1.Shanghai children'2.'3.s Medical Center affiliated to Shanghai Joao Tong University School of Medical
The National Natural Science Foundation of China (General Program, Key Program, Major Research Plan)
目的 先天性心脏病相关性肺动脉高压（pulmonary arterial hypertension related to congenital heart disease, PAH-CHD）是肺循环血流动力学异常所致的一种疾病，研究肺循环血流动力学特异性有助于了解PAH-CHD发生发展的生物力学因素，从而优化临床诊疗。方法 对5例PAH-CHD 患儿和5例无PAH（Non-PAH）的先天性心脏病患儿通过临床及影像资料收集，重建三维血管模型，利用计算流体动力学模拟肺动脉血液流动，对比分析肺动脉血流动力学相关速度流线、壁面切应力（wall shear stress, WSS）及单位体表面积平均能量损失（E ?）差异。结果 血流动力学相关指标显示，PAH-CHD患儿左右肺动脉分支处流速和WSS明显升高，主肺动脉处WSS明显降低，E ?呈显著增加趋势且与肺动脉直径及入口流量呈明显正相关。结论 肺动脉分支处流速和WSS的升高，主肺动脉WSS的降低，E ?的增加可能是PAH-CHD发生发展的潜在血流动力学特异性因素。
Aim: Hemodynamic disorder of the pulmonary artery (PA) is the main cause of pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). Studying the hemodynamic characteristics of the pulmonary vascular is helpful to understand the biomechanical factors in the occurrence and development of PAH-CHD, which will greatly benefit the control, improvement and treatment of PAH-CHD. Methods: Five PAH-CHD patients and five matched controls were enrolled. Subject-specific three-dimensional PA models were reconstructed based on computed tomography. Computational fluid dynamics was performed to compare the hemodynamic difference of flow patterns, wall shear stress (WSS) and normalized energy loss (E ?) in the two groups. Results: Hemodynamic analysis showed that the velocity and WSS were higher in the PA branches of PAH-CHD patients, in whom WSS was lower in the main PA. The E ? significantly increased in PAH-CHD patients and positively correlated with normalized PA diameter and inflow. Conclusion: The increased velocity and WSS in the PA branches, decreased WSS in the main PA, and increased E ? may be the potential biomechanical factors in the development of PAH-CHD.