Is TEE a Game Changer in Aortic Prosthetic Paravalvular Leak?

AbstractValve prosthesis have played an important role in the management of patients with valvular heart disease. However, the prosthetic heart valves used are not without complications. Almost all prosthetic heart valves are obstructive compared with native valves and associated with physiological washing jets. Because of shielding and artifacts it is very difficult to assess the prosthetic valve with TTE. Multiple thrombi and aortomitral continuity detection is cumbersome by TTE. Multiple angulations and off axis view in TEE help not only to characterize the prosthetic heart valve but also gives a three-dimensional surgical view to aid in reaching a diagnosis.

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Identification of mechanical prosthetic heart valves based on distinctive cinefluoroscopic and echocardiographic markers

The International Journal of Artificial Organs ◽

10.1177/0391398819860845 ◽

2019 ◽

Vol 42 (11) ◽

pp. 603-610 ◽

Cited By ~ 2

Author(s):

Macit Kalçık ◽

Ahmet Güner ◽

Mahmut Yesin ◽

Emrah Bayam ◽

Semih Kalkan ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Heart Valve ◽

Prosthetic Valve ◽

Heart Valves ◽

Large Body ◽

Mechanical Heart Valve ◽

Three Dimensional ◽

Prosthetic Heart Valves ◽

Mechanical Prostheses ◽

Valve Prostheses

The past 65 years have witnessed remarkable progress in the development of safe, hemodynamically favorable mechanical heart valves. Today, there are a large number and variety of prostheses in use and many prostheses have been used for a while and then discontinued. When patients lack reliable information about their heart valve prostheses, identification of valve model becomes difficult even for specialized physicians in this area. A combination of cinefluoroscopy and echocardiography makes it possible to provide accurate and detailed information regarding identification of prosthetic valve models. Fluoroscopic examination is a useful technique to evaluate patients following mechanical heart valve replacement. However, transthoracic echocardiography and transesophageal echocardiography have almost replaced cinefluoroscopy in the evaluation of prosthetic heart valves. Especially, real-time three-dimensional transesophageal echocardiography provides distinctive images of prosthetic heart valves, particularly for those in the mitral position. A large body of literature has been published to familiarize physicians with the radiological appearance of numerous mechanical prostheses. However, there is a lack of data regarding the identification of prosthetic valve models based on echocardiographic appearance. In this review, we aimed to describe distinctive echocardiographic and cinefluoroscopic markers for identifying the type and brand of several commonly used mechanical prosthetic heart valves.

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Hemodynamic Performance of Dysfunctional Prosthetic Heart Valve with the Concomitant Presence of Subaortic Stenosis: In Silico Study

Bioengineering ◽

10.3390/bioengineering7030090 ◽

2020 ◽

Vol 7 (3) ◽

pp. 90

Author(s):

Othman Smadi ◽

Anas Abdelkarim ◽

Samer Awad ◽

Thakir D. Almomani

Keyword(s):

Early Detection ◽

Heart Valve ◽

Heart Valves ◽

Cfd Simulation ◽

Treatment Plan ◽

Mechanical Heart Valve ◽

Prosthetic Heart Valve ◽

Subaortic Stenosis ◽

Prosthetic Heart Valves ◽

The Impact

The prosthetic heart valve is vulnerable to dysfunction after surgery, thus a frequent assessment is required. Doppler electrocardiography and its quantitative parameters are commonly used to assess the performance of the prosthetic heart valves and provide detailed information on the interaction between the heart chambers and related prosthetic valves, allowing early detection of complications. However, in the case of the presence of subaortic stenosis, the accuracy of Doppler has not been fully investigated in previous studies and guidelines. Therefore, it is important to evaluate the accuracy of the parameters in such cases to get early detection, and a proper treatment plan for the patient, at the right time. In the current study, a CFD simulation was performed for the blood flow through a Bileaflet Mechanical Heart Valve (BMHV) with concomitant obstruction in the Left Ventricle Outflow Tract (LVOT). The current study explores the impact of the presence of the subaortic on flow patterns. It also investigates the accuracy of (BMHV) evaluation using Doppler parameters, as proposed in the American Society of Echocardiography (ASE) guidelines.

