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You are here: Contents > 2014 > Volume 23 Number 4 July 2014 > AORTIC VALVE DISEASE > Aortic Interleaflet Triangles Reshaping: Hydrodynamic, Kinematic and Morphological Effects in In-Vitro Analysis

Aortic Interleaflet Triangles Reshaping: Hydrodynamic, Kinematic and Morphological Effects in In-Vitro Analysis

Claudia Romagnoni1,3, Andrea Mangini1-3, Riccardo Vismara2,3, Alberto Maria Leopaldi2,3, Monica Contino1,3, Massimo Giovanni Lemma1,3, Gianfranco Beniamino Fiore2,3, Carlo Antona1,3,4

1Cardiovascular Surgery Department, ‘Luigi Sacco’ University General Hospital, Milan, 2Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, 3ForCardio.Lab, Università di Milano - Politecnico di Milano, Milan, 4Università degli Studi di Milano, Milan, Italy

Background and aim of the study: Subcommissural triangles reshaping is a reparative technique used to remodel the ventriculo-aortic junction. The study aim was to evaluate, by means of in-vitro testing, the effects of this technique on hemodynamics, leaflet kinematics and aortic root functional unit morphology.

Methods: Twenty-one porcine aortic roots were tested in a pulsatile mock loop under basal conditions and after subcommissural triangles reshaping performed at 50% of the interleaflet triangles height. During each test, hydrodynamic quantities, high-speed digital videos and echocardiographic images were recorded.

Results: The comparison between pre- and postsurgery data showed a statistically significant increase in coaptation height (p <0.01) and length (p <0.01). Significant reductions were found in the virtual basal ring diameter (p <0.01), sinus of Valsalva diameters (p <0.01),

maximum leaflet opening (p <0.01), leaflet opening before rapid valve closing time (p <0.01) and maximum opening area (p <0.01). An opened valve time reduction (p <0.01) was observed due to an opening time reduction (p <0.01), offset by a closed valve time increase (p <0.01). A slow closing period increase (p <0.07) and a rapid closing phase reduction (p <0.01), were also highlighted without influence on the total closing time. A statistical, but not clinically significant, increase in pressure drop across the valve (p <0.01) and an effective orifice area reduction (p <0.01) were observed.

Conclusion: Subcommissural triangles reshaping performed at 50% of the interleaflet triangles’ height determines an increase in leaflet coaptation by remodeling the ventriculo-aortic junction. Some hydrodynamic and kinematic changes also occur, without any acute clinically threatening alterations.

The Journal of Heart Valve Disease 2014;23:424-431

Aortic Interleaflet Triangles Reshaping: Hydrodynamic, Kinematic and Morphological Effects in In-Vitro Analysis

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