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Fetal Transcatheter Trileaflet Heart Valve Hemodynamics: Implications of Scaling on Valve Mechanics and Turbulence

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Abstract

The scarcity of data available on the best approach for pulmonary fetal valve replacement or implantation necessitate an investigation on whether practices using adult transcatheter valves could be translated to fetal applications. The objective of this study is to evaluate the hemodynamic characteristics and the turbulent properties of a fetal sized trileaflet transcatheter pulmonary valve in comparison with an adult balloon-expandable valve in order to assess the possibility of designing valves for fetal applications using dynamic similarity. A 6 mm fetal trileaflet valve and a 26 mm SAPIEN 3 valve were assessed in a pulse duplicator. Particle image velocimetry was performed. Pressure gradient (ΔP), effective orifice area (EOA), regurgitant fractions (RF), pinwheeling indices (PI) and turbulent stresses were evaluated. ΔP was 8.56 ± 0.139 and 7.76 ± 0.083 mmHg with fetal valve and SAPIEN respectively (p < 0.0001); EOA was 0.10 ± 0.0007 and 2.1 ± 0.025 cm2 with fetal valve and SAPIEN respectively (p < 0.0001); RF with the fetal valve was 2.35 ± 1.99% and with SAPIEN 10.92 ± 0.11% (p < 0.0001); PI with fetal valve was 0.404 ± 0.01 and with SAPIEN 0.37 ± 0.07; The flow regime with the fetal valve was turbulent and Reynolds numbers reached about 7000 while those with the SAPIEN reached about 20,000 at peak velocity. Turbulent stresses were significantly higher with fetal valve compared with SAPIEN. Instantaneous viscous shear stresses with fetal valve were 5.8 times higher than those obtained with SAPIEN and Reynolds shear stresses were 2.5 times higher during peak systole. The fetal valve implantation leads to a turbulent flow (specific to this particular type and design of valve) regime unlike what is expected of a small valve with different flow properties compared to adult valves.

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Funding

The research done was partly supported by National Institutes of Health (NIH) under Award Number R01HL119824 and the American Heart Association (AHA) under Award Number 19POST34380804.

Disclosures

Dr. Dasi reports having patent applications filed on vortex generators and superhydrophobic/omniphobic surfaces. Dr. Dasi report having two patents filed on novel polymeric heart valves. No other conflicts were reported.

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Authors and Affiliations

  1. The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle NW, Atlanta, GA, 30313, USA

    Hoda Hatoum, Shelley Gooden & Lakshmi Prasad Dasi

  2. Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Megan Heitkemper, Kevin M. Blum, Jason Zakko, Tai Yi & Christopher K. Breuer

  3. Case Western Reserve University School of Medicine, UH Rainbow Babies & Children’s Hospital, Cleveland, OH, USA

    Martin Bocks

  4. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA

    Yen-Lin Wu & Yadong Wang

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  1. Hoda Hatoum
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Correspondence to Lakshmi Prasad Dasi.

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Hatoum, H., Gooden, S., Heitkemper, M. et al. Fetal Transcatheter Trileaflet Heart Valve Hemodynamics: Implications of Scaling on Valve Mechanics and Turbulence. Ann Biomed Eng 48, 1683–1693 (2020). https://doi.org/10.1007/s10439-020-02475-3

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