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Modeling of Tissue Fatigue Damage in Bio-Prosthetic Heart Valve

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53888 ◽

2011 ◽

Cited By ~ 1

Author(s):

Caitlin Martin ◽

Wei Sun

Keyword(s):

Fatigue Damage ◽

Heart Valve ◽

Anticoagulant Therapy ◽

Heart Valves ◽

Prosthetic Heart Valve ◽

Bovine Pericardium ◽

Prosthetic Heart Valves ◽

Mechanical Valves ◽

In Vivo Degradation

Bio-prosthetic heart valves (BHVs) with leaflets made of glutaraldehyde-treated bovine pericardium (GLBP), have been used extensively to replace diseased heart valves. BHVs display superior hemodynamics to mechanical valves and eliminate the need for anticoagulant therapy; however, they exhibit poor durability resulting from in vivo degradation and fatigue damage of the leaflets.

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Circulating Platelet Factors (Beta Thromboglobulin, Platelet Factor 4) In Patients With Prosthetic Heart Valves

10.1055/s-0038-1652861 ◽

1981 ◽

Author(s):

K Andrassy ◽

H Zebe ◽

J Koderisch ◽

A Duczek ◽

E Ritz

Keyword(s):

Heart Valves ◽

Prosthetic Heart Valves ◽

Valve Prosthesis ◽

Platelet Factor ◽

Protein Levels ◽

Platelet Protein ◽

Mitral Valve Prosthesis ◽

Significant Difference ◽

Aortic Valve Prosthesis ◽

Induced Aggregation

Despite anticoagulation, thromboembolic complications are frequent in patients with heart valve prosthesis (HVP). The present study was performed to investigate whether activation of platelets could be demonstrated in such patients. Platelet proteins in the circulation were measured as an index of platelet activation. Pat.: 33 pat. with mitral valve prosthesis (MVP) (19 with Bjφrk- Shiley (BS) and 14 pat. with Starr Edwards type (SE)) and 54 pat. with aortic valve prosthesis (35 BS; 10 SE; 9 bioprosthesis (BP). All pat. were anticoagulated (Dicumarol). Results : In MVP, a significant difference between BS and SE was observed with respect to LDH (247±48 vers. 474± 246) (p<0.05) but not with regard to Beta-TG and PF 4. There was no difference of platelet protein levels in presence/absence of atrial fibrillation. In 35% Beta TG (> 53 ng/ml) and PF 4 ( > 11 ng/ml) were above X±2 SD of CO. ADP and collagen induced aggregation (MA) was unchanged in all pat. (collagen 401 12; ADP 32±11; CO: collagen 39±7; ADP 32±6). In pat. with demonstrable hemolysis (LDH >250 IU), a significant correlation was observed between LDH and Beta TG/PF 4 both in MVP and AVP. MVP and AVP differed with respect to LDH (higher in AVP, p<0.05) and PF 4 (higher in MVP (p<0.01) but not with respect to Beta TG (differences of elimination of TG and PF 4?). Comment : In a high proportion of patients with HVP platelets are activated. The observation of elevated platelet indicator proteins is in agreement with previous findings of decreased platelet survival in HVP (Weily, H., New Engl. J. Med. 290, 534, 1974). Elevated platelet prot.may identify risk of thromboembolism.

