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首页> 外文期刊>International Journal of Cardiology >Pulmonary regurgitation: the effects of varying pulmonary artery compliance, and of increased resistance proximal or distal to the compliance.
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Pulmonary regurgitation: the effects of varying pulmonary artery compliance, and of increased resistance proximal or distal to the compliance.

机译：肺返流：肺动脉顺应性变化以及顺应性近端或远端阻力增加的影响。

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BACKGROUND: Pulmonary regurgitation is common after repair of tetralogy of Fallot, predisposing to right ventricular dilatation and potentially fatal arrhythmias. Magnetic resonance studies of such patients led us to hypothesize that the amount of regurgitation, in the absence of an effective valve, depends on pulmonary arterial compliance and on the location of resistance relative to the compliance. METHODS AND RESULTS: Using a pre-existing mathematical model representing the cardiovascular system, removal of the virtual pulmonary valve gave a triphasic pulmonary artery flow curve similar in shape to those recorded in patients with free regurgitation, with a regurgitant fraction of 30%. There was no reversal of flow at pulmonary capillary level, the regurgitant volume originating entirely from the compliance of the virtual pulmonary arteries and arterioles. Doubling their compliance increased regurgitation to 35%, whereas halving it decreased regurgitation to 23%. Doubling the total pulmonary vascularresistance by increasing arteriolar resistance increased regurgitation to 46%, whereas doubling it by simulating pulmonary annular stenosis proximal to the compliance limited regurgitation to 10%, but at the cost of a 32 mmHg peak systolic pressure drop. CONCLUSIONS: The model supported our hypotheses, indicating the relevance to pulmonary regurgitation of previously overlooked variables. The virtual pulmonary regurgitation was exacerbated by pulmonary artery compliance and by elevated resistance distal to it, but was limited by more proximal resistance. These relationships merit careful clinical investigation as they would have implications for the initial management, subsequent investigation and decisions on re-intervention in patients with pulmonary regurgitation.
机译：背景：法洛四联症修复后常见肺返流，易导致右心室扩张和潜在的致命性心律失常。对此类患者的磁共振研究使我们假设，在没有有效瓣膜的情况下，反流的数量取决于肺动脉顺应性以及相对于顺应性的抵抗力位置。方法和结果：使用代表心血管系统的预先存在的数学模型，移除虚拟肺动脉瓣可得到一条三角流的肺动脉血流曲线，其形状与自由反流患者所记录的相似，反流率为30％。在肺毛细血管水平没有血流逆转，反流体积完全来自虚拟肺动脉和小动脉的顺应性。将其依从性加倍会使反流率提高到35％，而减半将反流率降低到23％。通过增加小动脉阻力使总肺血管阻力增加一倍，可将反流率提高到46％，而通过模拟接近顺应性的肺动脉环形狭窄将其增加一倍，将反流率限制在10％，但代价是收缩压峰值降低32 mmHg。结论：该模型支持我们的假设，表明先前被忽略的变量与肺动脉反流的相关性。肺动脉顺应性和远端远端阻力的升高加剧了虚拟的肺返流，但由于近端阻力更大而受到限制。这些关系值得进行仔细的临床研究，因为它们将对肺返流患者的初始治疗，后续研究和重新干预决策产生影响。

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