The efficacy of sinus plication in aortic valvuloplasty for bicuspid aortic valve: experiments in a pulsatile flow simulation model
| Autor: | Satoshi Arimura, Hitoshi Kasegawa, Kiyotaka Iwasaki, Takashi Kunihara, Eita Kawasaki, Natsuki Nakama, Gohki Nishimura, Minoru Matsuhama, Jumpei Takada |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty medicine.medical_treatment Heart Valve Diseases Pulsatile flow Regurgitation (circulation) 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Bicuspid aortic valve Bicuspid Aortic Valve Disease Internal medicine medicine Animals Humans Lead (electronics) Sinus (anatomy) Retrospective Studies business.industry Ultrasound General Medicine medicine.disease Aortic valvuloplasty medicine.anatomical_structure 030228 respiratory system Aortic Valve Pulsatile Flow Regurgitant fraction Cardiology Cattle Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. |
| ISSN: | 1873-734X 1010-7940 |
| Popis: | OBJECTIVES Sinus plication has emerged as a promising tool that can lead to better stability in bicuspid aortic valve (BAV) repair. However, the mechanisms underlying the efficacy of this technique are unclear. We evaluated the hydrodynamic effect of sinus plication using the experimental pulsatile flow simulator and our original BAV model in vitro. METHODS Based on the computed tomography data of a BAV patient who had undergone aortic valvuloplasty, a BAV model (group C, n = 6) was developed with bovine pericardium and vascular prosthesis (J-graft Shield Neo Valsalva 24 mm). We performed sinus plication (group SP, n = 6) in the BAV model and compared hydrodynamic data with the control model in the pulsatile flow simulator. Non-fused cusp angle, annulus diameter and effective height were measured by ultrasonography. RESULTS The average flow was significantly increased in group SP compared to group C (4.24 ± 0.14 l/min vs 4.14 ± 0.15 l/min, respectively, P = 0.034). The mean transvalvular pressure gradient and regurgitant fraction were significantly decreased in group SP compared to group C (11.6 ± 4.3 mmHg vs 16.6 ± 5.0 mmHg, respectively, P = 0.009 and 14.1 ± 2.0% vs 17.4 ± 2.1%, respectively, P = 0.001). Ultrasound measurement indicated that non-fused cusp angle was significantly increased in group SP compared to group C (163.8° ± 9.2° vs 153.0° ± 4.6°, respectively, P = 0.012). CONCLUSIONS Sinus plication in the BAV model significantly increased the commissural angle. It was effective in not only controlling regurgitation but also improving valve opening. These finding should be confirmed by evaluating cusp stress and/or long-term durability in the future studies. |
| Databáze: | OpenAIRE |
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