Abstract
Right ventricle to pulmonary artery (RV-PA) continuity reconstruction traditionally is treaded by open repair with pulmonary valve implantation or replacement. Percutaneous pulmonary valve implantation (PPVI) has evolved as most exciting development surgical strategy with dysfunctional right ventricle-pulmonary artery conduits. However, size restrictions of the currently available valves for PPVI application prevents development in a larger pool of patients. We propose a formula for designing handmade trileaflet-valved conduits with different diameters. The formula is derived from a trigonometric function and can be used to estimate the optimal parameters for ePTFE-valved conduits for young adults and children. The purpose of this study is to investigate the hemodynamic and functional consequences of the new design using a mock circulation system. We recorded the diastolic valve leakage and calculated pulmonary regurgitation, regurgitation fraction, and ejection efficiency in pulsatile setting. Additionally, the prosthetic leaflet behavior was assessed with an endoscope camera and the pressure drops through valves were measured. All the in vitro parameters indicated that the ePTFE-valved conduits did not have an inferior outcome compared with commercial mechanical or tissue valve conduits and could decrease the regurgitation volume and increase the efficiency. Compatible early clinical outcomes were also found among ePTFE-valved conduits and other valved conduits used for RVOT reconstruction, and ePTFE-valved conduits could be implanted in patients of a significantly smaller size. In vitro experimental study provided evidence that a handmade ePTFE-valved conduit could be an attractive alternative to other commercialized valved conduits used for surgical Right ventricle to pulmonary artery (RV-PA) continuity reconstruction.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Hussam S. Suradi., et al., Percutaneous pulmonary valve implantation. Glob Cardiol Sci Pract, 2015. 2015(2): 23.
McElhinney DB, et al., Short- and medium-term outcomes after transcatheter pulmonary valve placement in the expanded multicenter US melody valve trial. Circulation. 010; 122(5):507–16, Epub 2010/07/21.
Yamashita, E., et al., Smaller-Sized Expanded Polytetrafluoroethylene Conduits With a Fan-Shaped Valve and Bulging Sinuses for Right Ventricular Outflow Tract Reconstruction. Ann Thorac Surg, 2016. 102(4): p. 1336–44.
Bonhoeffer P, et al., Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Kachaner J Lancet., 2000. 356(9239): p. 1403–5.
Lurz P, et al., Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation. 2008;117(15):1964–72, Epub 2008/04/09.
Ting-Wei Lin, Jieh-Neng Wang, Chung-Dann Kan, and Yu-Jen Yang, “Handmade trileaflet valved stent graft for pulmonary valve implantation,” The Journal of Thoracic and Cardio-vascular Surgery, vol. 148, no, 4, 2014, pp. 1753–1755.
Ming-Tai Lin, Jou-Kou Wang, Pei-Yuan Wu, Chun-Wei Lu, Te-I Chang, and Yih-Sharng Chen, “Successful transcatheter handmade-valved graft stent for branch pulmonary regurgitation: novel approach in a special event,” The Society of Thoracic Surgeons, vol. 12, 2016, pp. E541–543.
Pranav Loyalka, Michael Schechter, Angelo Nascimbene, Ajay Sundara Raman, Cezar A Ilieascu, Igor D Gregoric, and Biswajit Kar, “Transcatheter pulmonary valve replacement in a carcinoid heart,” Texas Heart Institute Journal, vol. 43, no. 4, 2016, pp. 341–344.
Chung-Dann Kan, Jieh-Neng Wang, Wei-ling Chen, Pong-Jeu Lu, Ming-Yao Chan, Chia-Hung Lin, and Wan-Chin Hsieh, “Applicability of the handmade ePTFE trileaflet-valved conduits for pulmonary valve reconstruction: an ex vivo and in vivo study,” The Journal of Thoracic and Cardiovascular Surgery, Article in Press, September 2017, http://dx.doi.org/10.1016/j.jtcvs.2017.09.049.
E. Yamashita, M. Yamagishi, T. Miyazaki, Y. Maeda, Y. Yamamoto, N. Kato, H. Hongu, and H. Yaku, “Smaller-sized expanded polytetrafluoroethylene conduits with a fan-shaped valve and bulging sinuses for right ventricular outflow tract reconstruction,” Ann Thorac Surg, vol. 102, no. 4, 2016, pp. 1336–44.
Cheng-Hsien Chiang, Ming-Long Yeh, Wei-Ling Chen, and Chung-Dann Kan, “Apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes,” Annals of Vascular Surgery, vol. 31, 2016, pp. 196–204.
Chung-Dann Kan, Wei-Ling Chen, Chia-Hung Lin, Jieh-Neng Wang, Pong-Jeu Lu, Ming-Yao Chan, and Jui-Te Wu, “Handmade trileaflet valve design and validation for pulmonary valved conduit reconstruction using taguchi method and cascade correlation machine learning model,” IEEE Access, Article in Press, December 2017, https://doi.org/10.1109/access.2017.2782686.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this paper
Cite this paper
Chen, WL., Wu, CC., Kan, CD. (2019). In Vitro Evaluation of Hemodynamic Performance for Right Ventricular Outflow Tract Reconstruction with Trileaflet ePTFE Valved Conduit. In: Lhotska, L., Sukupova, L., Lacković, I., Ibbott, G.S. (eds) World Congress on Medical Physics and Biomedical Engineering 2018. IFMBE Proceedings, vol 68/1. Springer, Singapore. https://doi.org/10.1007/978-981-10-9035-6_96
Download citation
DOI: https://doi.org/10.1007/978-981-10-9035-6_96
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-9034-9
Online ISBN: 978-981-10-9035-6
eBook Packages: EngineeringEngineering (R0)