Document Detail


The hemodynamic performance of standard bileaflet valves is impaired by a tilted implantation position.
MedLine Citation:
PMID:  12614795     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Severe sclerosis of the native aortic annulus can result in a tilted implantation position of mechanical prostheses. In this study, the effects of tilting and rotation on the hemodynamic performance of standard bileaflet valves were assessed in an extracorporeal mock circulatory system. METHODS: A pulsatile mock circulation driven by a Berlin Heart system was developed. Main physiological components of the human circulation were mimicked. SJM-AHPJ prostheses (21, 23, 25 mm) were mounted in an artificial aortic root containing physiologically oriented coronary ostia. All experiments were performed under constant conditions (stroke volume 60 ml, heart rate 70 bpm, systolic pressure 130 mmHg). Hydrostatic pressures were measured via fluid-filled catheters, transvalvular flow by ultrasonic probes. Data were digitally recorded at 50 Hz. Multiple pressure, volume, energy, and dimension parameters were derived off-line. Each valve was tested in a 0 degrees (untilted) versus 20 degrees (tilted) position at three axial rotation angles (0 degrees, 45 degrees, 90 degrees ). Tilting was performed independent of rotation by elevation of the prosthesis in the non-coronary sinus. RESULTS: In all valves and all rotation angles, tilting resulted in a size-dependent significant increase of mean pressure gradient (range, 28-35% [21 mm valve], 59-96% [23 mm valve], 124-220% [25 mm valve]), valvular resistance (39-51, 84-121, 177-332%), regurgitation volume (84-148, 32-131, 93-118%), and systolic energy loss (113-146, 30-132, 69-213%), as well as a decrease of total stroke volume (2-5, 0-11, 3-10%), effective stroke volume (6-11, 9-14, 14-22%), cardiac output (6-11, 8-14, 13-22%), and effective opening area (16-24, 32-37, 47-57%). The strongest impairment of hemodynamic performance was seen at 90 degrees rotation with reference to total and effective stroke volume, cardiac output, mean pressure gradient, and regurgitation fraction. CONCLUSIONS: Tilting of bileaflet valves resulted in a significant impairment of systolic and diastolic hemodynamics. Superiority of larger valves diminished in the tilted position. The strongest tilting effect was seen at 90 degrees rotation. Such a position should therefore be avoided or surgically corrected by rotating the valve.
Authors:
Martin Hartrumpf; Johannes M Albes; Tanja Krempl; Volker Rudolph; Thorsten Wahlers
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  23     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-03-04     Completed Date:  2003-07-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  283-91     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller-University-Hospital Jena, Bachstrasse 18, 07743 Jena, Germany. martin.hartrumpf@med.uni-jena.de
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MeSH Terms
Descriptor/Qualifier:
Aortic Valve / physiology,  surgery*
Cardiac Output / physiology
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / methods*
Hemodynamics
Hemorheology
Humans
Models, Cardiovascular
Prosthesis Design
Pulsatile Flow
Rotation
Stroke Volume / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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