The normal aortic valve leaflets effective height in pediatric patients: A guide to aortic valve repair.
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ABSTRACT:
SUBMITTER: Bouhout I
PROVIDER: S-EPMC8350880 | biostudies-literature | 2021 Aug
REPOSITORIES: biostudies-literature
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The normal aortic valve leaflets effective height in pediatric patients: A guide to aortic valve repair.
Bouhout Ismail I Chauvette Vincent V Rong Wu W Raboisson Marie-Josée MJ El-Hamamsy Ismail I Poirier Nancy N
JTCVS techniques 20210518
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Project description:Objective: By assessing the normal dimensions and the relationship between the aortic root and leaflets in Chinese population, the objective of this three-dimensional computed tomography (3DCT)-based study was to establish a matching reference for leaflets and aortic root for aortic valve (AV) repair. Method: Electrocardiogram-gated multi-detector CT was performed on 168 Chinese participants with a normal aortic valve. Measurements of the aortic annuli and leaflets were obtained. The correlations between and the ratios of the specific root and leaflet measurements were analyzed. The references for the leaflet and root dimensions were suggested based on geometric height (gH) using a linear regression equation. The utility of the ratios was tested with CT images of 15 patients who underwent aortic valve repair. Result: The mean annulus diameter (AD), sino-tubular junction (STJ) diameter, geometric height (gH), effective height (eH), free margin length (FML), commissural height (ComH), inter-commissural distance (ICD), and coaptation height (CH) were 22.4 ± 1.7 mm, 27.3 ± 2, 0.4 mm, 15.5 ± 1.7 mm, 8.9 ± 1.2 mm, 32.0 ± 3.4 mm, 17.9 ± 1.9 mm, 23.1 ± 2.3 mm, and 3.1 ± 0.6 mm, respectively. The gH/AD, FML/ICD, and eH/ComH ratios were 0.69 ± 0.07, 1.38 ± 0.08, and 0.50 ± 0.07, respectively. The gH correlated with all other leaflet and root measurements (P < 0.01), whereas the FML demonstrated a better correlation with ICD compared with gH (R2 = 0.75, and R2 = 0.37, respectively). The FML/ICD and eH/ComH ratios might be used to assess leaflet-root mismatch and post-repair leaflet billowing. Conclusion: The normal aortic valve measurements based on 3DCT revealed a specific relationship between the root and leaflets; and this will guide the development of an objective method of aortic valve repair.
| S-EPMC8645849 | biostudies-literature
Project description:BackgroundAlthough aortic valve reconstruction has become an alternative treatment for aortic valve disease, the design of the geometric parameters of the reconstructed leaflet still mainly depends on the experience of doctors. The present study investigates the effects of the height of the leaflets on the performance and biomechanical states of the reconstructed aortic valve.MethodsThis numerical study was carried out using the finite element approach and the lattice Boltzmann method. The dynamic and biomechanical characteristics of the leaflets were evaluated by using the finite element approach, while the blood flow in the aortic sinus was evaluated by applying the lattice Boltzmann method. Three types of leaflets with different heights were designed. Then the dynamic characteristics, stress distribution, and effective orifice area (EOA) of the aortic valve and flow pattern were calculated as the indicators.ResultsThe results demonstrated that the height of the leaflets could indeed regulate the performance and the biomechanical states of the aortic valve. The rapid valve opening times of the 3 types of leaflets gradually reduced along with the decrease of the height ratio (HR_0.8: 120 ms vs. HR_1.0: 68 ms vs. HR_1.2: 31 ms), while the rapid valve closing times (RVCTs) of the 3 types of leaflets were similar to each other (approximately 75 ms). Moreover, the radial displacement of the leaflet at the fully open time increased along with the decrease of the HR of the leaflets (HR_0.8: 8 mm vs. HR_1.0: 6 mm vs. HR_1.2: 4 mm). In addition, the stress level of the leaflets also increased with the increase of the height of the leaflets (max stress, HR_0.8: 0.5 MPa, vs. HR_1.0: 1.1 MPa, vs. HR_1.2: 1.8 MPa). Similarly, the low velocity region near the ascending aortic wall and the wall shear stress (WSS) level on the ventricular side of the leaflets also increased along with the increase of the HR of the leaflets.ConclusionsIn short, the height of the leaflets mainly affects the opening performance of the reconstructed aortic leaflets. The HR of the reconstructed leaflets for adults should be less than 1.0 to balance the opening and closing performance of aortic leaflets.
