].Eur Radiol,2012,22(10):2094-2102.DOI:10.1007/s00330-012-2465-7.
[14] Vergara C,Viscardi F,Antiga L,et al.Influence of bicuspid valve geometry on ascending aortic fluid dynamics:a parametric study[J].Artif Organs,2012,36(4):368-378.DOI:10.1111/j.1525-1594.2011.01356.x.
Memo
收稿日期:2025-3-9。
通讯作者:田杰,Email:jietian@cqmu.edu.cn