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| Numerical
and experimental studies of physiologic flows in the coronary
bridgings. |
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(cf. A4,
A5, A7, A18, A19, A21, C7, C16, C17, C30, C31, C43, C44)
The middle or long term results in coronary surgery show
non-negligeable rates of restenosis (38% of failure for the
venous graft; 15 to 28% for an arterial graft; only 46% of the
grafts viable after 20 years). The geometric and hemodynamics
configurations of bridging do not seem to be always optimized.
During the first weeks of action of a coronary bridging, clinical
studies have show that a non-neglectable flow could exist in
the stenosed coronary. However, no study takes the geometrical
shape of a stenosis into account, as the flow coming from the
sick coronary is commonly represented in the litterature by
a simple debt reduction, or even a total occlusion. To the reduction
of debt is actually added the dynamics of a jet coming from
the contriction. Numerous in vitro or in vivo studies realized
in models of bridging have shown three important areas of important
risk : the point, the heel and the floor of the receiving artery.
the interaction between the jet and the junction flow coming
from the graft cannot be neglected and the recirculation zone
downstream from the stenosis has a strong influence on the distribution
of the parietal friction. Within a thesis work (D6),
a numerical and experimental study were conducted in that direction,
for physiological flows, and in models of anastomose representing
a stenosed coronary. |
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