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,2026,(09):877-881.[doi:10.3760/cma.j.cn101785-202503023]
主动脉缩窄三维重建后计算流体动力学分析及临床应用
- Title:
- Fluid dynamics analysis and clinical application of three-dimensional reconstruction of aortic constriction
- Keywords:
- Aortic of Coarctation; Three-Dimensional Imaging; Computational Fluid Dynamics; Cardiology
- 摘要:
- 目的 探讨三维重建后计算流体动力学分析对主动脉缩窄（coarctation of aorta,COA）诊断和治疗的临床作用及意义。方法 回顾性分析重庆医科大学附属儿童医院2017年3月1日至2021年2月28日心血管科收治的40例COA患儿（缩窄组）及20例正常儿童（正常组）的临床资料和影像学数据，结合统计学及计算流体动力学(computational fluid dynamics,CFD)方法进行分析，挖掘其临床应用潜能。结果 缩窄组CFD测得压差为（63.1±5.1）mmHg，术前彩超测得压差为（64.1±5.2）mmHg，差异无统计学意义（P>0.05）；正常组CFD测得压差为（4.4±1.0）mmHg，与缩窄组的CFD及彩超压差比较，差异均有统计学意义（P<0.01），且相关数值符合临床诊断标准。基于CTA三维重建的CFD分析显示，缩窄组缩窄段最大压力下降均>35 mmHg，流体矢量图可见缩窄段压力急剧下降，压力曲线呈“短距离内快速跌落”特征；正常组对应位置压力下降均<10 mmHg，压力变化平缓，无显著跌落，两组血流动力学特征差异显著。结论 CFD与传统影像学在COA诊断中一致性良好，能提供更丰富的血流动力学信息，以更低成本、更少创伤实现对主动脉压力变化的精准评估，对COA患儿的诊断和治疗具有全面系统的指导意义。
- 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.
参考文献/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.
相似文献/References:
[1]宁岩松,张供.婴儿主动脉弓阻塞病变的外科治疗[J].临床小儿外科杂志,2010,9(06):407.
NING Yan song,ZHANG Gong,Surgical management of aortic arch obstruction associated with cardiac anomalies in infants.[J].Journal of Clinical Pediatric Surgery,2010,9(09):407.
[2]张凯,邓喜成,罗金文,等.新生儿主动脉缩窄合并室间隔缺损27例一期手术矫治效果分析[J].临床小儿外科杂志,2020,19(01):69.[doi:10.3969/j.issn.1671-6353.2020.01.014]
Zhang Kai,Deng Xicheng,Luo Jinwen,et al.Analysis of the effect of one-stage surgical correction in 27 neonates with aortic constriction and ventricular septal defect[J].Journal of Clinical Pediatric Surgery,2020,19(09):69.[doi:10.3969/j.issn.1671-6353.2020.01.014]
[3]陈仁伟,王海凡,艾力夏提·阿里甫,等.非体外循环下危重主动脉缩窄新生儿左胸后外侧切口手术的效果分析[J].临床小儿外科杂志,2021,20(09):861.[doi:10.12260/lcxewkzz.2021.09.012]
Chen Renwei,Wang Haifan,Ailixiati·alifu,et al.Analysis of the effect of coarctation of aorta in critically neonatal under off-pump[J].Journal of Clinical Pediatric Surgery,2021,20(09):861.[doi:10.12260/lcxewkzz.2021.09.012]
[4]秦津洁,何玲.基于影像的计算流体力学在主动脉缩窄评估中的研究进展[J].临床小儿外科杂志,2022,21(08):780.[doi:10.3760/cma.j.cn101785-202201038-014]
Qin Jinjie,He Ling.Research advances in assessing aortic coarctation by image-based computational fluid dynamics[J].Journal of Clinical Pediatric Surgery,2022,21(09):780.[doi:10.3760/cma.j.cn101785-202201038-014]
[5]何玮梅,单佳妮,刘喜旺,等.美国胸外科医师学会新生儿和婴儿孤立性主动脉缩窄外科手术管理指南(2024年版)解读及与国内专家共识的对比[J].临床小儿外科杂志,2024,23(07):606.[doi:10.3760/cma.j.cn101785-202407017-002]
He Weimei,Shan Jiani,Liu Xiwang,et al.Interpretation of the Society of Thoracic Surgeons Clinical Practice Guidelines on the Management of Neonates and Infants with Coarctation (2024) and comparison with domestic expert consensus[J].Journal of Clinical Pediatric Surgery,2024,23(09):606.[doi:10.3760/cma.j.cn101785-202407017-002]
[6]龚海南,张儒舫,陈小龙,等.儿童主动脉弓部畸形手术后再干预的影响因素分析[J].临床小儿外科杂志,2025,(10):946.[doi:10.3760/cma.j.cn101785-202405017-008]
Gong Hainan,Zhang Rufang,Chen Xiaolong,et al.Analysis of factors influencing reintervention after surgical repair of aortic arch anomalies in children[J].Journal of Clinical Pediatric Surgery,2025,(09):946.[doi:10.3760/cma.j.cn101785-202405017-008]
备注/Memo
收稿日期:2025-3-9。
通讯作者:田杰,Email:jietian@cqmu.edu.cn