Impact of Material Stiffness and Anisotropy on Coaptation Characteristics for Aortic Valve Cusps Reconstructed from Pericardium

The numerical assessment of reconstructed aortic valves competence and leaflet design optimization rely on both coaptation characteristics and the diastolic valve configuration. These characteristics can be evaluated by the shell or membrane formulations. The membrane formulation is preferable for surgical aortic valve neocuspidization planning since it is easy to solve. The results on coaptation zone sensitivity to the anisotropy of aortic leaflet material are contradictive, and there are no comparisons of coaptation characteristics based on shell and membrane models for anisotropic materials. In our study, we explore for the first time how the reduced model and anisotropy of the leaflet material affect the coaptation zone and the diastolic configuration of the aortic valve. To this end, we propose the method to mimic the real, sutured neo-leaflet, and apply our numerical shell and membrane formulations to model the aortic valve under the quasi-static diastolic pressure varying material stiffness and anisotropy directions. The shell formulation usually provides a lesser coaptation zone than the membrane formulation, especially in the central zone. The material stiffness does influence the coaptation zone: it is smaller for stiffer material. Anisotropy of the leaflet material does not affect significantly the coaptation characteristics, but can impact the deformed leaflet configuration and produce a smaller displacement.

Atrioventricular Septal Defect: What Is in a Name?

Robert Anderson has made a huge contribution to almost all aspects of morphology and understanding of congenital cardiac malformations, none more so than the group of anomalies that many of those in the practice of paediatric cardiology and adult congenital heart disease now call ‘Atrioventricular Septal Defect’ (AVSD). In 1982, with Anton Becker working in Amsterdam, their hallmark ‘What’s in a name?’ editorial was published in the Journal of Thoracic and Cardiovascular Surgery. At that time most described the group of lesions as ‘atrioventricular canal malformation’ or ‘endocardial cushion defect’. Perhaps more significantly, the so-called ostium primum defect was thought to represent a partial variant. It was also universally thought, at that time, that the left atrioventricular valve was no more than a mitral valve with a cleft in the aortic leaflet. In addition to this, lesions such as isolated cleft of the mitral valve, large ventricular septal defects opening to the inlet of the right and hearts with straddling or overriding tricuspid valve were variations of the atrioventricular canal malformation. Anderson and Becker emphasised the differences between the atrioventricular junction in the normal heart and those with a common junction for which they recommended the generic name, ‘atrioventricular septal defect’. As I will discuss, over many years, they continued to work with clinical cardiologists and cardiac surgeons to refine diagnostic criteria and transform the classification and understanding of this complex group of anomalies. Their emphasis was always on accurate diagnosis and communication, which is conveyed in this review.

Leaflet kinematics after the Yacoub and Florida-sleeve operations: results of an in vitro study

OBJECTIVES The Florida-sleeve is a valve-sparing technique that causes minimal interference to leaflet kinematics and aortic root dynamism. The aim of this in vitro study was to evaluate the effects of the Florida-sleeve and Yacoub techniques on aortic leaflet kinematics. METHODS Two groups of 6 whole porcine hearts were treated with either the Florida-sleeve technique or the Yacoub technique and tested in a pulsatile loop. Valve fluid dynamics, coronary flow analysis and valve echocardiograms were performed both before and after the procedures. RESULTS Both procedures showed no difference in rapid valve opening time as compared with their respective baseline values. The Florida-sleeve procedure showed a shorter slow closing time (192 ± 19 ms vs baseline 244 ± 14 ms, P = 0.016) and increased slow closing velocity (−1.5 ± 0.4 cm/s vs baseline −0.8 ± 0.4 cm/s, P = 0.038). In the rapid valve closing phase, the Yacoub procedure showed a trend towards slower closing valve velocity (−16 ± 9 cm/s vs baseline −25 ± 9 cm/s, P = 0.07). The Yacoub procedure showed larger leaflet displacement at the end of the slow valve closing time that was 2.0 ± 0.5 cm vs baseline 1.5 ± 0.3 cm, P = 0.044. When comparing the Florida-sleeve and Yacoub procedures, the former showed statistically significant shorter slow valve closing time (P = 0.017). CONCLUSIONS This study showed that the Florida-sleeve technique alters the slow closing phase of the aortic valve leaflet kinematics when compared with both the normal baseline and Yacoub procedure, while the latter showed a larger leaflet displacement before the rapid closing valve phase.

Computational Investigation of Wall Shear Stress Patterns on Calcified Aortic Valve Leaflets

Background: Aortic valve diseases affect about 25% of the population over 65 years of age. Aortic valve separates the left ventricle from the aorta, and consists of three half-moon shaped leaflets. The leaflets are highly dynamic structures which open during the ventricle contraction and close during the ventricle relaxation. Calcification on leaflet surfaces results in poor valve functioning which deteriorates the valve hemodynamics. Wall shear stresses (WSS) on the leaflet surfaces are considered to be strongly related with the initiation and progression of calcification. Aim: To investigate the effect of altered hemodynamics on the valve leaflet calcification, and to understand the role of WSS patterns in the progression of the aortic valve diseases. Methods: We investigate the hemodynamics of aortic valves using computational modeling. Fluid-structure interaction approach is employed to accurately determine the complex dynamic motion of valve leaflets. A 3D patient-specific aortic valve model is generated. Using finite element modeling, blood flow velocities, pressures, and WSS values are determined within the entire model, employing numerical techniques to obtain the characteristics of altered hemodynamics and spatial WSS patterns. Results: In case of calcification, WSS values are increased at both surfaces of the leaflets. On the ventricularis surface, there is a spatially-regular WSS distribution, which gradually increase from the leaflet attachment region to the leaflet tip. However, a spatially-complex WSS distribution is observed on the aortic leaflet surface. Conclusion: Relatively low WSS levels and spatiallycomplex WSS patterns on the aortic leaflet surface are observed as potential risk factors for the initiation and progression of aortic valve calcification.

Case Report: - Aortic Valve Replacement due to Aortic Valve Leaflet Perforation after PCI

- Percutaneous Coronary Intervention (PCI) is widely recognized as an effective treatment for Acute Coronary Syndrome (ACS). Inspite of advances in equipment and experience of interventional cardiologist, still there are rare complications occurred [1]. Iatrogenic injury of the aortic valve leaflet is a rare. Aortic insufficiency (AI) after a PCI suggests an iatrogenic valve injury. Aortic leaflet injury is not common but possible complication of PCI. Because of the serious consequences, it should be mentioned in the informed consent. Aortic repair of iatrogenic injury is possible, and it can be performed with excellent clinical and functional midterm results. So, Aortic valve replacement (AVR) is the last option [2].