Leaflet movement of the ATS valve in the aortic position: unique behavior observed in 19-mm valves.
BACKGROUND
Leaflet opening angles of ATS valves in vivo tend to be less than those reported by the manufacturer, and there is a wide variation in opening angles even among valves of the same size.


METHODS
Leaflet movement of aortic ATS valves was evaluated by cineradiography in 77 patients. The mean period from valve replacement to cineradiography was 40.2 months, and during that period, the ATS valve was replaced due to prosthetic valve obstruction in 1 of the 77 patients.


RESULTS
In 76 patients with a normally functioning ATS valve, the mean opening angle of 19-mm valves (66.3 degrees +/- 2.3 degrees) was significantly less (p < 0.0001) than that of ATS valves 21 mm or larger (72.2 degrees +/- 3.8 degrees in 21-mm, 72.4 degrees +/- 2.8 degrees in 23-mm, and 72.8 degrees +/- 2.9 degrees in 25-mm valves). No significant differences were found in the opening angles of ATS valves 21 mm or larger, and the opening angles exceeded 65 degrees in all 69 patients with valves in this category. In one case of obstruction in a 21-mm valve, the opening angle was 57.5 degrees. The closing angle was 24.9 degrees +/- 1.3 degrees, which corresponded well with the manufacturer's in vitro data.


CONCLUSIONS
The opening angle in the 19-mm ATS aortic valve is significantly less than that in valves 21 mm or larger, and an opening angle of less than 65 degrees probably indicates prosthetic valve obstruction in aortic ATS valves sized 21 mm or larger.
Aoyagi
Shigeaki
S
Department of Surgery, Kurume University School of Medicine, Kurume, Japan. aoyagi@med.kurume-u.ac.jp
Arinaga
Koichi
K
Fukunaga
Shuji
S
Tayama
Eiki
E
Kosuga
Tomokazu
T
Akashi
Hidetoshi
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D001241:Aspirin / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D002933:Cineradiography; D015897:Comorbidity; D015150:Echocardiography, Doppler; D004867:Equipment Design; D005260:Female; D006350:Heart Valve Prosthesis; D018056:Hemorheology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D011475:Prosthesis Failure; D012086:Reoperation; D013923:Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin