The desire for a low profile mechanical valve with better fluid dynamic performance led to the design and development of the St. Jude Medical bileaflet prosthesis. Comparative in vitro flow studies indicate that it has better pressure drop characteristics than the Björk-Shiley (convexo-concave) and Carpentier-Edwards porcine valves in current clinical use, especially in the small sizes. In the 21 to 27 mm aortic valve size range the St. Jude valve has an average performance index of 0.66, compared with 0.46 and 0.32 for the Björk-Shiley and Carpentier-Edwards valves, respectively. In contrast, the St. Jude valve has larger regurgitant volumes than both the Björk-Shiley and Carpentier-Edwards valves. Velocity measurements with a laser-Doppler anemometer indicate relatively centralized flow with small amounts of turbulence downstream of the St. Jude valve. The flow is unevenly distributed between the central and side orifices. The turbulent shear stresses are, however, large enough to cause sublethal or lethal damage to blood elements. Wall shear stresses are smaller than those measured downstream of the Björk-Shiley valve. Regions of flow separation were observed just downstream from the sewing ring, which could lead to excess tissue growth along the sewing ring. The results of this study indicate that overall in vitro fluid dynamic performance of the St. Jude valve is superior to that of the two other commonly used prostheses.
If color Doppler imaging is to continue to evolve into a reliable clinical method to noninvasively evaluate regurgitant lesions, then its grading methods must be quantitated and calibrated under extreme hemodynamic conditions. A left heart pulse duplicator was used to provide a completely controllable system to study aortic incompetence jet morphologies as a function of hemodynamic extremes. The system was first used to calibrate the limits of resolution of color Doppler imaging. Next, to define which jet features reliably predict the defect size or the regurgitant fraction and which are primarily influenced by instantaneous hemodynamic variables, we measured the jets' maximal length, width, proximal width, and temporal pattern of color variance during independent variations in the heart rate, cardiac output, and pressure gradient across the incompetent valve. The proximal jet width (immediately below the valve plane) was the only reliable independent predictor of both the defect size and the regurgitant fraction. Jet depth accurately predicted peak velocity (quantitated by laser Doppler velocimetry); it reliably predicted the severity of incompetence only at a known pressure gradient across the valve. Large defects (5 mm) produced jets with maximal color variance in early diastole, whereas small defects produced pandiastolic variance. Circulation 75, No. 4, 837-846, 1987. QUANTIFICATION of native and prosthetic valvular incompetence has traditionally relied upon contrast angiography. Besides
The in vitro hemodynamic characteristics of a variety of mechanical and tissue heart valve designs used during the past two decades were investigated in the aortic position under pulsatile flow conditions. The following valve designs were studied: Starr-Edwards ball and cage (model 1260), Björk-Shiley tilting disc (convexo-concave model), Medtronic-Hall tilting disc, St. Jude Medical bileaflet, Carpentier-Edwards porcine and pericardial (models 2625, 2650 and 2900), Hancock porcine (models 250 and 410) and Ionescu-Shiley standard pericardial. The Starr-Edward ball and cage, Björk-Shiley tilting disc, CarpentierEdwards porcine (model 2625) and Ionescu-Shiley standard pericardial valves were designed prior to 1975, while the Medtronic-Hall tilting disc, St. Jude Medical bileaflet, Hancock porcine (model 250), Hancock II porcine (model 410), Carpentier-Edwards porcine (model 2650) and Carpentier-Edwards pericardial (model 2900) valves were designed after 1975. The pressure drop results indicated that the valves designed prior to 1975 had performance indices of 0.30 to 0.45, whereas the valves designed after 1975 had performance indices of 0.40 to 0.70. The regurgitant volumes were higher for the mechanical deat University of British Columbia Library on July 10, 2015 jba.sagepub.com Downloaded from 580 signs (5.0 to 11.0 cm 3 /beat) compared to the tissue bioprostheses (1.0 to 5.0 cm 3 / beat). Two-dimensional laser Doppler anemometry studies indicated that the valves designed after 1975 tended to create more centralized flow fields, with reduced levels of turbulent shear stresses. However, none of the current valve designs is ideal: they all create areas of stasis and/or regions of low velocity reverse flow; and regions of elevated turbulent shear stresses that are capable of causing sub-lethal and/or lethal damage to the formed elements of blood.
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