This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by van't Veer, M. Articles by Pijls, N. Search for Related Content PubMed PubMed Citation Articles by van't Veer, M. Articles by Pijls, N. Related Collections Cardiac - physiology Valve disease

Influence of orientation of bi-leaflet valve prostheses on coronary perfusion pressure in humans

^a Department of Biomedical Engineering, Cardiovascular Biomechanics, University of Technology Eindhoven, Michelangelolaan 2, P.O.Box 1350, 5602 ZA Eindhoven, The Netherlands
^b Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
^c Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

*Corresponding author. Tel.: +31 40 239 7004; fax: +31 40 246 4837.

E-mail address: m.v.veer{at}tue.nl (M. van 't Veer).

Orientation of a bi-leaflet prosthesis (BLP) might influence coronary perfusion. The aim of this study was to investigate the influence of the orientation on coronary perfusion pressure during hyperemia and adrenergic stimulation. During hyperemia perfusion pressure determines coronary blood flow. Fourteen patients with normal coronary angiogram underwent aortic valve replacement (AVR) by a BLP, and seven received a bio-prosthesis. Patients receiving a BLP were randomized to either orientation A (hinge mechanism perpendicular to a line drawn between the coronary ostia) or B (hinge mechanism parallel to the line between the ostia). Six months after surgery all patients underwent cardiac catheterization. Pressures were measured during resting conditions, during maximum hyperemia, and during maximum adrenergic stimulation with a guiding catheter in the aortic arch (P_ao), simultaneously with a sensor tipped guide wire in the coronary artery (P_cor) and in the aortic root (P_root). P_ao-P_root described a flow-induced pressure drop in the aortic root (Venturi effect) and the gradient P_root-P_cor described coronary ostium abnormalities. Only small non-significant differences in myocardial perfusion pressure were found between different orientations of a bi-leaflet prosthesis or between bi-leaflet prostheses and bio-prostheses in P_ao-P_root and P_root-P_cor.

Key Words: Physiological measurements; Coronary arteries; Heart valve prostheses