Influence of orientation of bi-leaflet valve prostheses on coronary perfusion pressure in humans.
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).
Department of Biomedical Engineering, Cardiovascular Biomechanics, University of Technology Eindhoven, Michelangelolaan 2, P.O.Box 1350, 5602 ZA Eindhoven, The Netherlands. m.v.veer@tue.nl
Marcel
M
van't Veer
Bart
B
van Straten
Frans
F
vande Vosse
Nico
N
Pijls
D000241:Adenosine; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D001794:Blood Pressure / Q000187:drug effects; D006328:Cardiac Catheterization; D002316:Cardiotonic Agents / Q000008:administration & dosage; D003326:Coronary Circulation / Q000187:drug effects; D004280:Dobutamine / Q000008:administration & dosage; D005260:Female; D006339:Heart Rate; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced / Q000503:physiopathology; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011474:Prosthesis Design; D012107:Research Design; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D004280:Dobutamine; D000241:Adenosine