To characterise hydrodynamic properties of prosthetic heart valves in mitral position, ultrasonic velocity measurements were performed using a cardiovascular simulator. A Duromedics and a Saint-Jude Medical bileaflet heart valve were tested. The Saint-Jude valve was oriented first in an anatomical position, i.e. the tilt axis parallel to the septal wall, and then in an anti-anatomical position. In the anti-anatomical position, from mid diastole to mid systole, two contrarotative vortices are generated in the ventricle by the interaction between the flow directed by the leaflets downstream from the lateral orifices and the ventricular wall motions. In the anatomical position, the mitral flow penetrates the ventricle principally through the lateral orifice proximal to the septal wall, due to the vortex in the atrial chamber. The mitral inflow then circulates along the septal wall to the apex, and produces a large ventricular vortex during systole. In the anatomical position, the Saint-Jude thus provides a better ventricular washout during this phase. The mitral inflow through the Duromedics in the anti-anatomical position produces two contrarotative vortices in the ventricle, but in the opposite sense than downstream the Saint-Jude valve; the flows that penetrate through the lateral orifices are directed to the ventricular walls and then recirculate to the centre of the ventricle, providing a very fluctuating flow near the apex. Thus, a slight difference in valve design produces a significant difference in the ventricular flow fields.
Midterm Clinical Outcomes of the St Jude Medical Epic Porcine Bioprosthesis in the Mitral Position
