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Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation

The hemodynamic and geometric factors leading to propagation of acute Type B dissections are poorly understood. The objective is to elucidate whether geometric and hemodynamic parameters increase the predilection for aortic dissection propagation. A pulse duplicator set-up was used on porcine aorta...

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Autores principales: Peelukhana, Srikara V., Wang, Yanmin, Berwick, Zachary, Kratzberg, Jarin, Krieger, Joshua, Roeder, Blayne, Cloughs, Rachel E., Hsiao, Albert, Chambers, Sean, Kassab, Ghassan S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331108/
https://www.ncbi.nlm.nih.gov/pubmed/27510916
http://dx.doi.org/10.1007/s10439-016-1705-4
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author Peelukhana, Srikara V.
Wang, Yanmin
Berwick, Zachary
Kratzberg, Jarin
Krieger, Joshua
Roeder, Blayne
Cloughs, Rachel E.
Hsiao, Albert
Chambers, Sean
Kassab, Ghassan S.
author_facet Peelukhana, Srikara V.
Wang, Yanmin
Berwick, Zachary
Kratzberg, Jarin
Krieger, Joshua
Roeder, Blayne
Cloughs, Rachel E.
Hsiao, Albert
Chambers, Sean
Kassab, Ghassan S.
author_sort Peelukhana, Srikara V.
collection PubMed
description The hemodynamic and geometric factors leading to propagation of acute Type B dissections are poorly understood. The objective is to elucidate whether geometric and hemodynamic parameters increase the predilection for aortic dissection propagation. A pulse duplicator set-up was used on porcine aorta with a single entry tear. Mean pressures of 100 and 180 mmHg were used, with pulse pressures ranging from 40 to 200 mmHg. The propagation for varying geometric conditions (%circumference of the entry tear: 15–65%, axial length: 0.5–3.2 cm) were tested for two flap thicknesses (1/3rd and 2/3rd of the thickness of vessel wall, respectively). To assess the effect of pulse and mean pressure on flap dynamics, the %true lumen (TL) cross-sectional area of the entry tear were compared. The % circumference for propagation of thin flap (47 ± 1%) was not significantly different (p = 0.14) from thick flap (44 ± 2%). On the contrary, the axial length of propagation for thin flap (2.57 ± 0.15 cm) was significantly different (p < 0.05) from the thick flap (1.56 ± 0.10 cm). TL compression was observed during systolic phase. For a fixed geometry of entry tear (%circumference = 39 ± 2%; axial length = 1.43 ± 0.13 cm), mean pressure did not have significant (p = 0.84) effect on flap movement. Increase in pulse pressure resulted in a significant change (p = 0.02) in %TL area (52 ± 4%). The energy acting on the false lumen immediately before propagation was calculated as 75 ± 9 J/m(2) and was fairly uniform across different specimens. Pulse pressure had a significant effect on the flap movement in contrast to mean pressure. Hence, mitigation of pulse pressure and restriction of flap movement may be beneficial in patients with type B acute dissections.
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spelling pubmed-53311082017-03-14 Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation Peelukhana, Srikara V. Wang, Yanmin Berwick, Zachary Kratzberg, Jarin Krieger, Joshua Roeder, Blayne Cloughs, Rachel E. Hsiao, Albert Chambers, Sean Kassab, Ghassan S. Ann Biomed Eng Article The hemodynamic and geometric factors leading to propagation of acute Type B dissections are poorly understood. The objective is to elucidate whether geometric and hemodynamic parameters increase the predilection for aortic dissection propagation. A pulse duplicator set-up was used on porcine aorta with a single entry tear. Mean pressures of 100 and 180 mmHg were used, with pulse pressures ranging from 40 to 200 mmHg. The propagation for varying geometric conditions (%circumference of the entry tear: 15–65%, axial length: 0.5–3.2 cm) were tested for two flap thicknesses (1/3rd and 2/3rd of the thickness of vessel wall, respectively). To assess the effect of pulse and mean pressure on flap dynamics, the %true lumen (TL) cross-sectional area of the entry tear were compared. The % circumference for propagation of thin flap (47 ± 1%) was not significantly different (p = 0.14) from thick flap (44 ± 2%). On the contrary, the axial length of propagation for thin flap (2.57 ± 0.15 cm) was significantly different (p < 0.05) from the thick flap (1.56 ± 0.10 cm). TL compression was observed during systolic phase. For a fixed geometry of entry tear (%circumference = 39 ± 2%; axial length = 1.43 ± 0.13 cm), mean pressure did not have significant (p = 0.84) effect on flap movement. Increase in pulse pressure resulted in a significant change (p = 0.02) in %TL area (52 ± 4%). The energy acting on the false lumen immediately before propagation was calculated as 75 ± 9 J/m(2) and was fairly uniform across different specimens. Pulse pressure had a significant effect on the flap movement in contrast to mean pressure. Hence, mitigation of pulse pressure and restriction of flap movement may be beneficial in patients with type B acute dissections. Springer US 2016-08-10 2017 /pmc/articles/PMC5331108/ /pubmed/27510916 http://dx.doi.org/10.1007/s10439-016-1705-4 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Article
Peelukhana, Srikara V.
Wang, Yanmin
Berwick, Zachary
Kratzberg, Jarin
Krieger, Joshua
Roeder, Blayne
Cloughs, Rachel E.
Hsiao, Albert
Chambers, Sean
Kassab, Ghassan S.
Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation
title Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation
title_full Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation
title_fullStr Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation
title_full_unstemmed Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation
title_short Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation
title_sort role of pulse pressure and geometry of primary entry tear in acute type b dissection propagation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331108/
https://www.ncbi.nlm.nih.gov/pubmed/27510916
http://dx.doi.org/10.1007/s10439-016-1705-4
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