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首页> 外文期刊>Journal of Biomechanics >Analytical modeling of the instantaneous maximal transvalvular pressure gradient in aortic stenosis.
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Analytical modeling of the instantaneous maximal transvalvular pressure gradient in aortic stenosis.

机译：主动脉瓣狭窄瞬间最大经瓣压力梯度的分析模型。

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摘要

In presence of aortic stenosis, a jet is produced downstream of the aortic valve annulus during systole. The vena contracta corresponds to the location where the cross-sectional area of the flow jet is minimal. The maximal transvalvular pressure gradient (TPG(max)) is the difference between the static pressure in the left ventricle and that in the vena contracta. TPG(max) is highly time-dependent over systole and is known to depend upon the transvalvular flow rate, the effective orifice area (EOA) of the aortic valve and the cross-sectional area of the left ventricular outflow tract. However, it is still unclear how these parameters modify the TPG(max) waveform. We thus derived an explicit analytical model to describe the instantaneous TPG(max) across the aortic valve during systole. This theoretical model was validated with in vivo experiments obtained in 19 pigs with supravalvular aortic stenosis. Instantaneous TPG(max) was measured by catheter and its waveform was compared with the one determined from the derived equation. Our results showed a very good concordance between the measured and predicted instantaneous TPG(max). Total relative error and mean absolute error were on average 9.4+/-4.9% and 2.1+/-1.1 mmHg, respectively. The analytical model proposed and validated in this study provides new insight into the behaviour of the TPG(max) and thus of the aortic pressure at the level of vena contracta. Because the static pressure at the coronary inlet is similar to that at the vena contracta, the proposed equation will permit to further examine the impact of aortic stenosis on coronary blood flow.
机译：在主动脉瓣狭窄的情况下，在心脏收缩期间在主动脉瓣环的下游产生射流。腔收缩对应于射流的横截面面积最小的位置。最大的跨瓣压力梯度（TPG（max））是左心室和腔静脉收缩中的静压力之差。 TPG（max）在整个收缩期高度依赖于时间，并且已知其取决于瓣膜流速，主动脉瓣的有效孔面积（EOA）和左心室流出道的横截面积。但是，仍不清楚这些参数如何修改TPG（max）波形。因此，我们得出了一个明确的分析模型来描述收缩期跨主动脉瓣的瞬时TPG（max）。该理论模型已通过在19例主动脉瓣上狭窄的猪中进行的体内实验得到了验证。通过导管测量瞬时TPG（max），并将其波形与从推导方程确定的波形进行比较。我们的结果表明，实测和预测的瞬时TPG（max）之间有很好的一致性。总相对误差和平均绝对误差分别平均为9.4 +/- 4.9％和2.1 +/- 1.1 mmHg。在本研究中提出并验证的分析模型为TPG（max）的行为提供了新的见识，从而为腔静脉收缩水平的主动脉压提供了新的见解。由于冠状动脉入口处的静压与腔静脉收缩处的静压相似，因此提出的方程式将允许进一​​步检查主动脉瓣狭窄对冠状动脉血流的影响。

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