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Warfarin Versus Warfarin and Dipyridamole on the Incidence of Arterial Throms Embolism in Prosthetic Heart Valve Patients

10.1055/s-0039-1684653 ◽

1979 ◽

Cited By ~ 1

Author(s):

S.M. Rajah ◽

N. Sreeharan ◽

S. Rao ◽

D.A. Watson

Keyword(s):

Atrial Fibrillation ◽

Heart Valves ◽

Prosthetic Heart Valve ◽

Prosthetic Heart Valves ◽

Post Mortem ◽

Randomised Study ◽

Yearly Incidence ◽

The Mean ◽

Prospective Randomised Study

The effect of Warfarin (W) was compared with a combination of Warfarin and Dipyridamole (W+D) on the incidence of arterial thrombo-embolism in patients with prosthetic heart valves in a prospective randomised study. Sixty-four and 53 patients were allocated to W and W+D. The two groups were comparable as regards age, sex, arrhythmias and site and type of valves. The dose of W was determined by regular monitoring of prothrombin ratio 0.9 - 3) and that of D by monitoring serum D levels to between 2 and 4 μmol/l. The mean period of follow-up was 26.98 months (range 1 to 36) for W and 22.02 months (range 1 to 36) for W+D. Six patients in W and 1 in W+D developed arterial thrombo-embolic episodes giving an incidence of 0.0035 per patient month for W and 0.0009 per patient month for W+D. An actuarial analysis of the yearly incidence of thrombo-embolism confirmed the superiority of W+D over W. Of the 6 failures in W, 5 were in sinus rhythm and 1 in atrial fibrillation and all had cerebral embolic episodes. The failure in W+D was a patient in atrial fibrillation who died suddenly 6 weeks after surgery and the post-mortem showed clots on both mitral and aortic prostheses.

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Research Contribution of Prosthetic Valve Manufacturers Interfacing Academic-Industry Research Efforts

10.1115/imece1999-0380 ◽

1999 ◽

Author(s):

Xiao Gong ◽

Yi-Ren Woo ◽

Ajit P. Yoganathan ◽

Andreas Anayiotos

Keyword(s):

Heart Valve ◽

Heart Valves ◽

Clinical Performance ◽

Thrombus Formation ◽

Academic Research ◽

Prosthetic Heart Valve ◽

Structural Safety ◽

Prosthetic Heart Valves ◽

Implantable Medical Device ◽

Valve Design

Abstract Prosthetic heart valve is one of the most successful implantable medical devices. However, introducing better performing and longer lasting prosthetic mechanical heart valves (MHV) into clinical use has been slow because predicting the long term performance of a new valve design is difficult. Although significant progresses in many scientific fronts relevant to prosthetic heart valve development have been achieved, we still have an imperfect understanding of host responses to an implantable medical device and incomplete knowledge in associating hemodynamic characteristics of a valve design to clinical performance. Valve designers, frequently need to over design the valve components to ensure structural safety and thus, sacrifice the opportunity to optimize performance. Complications such as infection, thrombus formation, thromboembolic incidents, and hemorrhage associated to the use of prosthetic valves are still reported and valve designers are working hard to eliminate them. Further advancing scientific knowledge in designing and evaluating prosthetic heart valves is of great interest to many Valve designers and manufacturers. Interfacing Industry and Academic research efforts has been thwarted due to predominantly proprietary issues. Considering the benefits of a better performing MHV to the patients, this industry session will bring researchers from various MHV companies and academic institutions to discuss how to share the results of scientific studies more effectively. This will help accelerate new MHV development without compromising the confidentiality of key valve design information. The issue of standardized MHV testing will also be addressed.

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An Unusual Localization of a Cardiac Pseudoaneurysm Complicated by Paravalvular Leak in a Patient with Prosthetic Heart Valves

Echocardiography ◽

10.1111/echo.13086 ◽

2015 ◽

Vol 33 (2) ◽

pp. 330-332

Author(s):

Mehmet A. Vatankulu ◽

Osman Sönmez ◽

Mehmet Akkaya ◽

Cemalettin Aydin

Keyword(s):

Heart Valves ◽

Paravalvular Leak ◽

Prosthetic Heart Valves

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Impact of prosthetic heart valves on pregnancy in Bangladeshi women

Perfusion ◽

10.1177/0267659118817712 ◽

2019 ◽

Vol 34 (6) ◽

pp. 446-452 ◽

Cited By ~ 4

Author(s):

Redoy Ranjan ◽

Dipannita Adhikary ◽

Sanjoy Kumar Saha ◽

Sabita Mandal ◽

Kamrul Hasan ◽

...

