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Interact CardioVasc Thorac Surg 2007;6:588-592. doi:10.1510/icvts.2007.156877
© 2007 European Association of Cardio-Thoracic Surgery
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Right arrow Cardiac - physiology
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Work in progress report - Valves

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

Marcel van't Veera,b,c,*, Bart van Stratenb, Frans vande Vossea and Nico Pijlsa,c

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 (Pao), simultaneously with a sensor tipped guide wire in the coronary artery (Pcor) and in the aortic root (Proot). Pao-Proot described a flow-induced pressure drop in the aortic root (Venturi effect) and the gradient Proot-Pcor 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 Pao-Proot and Proot-Pcor.

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

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