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Ex Vivo Modeling of Atrioventricular Valve Mechanics in Single Ventricle Physiology

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Abstract

Single ventricle physiology (SVP) is used to describe any congenital heart lesion that is unable to support independent pulmonary and systemic circulations. Current treatment strategies rely on a series of palliation surgeries that culminate in the Fontan physiology, which relies on the single functioning ventricle to provide systemic circulation while passively routing venous return through the pulmonary circulation. Despite significant reductions in early mortality, the presence of atrioventricular valve (AVV) regurgitation is a key predictor of heart failure in these patients. We sought to evaluate the biomechanical changes associated with the AVV in SVP physiologies. Left and right ventricles were sutured onto patient-derived 3D-printed mounts and mounted into an ex vivo systemic heart simulator capable of reproducing Norwood, Glenn, Fontan and Late Fontan physiologies. We found that the tricuspid anterior leaflet experienced elevated maximum force, average force, and maximum yank compared to the posterior and septal leaflets. Between physiologies, maximum yank was greatest in the Norwood physiology relative to the Glenn, Fontan, and Late Fontan physiologies. These contrasting trends suggest that long- and short-term mechanics of AVV failure in single ventricle differ and that AVV interventions should account for asymmetries in force profiles between leaflets and physiologies.

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Abbreviations

AVV:

Atrioventricular valve

CO:

Cardiac output

HR:

Heart rate

MAP:

Mean arterial pressure

MV:

Mitral valve

SVP:

Single ventricle physiology

TV:

Tricuspid valve

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Acknowledgments

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR003143) and the Stanford Maternal & Child Health Research Institute Pilot Grant Program. This work was also supported in part by the National Institutes of Health (NIH R01 HL089315-01, Y.J.W.). Part of this work was performed at the Stanford Nano Shared Facilities (SNSF), supported by the National Science Foundation (ECCS-1542152).

Funding

Funding was provided by National Center for Advancing Translational Sciences (Grant Number KL2TR003143).

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Stanford University, 870 Quarry Rd, Stanford, CA, 94304, USA

    Stephen C. Moye, Sumanth Kidambi, James Y. Lee, Teaghan H. Cowles, Shane D. Gilligan-Steinberg, Amelia Y. Bryan, Rob Wilkerson, Y. Joseph Woo & Michael R. Ma

  2. Department of Bioengineering, Stanford University, 443 Via Ortega, Stanford, CA, 94305, USA

    Y. Joseph Woo

  3. Falk Cardiovascular Research Center, 870 Quarry Road Extension, Palo Alto, CA, 94304, USA

    Michael R. Ma

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  1. Stephen C. Moye
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Correspondence to Michael R. Ma.

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Associate Editor Ellen Kuhl oversaw the review of this article.

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Supplementary Information

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Supplementary Video 1. Tricuspid valve in the univentricular simulator during the Late Fontan physiology (800 ms/cycle). Supplementary file1 (MP4 71274 kb).

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Moye, S.C., Kidambi, S., Lee, J.Y. et al. Ex Vivo Modeling of Atrioventricular Valve Mechanics in Single Ventricle Physiology. Ann Biomed Eng 51, 1738–1746 (2023). https://doi.org/10.1007/s10439-023-03178-1

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  • DOI: https://doi.org/10.1007/s10439-023-03178-1

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