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Risk Assessment using Image-Based Hemodynamic Modeling of Patients with Coronary Artery Aneurysms caused by Kawasaki Disease.

机译：使用基于图像的血流动力学模型对川崎病引起的冠状动脉瘤患者进行风险评估。

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摘要

Kawasaki Disease (KD) is the leading cause of acquired heart disease in children and can result in life-threatening coronary artery aneurysms in up to 25% of patients. These aneurysms put patients at risk of thrombus formation, myocardial infarction and sudden death. Clinicians must therefore decide which patients should be treated with anticoagulant medication and/or surgical and percutaneous intervention. Current recommendations regarding initiation of anticoagulant therapy are based on anatomy alone with historical data suggesting that patients with aneurysms &;Firstly, a finite element framework with a lumped parameter boundary condition was implemented following a circuit analogy. A patient-specific case study was carried out to study the abnormalities in hemodynamics arising due to the presence of the aneurysms in the coronary arteries. Furthermore, simulations were performed on a virtual normal control model created from the same CT image data to demonstrate order of magnitude variation of several local hemodynamic quantities despite no differences in global flow and pressure waveforms between the two models.;Secondly, blood flow simulations were performed on patient-specific models on a cohort of KD patients with coronary aneurysms and one KD patient with no coronary aneurysms. Key hemodynamic quantities including shear stress and residence times were computed in addition to geometric parameters and compared to the corresponding values in the normal vessels with no aneurysms. The findings uncovered various non-intuitive relationships between the flow parameters and geometry relating to the risk of thrombosis. The study suggested that a clinical risk index based on simulation and geometric data could be used to select patients for anticoagulant therapy.;To our knowledge, we performed the first cardiovascular simulations for KD patients with coronary aneurysms. This thesis lays the framework for the construction of a simulation based clinical risk index by considering a larger cohort of patient data that may be clinically useful in patient management for KD patients with coronary aneurysms.
机译：川崎病（KD）是儿童后天性心脏病的主要原因，可导致多达25％的患者危及生命的冠状动脉瘤。这些动脉瘤使患者处于血栓形成，心肌梗塞和猝死的危险中。因此，临床医生必须决定应使用抗凝药物和/或手术和经皮介入治疗哪些患者。当前关于开始抗凝治疗的建议仅基于解剖学和历史数据，这提示患有动脉瘤的患者；首先，在电路模拟之后，采用集总参数边界条件的有限元框架。进行了针对特定患者的案例研究，以研究由于冠状动脉内存在动脉瘤而引起的血液动力学异常。此外，在由相同的CT图像数据创建的虚拟正常对照模型上进行了仿真，以证明尽管两个模型之间的总体流量和压力波形没有差异，但几个局部血液动力学量的量级变化。在一组具有冠状动脉瘤的KD患者和一名无冠状动脉瘤的KD患者的特定患者模型上进行了研究。除几何参数外，还计算了包括剪切应力和停留时间在内的关键血液动力学量，并将其与无动脉瘤的正常血管中的相应值进行了比较。该发现揭示了流量参数和几何形状之间与血栓形成风险相关的各种非直观关系。该研究表明，基于模拟和几何数据的临床风险指数可用于选择抗凝治疗的患者。据我们所知，我们对KD冠状动脉瘤患者进行了首次心血管模拟。本论文通过考虑更大的患者数据队列为构建基于模拟的临床风险指数奠定了框架，该数据可能对KD冠状动脉瘤患者的临床管理具有临床意义。

著录项

  • 作者

    Sengupta, Dibyendu.;

  • 作者单位

    University of California, San Diego.;

  • 授予单位 University of California, San Diego.;
  • 学科 Engineering Mechanical.;Computer Science.
  • 学位 Ph.D.
  • 年度 2013
  • 页码 125 p.
  • 总页数 125
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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