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Impact of revascularization on the distal to proximal pressure ratio in case of multiple coronary stenoses

dc.contributor.authorANSELMI, Amedeo
hal.structure.identifierCentre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
dc.contributor.authorCORBINEAU, Hervé
hal.structure.identifierCentre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
dc.contributor.authorVERHOYE, Jean-Philippe
hal.structure.identifierInstitut de Mécanique et d'Ingénierie [I2M]
dc.contributor.authorDROCHON, Agnès
dc.date2021
dc.date.accessioned2021-05-14T09:31:04Z
dc.date.available2021-05-14T09:31:04Z
dc.date.issued2021
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/75856
dc.description.abstractEnObjective: In order to take a decision about the revascularization approach to be adopted, it is of fundamental importance to determine whether coronary artery stenoses induce ischemia or not. An index, named (Fractional Flow Reserve), based on pressure measurements has been proposed to this aim and is usually interpreted in terms of flows. The objective of this work is to compute simultaneously pressures and flow rates in the coronary network of patients with three-vessel disease, in order to study more precisely the relationship between these two quantities. Approach: 22 patients have been included in the study. Some pressure and flow rates measurements were collected during by-pass surgery. These clinical data allow to determine parameters for a patient’s specific model, based on the electric / hydraulic analogy. Collateral pathways are included in the model, as well as the severity of the disease and the impact of revascularization. Main Results: For patients with stenoses on LAD, LCx, LMCA and occlusion of the RCA, the flow rate delivered to the right territory is of course a function of the aortic pressure, the left stenoses severity, and the pressure distal to the thrombosis. But it mainly depends on the capillary and collateral resistances, and on the proportion between them. Abnormal microvascular hemodynamics, may be present in patients with non-hemodynamic significant lesions as assessed by the pressure ratio. Complete revascularization with the 3 grafts is demonstrated to be fully justified. The direction of collateral flows may be reversed, depending on the pressure gradient. In any case, they remain low and become negligible when the 3 grafts are operating. Significance: Surgical decision based only on pressure measurements may miss some real hemodynamic problem due to the considered stenosis. This risk is even greater in case of serial stenoses.
dc.language.isoen
dc.subject.encoronary three-vessel disease
dc.subject.enhydrodynamic impact of stenoses
dc.subject.enby-pass grafting
dc.subject.enFractional Flow Reserve
dc.subject.encollateral flow
dc.subject.enanalog electric model
dc.subject.enflow and pressure simulations
dc.title.enImpact of revascularization on the distal to proximal pressure ratio in case of multiple coronary stenoses
dc.typeArticle de revue
dc.subject.halSciences de l'ingénieur [physics]
dc.subject.halSciences du Vivant [q-bio]
bordeaux.journalJournal of Biomedical Science and Engineering
bordeaux.hal.laboratoriesInstitut de Mécanique et d’Ingénierie de Bordeaux (I2M) - UMR 5295*
bordeaux.institutionUniversité de Bordeaux
bordeaux.institutionBordeaux INP
bordeaux.institutionCNRS
bordeaux.institutionINRAE
bordeaux.institutionArts et Métiers
bordeaux.peerReviewedoui
hal.identifierhal-03148419
hal.version1
hal.origin.linkhttps://hal.archives-ouvertes.fr//hal-03148419v1
bordeaux.COinSctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Journal%20of%20Biomedical%20Science%20and%20Engineering&rft.date=2021&rft.au=ANSELMI,%20Amedeo&CORBINEAU,%20Herv%C3%A9&VERHOYE,%20Jean-Philippe&DROCHON,%20Agn%C3%A8s&rft.genre=article


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