Keyword(s):

Pregnancy Outcome ◽

Heart Valve ◽

Heart Valves ◽

Prosthetic Heart Valve ◽

Study Groups ◽

Prosthetic Heart Valves ◽

Group I ◽

Mechanical Prostheses ◽

Warfarin Embryopathy ◽

Group Ii

Background: This study evaluated pregnancy outcome in women with a prosthetic heart valve, especially with the oral anticoagulation therapy that must be weighed against the risk of intracardiac thrombosis. Methods: This multicenter, retrospective, cohort study was undertaken between January 2012 and June 2017. The principal maternal outcome variables included bleeding and thromboembolic complications, infective endocarditis, prosthetic valve thrombosis and heart failure. However, the main foetal outcome variables included miscarriage, mortality, preterm baby, warfarin embryopathy, low birthweight and the mode of delivery. Results: A total of 265 pregnancies in women with prosthetic heart valves were evaluated in two groups: Group I (n = 182) covers a mechanical valve, while Group II (n = 82) covers a bioprosthetic valve. The mean age of the patients was 25.2 ± 2.5 years and 24.5 ± 5.2 years in Group I and Group II, respectively. Approximately 80% of the patients had normal echocardiography findings. However, Group I (mechanical prostheses) has a higher incidence (11.54%) of thrombus formation in comparison with the bioprostheses. Hemorrhagic complications and spontaneous miscarriage were statistically significant (p⩽0.05) between the study groups. However, normal pregnancy outcome (91.57%) was significantly higher (p⩽0.05) in Group II compared to Group I (61.54%). Mean birthweight and mean APGAR score were found normal in both study groups. Only 2.75% of patients have warfarin embryopathy in Group I. Furthermore, comparison of SF-36 scores for HRQOL (Health-Related Quality of Life) before and after pregnancy were statistically insignificant among the study population. Conclusion: Proper antenatal care and early risk stratification are the fundamental measures to improve the maternal and foetal outcomes in a patient with a prosthetic heart valve.

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Design Optimization of a Novel Polymeric Prosthetic Heart Valve and a Ventricular Assist Device via Device Thrombogenicity Emulation

ASME 2013 Conference on Frontiers in Medical Devices: Applications of Computer Modeling and Simulation ◽

10.1115/fmd2013-16173 ◽

2013 ◽

Author(s):

Thomas E. Claiborne ◽

Wei-Che Chiu ◽

Marvin J. Slepian ◽

Danny Bluestein

Keyword(s):

Heart Valves ◽

Anticoagulation Therapy ◽

Prosthetic Heart Valve ◽

Total Artificial Heart ◽

Ventricular Assist Devices ◽

Circulatory Support ◽

Prosthetic Heart Valves ◽

Ventricular Assist ◽

Mechanical Circulatory Support Devices ◽

Optimization Methodology

Thrombotic complications, such as hemorrhage or embolism, remain a major concern of blood contacting medical devices [1], including prosthetic heart valves (PHV) and mechanical circulatory support devices, e.g. ventricular assist devices (VAD) or the Total Artificial Heart (TAH) [2]. In most cases device recipients require life-long anticoagulation therapy, which increases the risk of hemorrhagic stroke and other bleeding disorders. In order to obviate the need for anticoagulants and reduce stroke risks, our group developed a unique optimization methodology, Device Thrombogenicity Emulation (DTE) [2–5]. With the DTE, the thrombogenic potential of a device is evaluated using extensive numerical modeling and calculating multiple platelet trajectories flowing through the device. The platelet stress-time waveforms are then emulated in our Hemodynamic Shearing Device (HSD) and their activation level is measured with our Platelet Activation State (PAS) assay. This provides a proxy validation of the simulation. We identify high shear stress producing regions within the device and modify its design to reduce or eliminate those potentially thrombogenic ‘hot-spots.’ Through an iterative process, we can optimize the device design prior to prototyping.

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