日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 33(5): 371-384 (2017)
doi:10.9794/jspccs.33.371

ReviewReview

先天性心疾患治療における血流解析手法の役割Role of Blood Flow Imaging in Treating Congenital Heart Disease in Clinical Practice

1京都府立医科大学心臓血管外科心臓血管血流解析学Department of Cardiovascular Surgery and Cardiovascular Imaging Labo, Kyoto Prefectural University of Medicine ◇ Kyoto, Japan

2京都府立医科大学小児心臓血管外科Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine ◇ Kyoto, Japan

発行日:2017年9月1日Published: September 1, 2017
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近年のコンピュータ技術の進歩に伴い循環器画像診断は変容を遂げつつある.カラー3次元動画を自在に使えるよう今日,心臓血管の形態のみならず血流をわかりやすく可視化する技法である『血流解析』が台頭しつつある.血流解析では異常血流を可視化し,乱流がもたらす心筋や血管内皮への力学的なストレスを可視化し,心臓弁膜症,心筋症,冠動脈疾患,大動脈疾患など幅広い循環器疾患において病態生理の詳細に迫ることが可能になる.また,これらの力学的なストレスが心不全や血管イベントなどを予測できるのではないかという期待がある.特に,先天性心疾患は解剖も生理学も複雑で,複雑な修復を余儀なくされ,従来血流解析と最もなじみの深い領域であった.また昨今の周術期管理の向上により遠隔期を迎える患者も増多しており予測医療としての血流解析の担う役割は大きい.本稿では血流解析手法の詳細を説明すると同時に先天性心疾患での役割を議論する.

With recent improvements in computer technology, prominent progress has occurred in cardiovascular imaging. Blood flow imaging visualizes complicated blood flow inside the cardiovascular lumen via 3D color video, in addition to providing traditional geometrical information such as heart chamber size and vessel diameter. Because blood flow imaging provides detailed information about diseased flow, elucidates the pathophysiology of cardiovascular disease, and visualizes mechanical stress on the ventricular chamber or vessel intima, it has been identified as a novel tool for predictive medicine for heart valve disease, cardiomyopathy, coronary arterial disease, and aortic disease. Congenital heart disease has a complicated anatomy and physiology; thus, blood flow imaging has been expected to have clinical applicability for congenital heart disease for decades. Even with the sophistication of perioperative patient management in congenital heart disease, blood flow imaging plays an essential role in predicting long-term outcomes in patients with congenital heart disease.

In this review, we explained the details of blood flow imaging, including 4D flow MRI, several types of novel echocardiography blood flow visualization software, and computational simulations. Echocardiography and MRI flow imaging are based on flow measurements, which carry limitations concerning spatial and temporal resolution. Conversely, computer simulation enables “virtual surgery” with sufficient resolution, but visualized flow is dependent on the calculation assumption. We also discussed effective clinical applications of these methods in patients with congenital heart disease, especially considering long-term outcomes, by reviewing the literature and introducing several complicated cases.

Key words: blood flow imaging; 4D flow MRI; echocardiography vector flow mapping; computational fluid dynamics; predictive medicine

This page was created on 2017-09-20T09:35:21.031+09:00
This page was last modified on 2017-10-31T17:09:53.899+09:00


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