Surgical reconstruction of semilunar valves in the growing child: Should we mimic the venous valve? A simulation study.
Neither heart valve repair methods nor current prostheses can accommodate patient growth. Normal aortic and pulmonary valves have 3 leaflets, and the goal of valve repair and replacement is typically to restore normal 3-leaflet morphology. However, mammalian venous valves have bileaflet morphology and open and close effectively over a wide range of vessel sizes. We propose that they might serve as a model for pediatric heart valve reconstruction and replacement valve design. We explore this concept using computer simulation.



We use a finite element method to simulate the ability of a reconstructed cardiac semilunar valve to close competently in a growing vessel, comparing a 3-leaflet design with a 2-leaflet design that mimics a venous valve. Three venous valve designs were simulated to begin to explore the parameter space.



Simulations show that for an initial vessel diameter of 12 mm, the venous valve design remains competent as the vessel grows to 20 mm (67%), whereas the normal semilunar design remains competent only to 13 mm (8%). Simulations also suggested that systolic function, estimated as effective orifice area, was not detrimentally affected by the venous valve design, with all 3 venous valve designs exhibiting greater effective orifice area than the semilunar valve design at a given level of vessel growth.



Morphologic features of the venous valve design make it well suited for competent closure over a wide range of vessel sizes, suggesting its use as a model for semilunar valve reconstruction in the growing child.
Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass. Electronic address: peter.hammer@childrens.harvard.edu.
Peter E
PE
Hammer
Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Division of Materials Science and Engineering, Boston University, Boston, Mass.
Erin G
EG
Roberts
Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass.
Sitaram M
SM
Emani
Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass.
Pedro J
PJ
Del Nido
D001021:Aortic Valve / Q000601:surgery*; D002648:Child; D003198:Computer Simulation; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008953:Models, Anatomic; D011664:Pulmonary Valve / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D055422:Venous Valves
accommodate growth; reconstruction; repair; semilunar valve; simulation; venous valve
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