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In Vitro Assessment of Right Ventricular Outflow Tract Anatomy and Valve Orientation Effects on Bioprosthetic Pulmonary Valve Hemodynamics

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Abstract

Purpose

The congenital heart defect Tetralogy of Fallot (ToF) affects 1 in 2500 newborns annually in the US and typically requires surgical repair of the right ventricular outflow tract (RVOT) early in life, with variations in surgical technique leading to large disparities in RVOT anatomy among patients. Subsequently, often in adolescence or early adulthood, patients usually require surgical placement of a xenograft or allograft pulmonary valve prosthesis. Valve longevity is highly variable for reasons that remain poorly understood.

Methods

This work aims to assess the performance of bioprosthetic pulmonary valves in vitro using two 3D printed geometries: an idealized case based on healthy subjects aged 11 to 13 years and a diseased case with a 150% dilation in vessel diameter downstream of the valve. Each geometry was studied with two valve orientations: one with a valve leaflet opening posterior, which is the native pulmonary valve position, and one with a valve leaflet opening anterior.

Results

Full three-dimensional, three-component, phase-averaged velocity fields were obtained in the physiological models using 4D flow MRI. Flow features, particularly vortex formation and reversed flow regions, differed significantly between the RVOT geometries and valve orientations. Pronounced asymmetry in streamwise velocity was present in all cases, while the diseased geometry produced additional asymmetry in radial flows. Quantitative integral metrics demonstrated increased secondary flow strength and recirculation in the rotated orientation for the diseased geometry.

Conclusions

The compound effects of geometry and orientation on bioprosthetic valve hemodynamics illustrated in this study could have a crucial impact on long-term valve performance.

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Acknowledgements

We gratefully acknowledge Professor Richard Figliola for his assistance in adjusting the experimental design in order to produce physiological results. In addition, we thank Dr. Katsuhide Maeda for the opportunity to personally observe pulmonary valve replacement surgeries. The authors also thank their funding sources: The Stanford Maternal and Child Health Research Institute (Marsden, Eaton, and McElhinney), the American Heart Association (Marsden, Eaton, and McElhinney), the Stanford Bio-X Bowes Fellowship (Schiavone), the Vera Moulton Wall Center (Marsden), and the Benchmark Capital Fellowship (Marsden).

Funding Information

This work is funded by The Stanford Maternal and Child Health Research Institute, the American Heart Association, the Stanford Bio-X Bowes Fellowship, the Vera Moulton Wall Center, and the Benchmark Capital Fellowship.

Conflict of interest

N.K. Schiavone, C.J. Elkins, J.K. Eaton, and A.L. Marsden declare they have no conflicts of interest. D.B. McElhinney is a proctor and consultant for Medtronic, which is not directly relevant to this study.

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Authors and Affiliations

  1. Mechanical Engineering, Stanford University, Stanford, CA, USA

    Nicole K. Schiavone, Christopher J. Elkins & John K. Eaton

  2. Cardiothoracic Surgery, Stanford University, Stanford, CA, USA

    Doff B. McElhinney

  3. Pediatrics and Bioengineering, Stanford University, Stanford, CA, USA

    Alison L. Marsden

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  1. Nicole K. Schiavone
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Correspondence to Alison L. Marsden.

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Schiavone, N.K., Elkins, C.J., McElhinney, D.B. et al. In Vitro Assessment of Right Ventricular Outflow Tract Anatomy and Valve Orientation Effects on Bioprosthetic Pulmonary Valve Hemodynamics. Cardiovasc Eng Tech 12, 215–231 (2021). https://doi.org/10.1007/s13239-020-00507-6

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