Influence of a tilting prosthetic mitral valve orientation on the left ventricular flow — an experimental in vivo magnetic resonance imaging study

Mächler, Heinrich; Reiter, Gert; Perthel, Mathias; Reiter, Ursula; Bergmann, Peter G.; Zink, Michael; Rienmüller, R.; Laas, J.

doi:10.1016/j.ejcts.2007.02.038

Cited by 22 publications

(13 citation statements)

References 20 publications

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“…The present results have implications for cardiac surgery aimed at correcting the intracardiac flow (17,18), as well as for studies on cardiac morphogenesis. Multiscale biological modeling connecting the cellular mechanisms of cardiac contraction to flow dynamics, combined with the wide variety of bioimaging modalities, could be a powerful tool for in silico biology (23).…”

Section: Discussionmentioning

confidence: 84%

The looped heart does not save energy by maintaining the momentum of blood flowing in the ventricle

Watanabe

Sugiura²,

Hisada³

2008

American Journal of Physiology-Heart and Circulatory Physiology

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Previous studies suggested that the reconstruction or maintenance of physiological blood flow paths in the heart is important to obtain a good outcome following cardiac surgery, but this concept has no established theoretical foundation. We developed a multiscale, multiphysics heart simulator, based on the finite element method, and compared the hemodynamics of ventricles with physiological and nonphysiological flow paths. We found that the physiological flow path did not have an energy-saving effect but facilitated the separation of the outflow and inflow paths, so avoiding any mixing of the blood. The work performed by the ventricular wall was comparable at slower and faster heart rates (physiological vs. nonphysiological, 0.864 vs. 0.874 J, heart rate = 60 beats/min; and 0.599 vs. 0.590 J, heart rate = 100 beats/min), indicating that chiral asymmetry of the flow paths in the mammalian heart has minimal functional merit. At lower heart rates, the blood coming in the first beat was cleared almost completely by the ninth beat in both models. However, at high heart rates, such complete clearance was observed only in the physiological model, whereas 27.0% of blood remained in the nonphysiological model. This multiscale heart simulator provided detailed information on the cardiac mechanics and flow dynamics and could be a useful tool in cardiac physiology.

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Section: Discussionmentioning

confidence: 84%

The looped heart does not save energy by maintaining the momentum of blood flowing in the ventricle

Watanabe

Sugiura²,

Hisada³

2008

American Journal of Physiology-Heart and Circulatory Physiology

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“…19 However, when placed in the antianatomic position, blood flow shifted toward the septum and resulted in higher velocities of the stream profiles and turbulence apically. 14 The resultant diastolic gradient in the antianatomic position is higher than in the anatomic position. 14,20 When interrogating the tilting-disc valve in the antianatomic position, the inner spectral envelope represents the gradient of the flow through the valve.…”

Section: The Outer Envelope Of a Mitral Prosthesis Continuous-wave Domentioning

confidence: 98%

Inverted Aortic Prosthesis in the Mitral Position: Is Upside Down Always the Right Side Up?

Khoche

Cobey

2019

Journal of Cardiothoracic and Vascular Anesthesia

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“…The visualization of aortic flow was performed with a dynamic color-encoded velocity vector map created by a dedicated software tool (4D Flow; Siemens Medical Solutions) (19). After velocity field calculations were performed for all pixels above a signal-to-noise threshold in the magnitude images, a dynamic map of velocity vectors was obtained in the chosen slice.…”

Section: Visualization Of Aortic Flowmentioning

confidence: 99%

Breathhold time‐resolved three‐directional MR velocity mapping of aortic flow in patients after aortic valve‐sparing surgery

Liu

Weale

Reiter

et al. 2009

Magnetic Resonance Imaging

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Purpose:To evaluate the utility of breathhold time-resolved three-directional MR velocity mapping for quantifying the restoration of normal flow patterns in patients after aortic valve-sparing surgery. Materials and Methods:Breathhold time-resolved threedirectional MR velocity mapping was performed on 13 patients with aortic valve-sparing surgery. Ten healthy volunteers and 12 patients with ascending aortic aneurysm underwent the same MR examination for comparison. Aortic laminar flow, turbulent flow, and the presence of vortical flow in the sinuses of Valsalva were semiquantitatively assessed and statistically compared between the three groups of subjects. Results:The average score of laminar flow in the ascending aorta for patients with surgery was not significantly different from that of volunteers (P ϭ 0.210), but was significantly greater than that of patients with aneurysm (P Ͻ 0.01). The average score of turbulent flow in patients with surgery was significantly smaller than that of patients with aneurysm (P Ͻ 0.01). The presence of systolic vortical flow in the sinuses of Valsalva for patients with surgery was not significantly different from that of healthy volunteers (P ϭ 0.405) and patients with aneurysm (P ϭ 0.238). Conclusion:Breathhold time-resolved three-directional MR velocity mapping allows for quantifying flow patterns in the aortic root and ascending aorta.Normal laminar flow in the ascending aorta and vortical flow in the sinuses of Valsalva can be restored in patients after aortic valve-sparing surgery.

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Influence of a tilting prosthetic mitral valve orientation on the left ventricular flow — an experimental in vivo magnetic resonance imaging study

Abstract: To achieve optimal hemodynamics, orientation of the mitral tilting valve has to be considered carefully, as has been long known from aortic valve replacement studies.

Cited by 22 publications

References 20 publications

The looped heart does not save energy by maintaining the momentum of blood flowing in the ventricle

The looped heart does not save energy by maintaining the momentum of blood flowing in the ventricle

Inverted Aortic Prosthesis in the Mitral Position: Is Upside Down Always the Right Side Up?

Breathhold time‐resolved three‐directional MR velocity mapping of aortic flow in patients after aortic valve‐sparing surgery

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