Optimal Insertion Technique for the Björk-Shiley Valve in the Narrow Aortic Ostium

Olin, Christian; Bomfim, Vollmer; Halvazulis, Vasilis; Holmgren, A.; Lamke, Bertil

doi:10.1016/s0003-4975(10)60687-x

Cited by 15 publications

(9 citation statements)

References 19 publications

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“…The optimization of percutaneous valve prosthesis implantation, in addition to its placement according to the patient’s native flow pattern, can be a means of ensuring its best performance after TAVI. 16 , 17 The generation of a blood flow with a hemodynamic pattern closer to the physiological one can have a beneficial impact on the patients’ survival. 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

Influence of the tilt angle of Percutaneous Aortic Prosthesis on Velocity and Shear Stress Fields

Gomes¹,

Camargo²,

Santos³

et al. 2017

Arquivos Brasileiros De Cardiologia

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BackgroundDue to the nature of the percutaneous prosthesis deployment process, a variation in its final position is expected. Prosthetic valve placement will define the spatial location of its effective orifice in relation to the aortic annulus. The blood flow pattern in the ascending aorta is related to the aortic remodeling process, and depends on the spatial location of the effective orifice. The hemodynamic effect of small variations in the angle of inclination of the effective orifice has not been studied in detail.ObjectiveTo implement an in vitro simulation to characterize the hydrodynamic blood flow pattern associated with small variations in the effective orifice inclination.MethodsA three-dimensional aortic phantom was constructed, reproducing the anatomy of one patient submitted to percutaneous aortic valve implantation. Flow analysis was performed by use of the Particle Image Velocimetry technique. The flow pattern in the ascending aorta was characterized for six flow rate levels. In addition, six angles of inclination of the effective orifice were assessed.ResultsThe effective orifice at the -4º and -2º angles directed the main flow towards the anterior wall of the aortic model, inducing asymmetric and high shear stress in that region. However, the effective orifice at the +3º and +5º angles mimics the physiological pattern, centralizing the main flow and promoting a symmetric distribution of shear stress.ConclusionThe measurements performed suggest that small changes in the angle of inclination of the percutaneous prosthesis aid in the generation of a physiological hemodynamic pattern, and can contribute to reduce aortic remodeling.

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Section: Discussionmentioning

confidence: 99%

Influence of the tilt angle of Percutaneous Aortic Prosthesis on Velocity and Shear Stress Fields

Gomes¹,

Camargo²,

Santos³

et al. 2017

Arquivos Brasileiros De Cardiologia

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“…2a, 3a) suggest that elevated turbulence intensity occurs downstream from both orifices, but with the highest values in the flow from the minor orifice. Several groups have advocated that tilting-disc valves in the aortic position should be oriented with the larger orifice directed toward the noncoronary sinus (2,27). The tilting-disc valve in this orientation may create eccentric flow in the ascending aorta that is more similar to the normal pattern of spiraling flow, resulting in more favorable hemodynamics compared with a bileaflet valve.…”

Section: Discussionmentioning

confidence: 99%

“…Optimizing implantation and orientation of prosthetic valves according to native flow patterns may be one way to ensure best possible prosthetic performance (2). Improved hemodynamics may improve long-term patient survival (3) and has been shown to be a significant determinant of regression of left ventricular hypertrophy after aortic valve replacement (4).…”

mentioning

confidence: 99%

In vitro assessment of flow patterns and turbulence intensity in prosthetic heart valves using generalized phase‐contrast MRI

Kvitting

Dyverfeldt

Sigfridsson

et al. 2010

Magnetic Resonance Imaging

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Purpose: To assess in vitro the three-dimensional mean velocity field and the extent and degree of turbulence intensity (TI) in different prosthetic heart valves using a generalization of phase-contrast MRI (PC-MRI). Materials and Methods:Four 27-mm aortic valves (Björk-Shiley Monostrut tilting-disc, St. Jude Medical Standard bileaflet, Medtronic Mosaic stented and Freestyle stentless porcine valve) were tested under steady inflow conditions in a Plexiglas phantom. Three-dimensional PC-MRI data were acquired to measure the mean velocity field and the turbulent kinetic energy (TKE), a direction-independent measure of TI. Conclusion:The TI downstream from a prosthetic heart valve is dependent on the specific valve design. Generalized PC-MRI can be used to quantify velocity and TI downstream from prosthetic heart valves, which may allow assessment of these aspects of prosthetic valvular function in postoperative patients.

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“…Nicks et al reported a technique for the enlargement of a small aortic root by an operation whereby the small aortic root has been enlarged by insertion of a Dacron fabric gusset that it will accommodate a larger sized prosthesis 17 . In many cases, enlarging the annulus by 2-4 mm may be sufficient.…”

Section: Nicks Proceduresmentioning

confidence: 99%

Operative Management – Patient-Prosthesis Mismatch

Tsutsumi¹

2011

Aortic Valve Stenosis - Current View on Diagnostics and Treatment

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Optimal Insertion Technique for the Björk-Shiley Valve in the Narrow Aortic Ostium

Cited by 15 publications

References 19 publications

Influence of the tilt angle of Percutaneous Aortic Prosthesis on Velocity and Shear Stress Fields

Influence of the tilt angle of Percutaneous Aortic Prosthesis on Velocity and Shear Stress Fields

In vitro assessment of flow patterns and turbulence intensity in prosthetic heart valves using generalized phase‐contrast MRI

Operative Management – Patient-Prosthesis Mismatch

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