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PubMed · 10149054

Optimization of a trileaflet valve design.

Abstract

This study investigates the fundamental principles that should govern the basic design of an optimal trileaflet valve. The geometry of the leaflets is described in terms of radius of the base (Rb), radius of the commissures (Rc), height of the valve (H), height of the commissures (Hs), and angle of the open leaflet to vertical (beta). Using computer-aided design software and these design parameters, a computer model of the valve was constructed. Choosing the parameters empirically did not produce an optimal valve. The four criteria for optimal performance were defined as: (1) a certain minimum coaptation height, (2) no folds in the leaflet, (3) minimum valve height, and (4) minimum leaflet flexion. Mathematical relationships were established between the design parameters and the performance parameters. These relationships indicated that the parameters Rc, Hs, and beta could be used to minimize valve height; however, a reduction in valve height must be balanced against the accompanying increase in leaflet flexion. For an optimal valve, the design parameters were Rb = 10 mm, then Rc = 8 to 10 mm, H = 11.5 mm, Hs = 2.4 to 2.6 mm, and beta = 4 degrees to 11 degrees . The optimal valve of any radius can be designed by scaling Rc, H, and Hs with respect to Rb. These design parameters were similar to those of the natural aortic valve. Trileaflet bioprosthetic valves designed on these principles are expected to have enhanced efficiency and longevity.

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BibTeXRIS

M J Thubrikar, S Samanta, S P Nolan. 1991. Optimization of a trileaflet valve design.. https://pubmed.ncbi.nlm.nih.gov/10149054/

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Early outcomes of tricuspid valve replacement in young children.

BACKGROUND: Early outcomes after tricuspid valve replacement in young children are ill defined. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1984 to 2002) was reviewed to evaluate the results of tricuspid valve replacement in children <6 years of age. METHODS AND RESULTS: Ninety-seven patients who underwent initial tricuspid valve replacement are included in the present analysis. The most frequent cardiac diagnoses were Ebstein's anomaly (40%), pulmonary atresia (11%), and tetralogy of Fallot (8%). Age at tricuspid valve replacement was 2.9+/-1.7 years (mean+/-SD). Mean patient weight was 12.7+/-6.1 kg. The major outcome was survival to discharge. Associations among age, diagnosis, valve type/size, and outcome were evaluated through the use of chi2 analysis and logistic regression model fitting approaches. Hospital mortality was 26% and was very high (64%) in patients <1 year of age. A large size-to-weight ratio was the strongest predictor of mortality based on multivariable analysis (P<0.001). Mortality was 54% for patients with a size-to-weight ratio >2.5. Other complications included heart block requiring a pacemaker (13%) and thrombosis (5%). Pacemaker implantation was associated with the use of a mechanical valve (23% versus 6% bioprosthetic valve; P=0.01) CONCLUSIONS: Tricuspid valve replacement in young children is associated with high mortality, especially in infants <1 year of age. Surgical options other than tricuspid valve replacement such as transplantation may need to be considered in infants.

Bioprosthesis↗