| S-EPMC9186252 | biostudies-literature
Project description: Not available
| S-EPMC8311622 | biostudies-literature
Project description:Objective: Aortic valve (AV) leaflets rely on a precise extracellular matrix (ECM) microarchitecture for appropriate biomechanical performance. The ECM structure is maintained by valvular interstitial cells (VICs), which reside within the leaflets. The presence of pigment produced by a melanocytic population of VICs in mice with dark coats has been generally regarded as a nuisance, as it interferes with histological analysis of the AV leaflets. However, our previous studies have shown that the presence of pigment correlates with increased mechanical stiffness within the leaflets as measured by nanoindentation analyses. In the current study, we seek to better characterize the phenotype of understudied melanocytic VICs, explore the role of these VICs in ECM patterning, and assess the presence of these VICs in human aortic valve tissues. Approach and Results: Immunofluorescence and immunohistochemistry revealed that melanocytes within murine AV leaflets express phenotypic markers of either neuronal or glial cells. These VIC subpopulations exhibited regional patterns that corresponded to the distribution of elastin and glycosaminoglycan ECM proteins, respectively. VICs with neuronal and glial phenotypes were also found in human AV leaflets and showed ECM associations similar to those observed in murine leaflets. A subset of VICs within human AV leaflets also expressed dopachrome tautomerase, a common melanocyte marker. A spontaneous mouse mutant with no aortic valve pigmentation lacked elastic fibers and had reduced elastin gene expression within AV leaflets. A hyperpigmented transgenic mouse exhibited increased AV leaflet elastic fibers and elastin gene expression. Conclusions: Melanocytic VIC subpopulations appear critical for appropriate elastogenesis in mouse AVs, providing new insight into the regulation of AV ECM homeostasis. The identification of a similar VIC population in human AVs suggests conservation across species.
| S-EPMC8257952 | biostudies-literature
Project description:Calcific aortic valvular disease (CAVD) is characterized by sclerosis of the aortic valve leaflets and recent clinical studies have linked several other risk factors to this disease, including male sex. In this study we examined potential sex-related differences in gene expression profiles between porcine male and female valvular interstitial cells (VICs) to explore possible differences in CAVD propensity on the cellular level.
2013-01-02 | GSE33654 | GEO
Project description:Calcific aortic valvular disease (CAVD) is characterized by sclerosis of the aortic valve leaflets and recent clinical studies have linked several other risk factors to this disease, including male sex. In this study we examined potential sex-related differences in gene expression profiles between porcine male and female valvular interstitial cells (VICs) to explore possible differences in CAVD propensity on the cellular level. RNA samples from three male and three female healthy porcine aortic valve leaflets (denuded of endothelial cells) were isolated, processed, and hybridized to AffymetrixM-BM-. GeneChip Porcine Genome microarrays according to manufacturerM-bM-^@M-^Ys instructions. Mean expression values of each probe set in the male samples were compared with those in the female samples.
2013-01-02 | E-GEOD-33654 | biostudies-arrayexpress
Project description:AimsAortic valve calcification in aortic sclerosis, a precursor of aortic stenosis (AS), is not always present in all three leaflets; how calcification develops in each leaflet is unknown. We aimed to investigate the natural history of calcification development in each aortic valve leaflet and the prognostic value of the number of calcified leaflets.Methods and resultsIn a retrospective multicentre cohort study of patients undergoing haemodialysis without AS, we observed calcification development in each aortic valve leaflet using echocardiography. We investigated the association between the number of calcified leaflets and AS development and mortality using time-to-event analysis. Among the 1507 patients (mean age, 66 years; 66% male) included in the longitudinal echocardiography analysis, 709 (47%) had aortic sclerosis at baseline: one-leaflet calcified, 370 (52%); two-leaflet calcified, 215 (30%); and three-leaflet calcified, 124 (17%). The median time for one calcified leaflet increase was 3-4 years, and 251 (17%) patients developed AS during a median 3.2-year follow-up. The increased number of calcified aortic valve leaflets was associated with developing AS; compared with that of one-leaflet calcified, the adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of two- and three-leaflet calcified were 2.12 (1.49-3.00) and 4.43 (3.01-6.52), respectively; the aHR (95% CI) per one calcified leaflet increase was 2.24 (1.96-2.55). It was also associated with all-cause mortality; the aHR (95% CI) per one calcified leaflet increase was 1.18 (1.08-1.27).ConclusionThe number of calcified aortic valve leaflets strongly predicted AS development and even mortality in patients undergoing haemodialysis, suggesting the usefulness of assessing calcification for each valve leaflet separately using echocardiography.
| S-EPMC11809437 | biostudies-literature
Project description: Not available
| S-EPMC10580087 | biostudies-literature
Project description:In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm(2)/m(2). The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.
| S-EPMC4251327 | biostudies-literature