Influence of a tilting prosthetic mitral valve orientation on the left ventricular flow — an experimental in vivo magnetic resonance imaging study
Identifieur interne : 000550 ( Main/Exploration ); précédent : 000549; suivant : 000551Influence of a tilting prosthetic mitral valve orientation on the left ventricular flow — an experimental in vivo magnetic resonance imaging study
Auteurs : Heinrich M Chler [Autriche] ; Gert Reiter [Autriche] ; Mathias Perthel [Allemagne] ; Ulrike Reiter [Autriche] ; Peter Bergmann [Autriche] ; Michael Zink [Autriche] ; Rainer Rienmüller [Autriche] ; Joachim Laas [Allemagne]Source :
- European Journal of Cardio-Thoracic Surgery [ 1010-7940 ] ; 2007-07.
English descriptors
Abstract
Objective: Orientation-related monoleaflet mechanical valve flow and velocity studies in the downstream are limited in mitral valve replacement studies. Methods: In five sheep, ventricular blood flow was visualized prior to the implantation of a Medtronic Hall tilting valve model. In six sheep, the implant orientation was either anatomical (disc aligned with the anterior leaflet) or anti-anatomical. The mitral subvalvular apparatus was preserved. Sheep were positioned within an 1.5 T field strength MR scanner (Magnetom Sonata; Siemens) to assess time-dependent three dimensional blood flow. Results: The preoperative ventricular velocity profiles presented negligible individual variances. Streamlines passed homogeneously without any spatial differences in flow velocities into the left ventricle. Starting from the anatomical position, blood entered mainly through the major orifice of the mechanical valve. The single artificial leaflet mimicked the rudder effect of the natural anterior mitral leaflet, preventing blood streaming directly towards the septum. The area with inhomogeneous blood velocities in the ventricle increased but not significantly from the preoperative status. The non-axial inflow not directed directly to the apex converted to a similar helix as observed in the preoperative cases. Anti-anatomical orientation of the prosthesis caused a significant increase in turbulence immediately after passing the mitral prosthesis. The main stream was changed so significantly that the blood flow shifted towards the septum and caused higher velocities of the stream profiles and turbulence apically. Conclusions: 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.
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DOI: 10.1016/j.ejcts.2007.02.038
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Methods: In five sheep, ventricular blood flow was visualized prior to the implantation of a Medtronic Hall tilting valve model. In six sheep, the implant orientation was either anatomical (disc aligned with the anterior leaflet) or anti-anatomical. The mitral subvalvular apparatus was preserved. Sheep were positioned within an 1.5 T field strength MR scanner (Magnetom Sonata; Siemens) to assess time-dependent three dimensional blood flow. Results: The preoperative ventricular velocity profiles presented negligible individual variances. Streamlines passed homogeneously without any spatial differences in flow velocities into the left ventricle. Starting from the anatomical position, blood entered mainly through the major orifice of the mechanical valve. The single artificial leaflet mimicked the rudder effect of the natural anterior mitral leaflet, preventing blood streaming directly towards the septum. The area with inhomogeneous blood velocities in the ventricle increased but not significantly from the preoperative status. The non-axial inflow not directed directly to the apex converted to a similar helix as observed in the preoperative cases. Anti-anatomical orientation of the prosthesis caused a significant increase in turbulence immediately after passing the mitral prosthesis. The main stream was changed so significantly that the blood flow shifted towards the septum and caused higher velocities of the stream profiles and turbulence apically. Conclusions: 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.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Autriche</li></country></list><tree><country name="Autriche"><noRegion><name sortKey="M Chler, Heinrich" sort="M Chler, Heinrich" uniqKey="M Chler H" first="Heinrich" last="M Chler">Heinrich M Chler</name></noRegion><name sortKey="Bergmann, Peter" sort="Bergmann, Peter" uniqKey="Bergmann P" first="Peter" last="Bergmann">Peter Bergmann</name><name sortKey="M Chler, Heinrich" sort="M Chler, Heinrich" uniqKey="M Chler H" first="Heinrich" last="M Chler">Heinrich M Chler</name><name sortKey="Reiter, Gert" sort="Reiter, Gert" uniqKey="Reiter G" first="Gert" last="Reiter">Gert Reiter</name><name sortKey="Reiter, Gert" sort="Reiter, Gert" uniqKey="Reiter G" first="Gert" last="Reiter">Gert Reiter</name><name sortKey="Reiter, Ulrike" sort="Reiter, Ulrike" uniqKey="Reiter U" first="Ulrike" last="Reiter">Ulrike Reiter</name><name sortKey="Rienmuller, Rainer" sort="Rienmuller, Rainer" uniqKey="Rienmuller R" first="Rainer" last="Rienmüller">Rainer Rienmüller</name><name sortKey="Zink, Michael" sort="Zink, Michael" uniqKey="Zink M" first="Michael" last="Zink">Michael Zink</name></country><country name="Allemagne"><noRegion><name sortKey="Perthel, Mathias" sort="Perthel, Mathias" uniqKey="Perthel M" first="Mathias" last="Perthel">Mathias Perthel</name></noRegion><name sortKey="Laas, Joachim" sort="Laas, Joachim" uniqKey="Laas J" first="Joachim" last="Laas">Joachim Laas</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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