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An In Vitro Circulatory Loop Model of the Pediatric Right Ventricular Outflow Tract as a Platform for Valve Evaluation

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Abstract

Purpose

Tetralogy of Fallot and other conditions affecting the right ventricular outflow tract (RVOT) are common in pediatric patients, but there is a lack of quantitative comparison among techniques for repairing or replacing the pulmonary valve. The aim of this study was to develop a robust in vitro system for quantifying flow conditions after various RVOT interventions.

Methods

An infant-sized mock circulatory loop that includes a 3D-printed RVOT anatomical model was developed to evaluate flow conditions after different simulated surgical repairs. Physiologically correct flow and pressure were achieved with custom compliant tubing and a tunable flow restrictor. Pressure gradient, flow regurgitation, and coaptation height were measured for two monocusp leaflet designs after tuning the system with a 12 mm Hancock valved conduit.

Results

Measurements were repeatable across multiple samples of two different monocusp designs, with the wider leaflet in the 50% backwall model consistently exhibiting lower pressure gradient but higher regurgitation compared to the leaflet in the 40% backwall model. Coaptation height was measured via direct visualization with endoscopic cameras, revealing a shorter area of contact for the wider leaflet (3.3-4.0 mm) compared to the narrower one (4.3 mm).

Conclusion

The 3D-printed RVOT anatomical model and in vitro pulmonary circulatory loop developed in this work provide a platform for planning and evaluating surgical interventions in the pediatric population. Measurements of regurgitation, pressure gradient, and coaptation provide a quantitative basis for comparison among different valve designs and positions.

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Abbreviations

RVOT:

Right-ventricular outflow tract

ToF:

Tetralogy of Fallot

MPA:

Main pulmonary artery

RV:

Right ventricle

e-PTFE:

Expanded polytetrafluoroethylene

STJ:

Sinotubular junction

BW:

Backwall (corresponding to native MPA tissue in transannular patch repair)

TPU:

Thermoplastic polyurethane

MCL:

Mock circulatory loop

NP:

Normal physiology (see Table 2)

HCO:

High cardiac output (see Table 2)

HPVR:

High pulmonary vascular resistance (see Table 2)

fR :

Regurgitant fraction

fC :

Closing volume fraction

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Acknowledgements

This work was supported by internal funds.

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Authors and Affiliations

  1. Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA

    Shannen B. Kizilski, Nicholas E. Kneier, Martha D. Chaillo Lizarraga, Noah E. Schulz, Peter E. Hammer & David M. Hoganson

  2. Harvard Medical School, Boston, MA, USA

    Shannen B. Kizilski, Xiaoya Zhang, Peter E. Hammer & David M. Hoganson

  3. Department of Cardiac Surgery, First Hospital of Tsinghua University, Beijing, China

    Xiaoya Zhang

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  1. Shannen B. Kizilski
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Correspondence to Shannen B. Kizilski.

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S.B. Kizilski, X. Zhang, N.E. Kneier, M.D. Chaillo Lizarraga, N.E. Schulz, P.E. Hammer, and D.M. Hoganson declare that they have no conflicts of interest.

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Kizilski, S.B., Zhang, X., Kneier, N.E. et al. An In Vitro Circulatory Loop Model of the Pediatric Right Ventricular Outflow Tract as a Platform for Valve Evaluation. Cardiovasc Eng Tech 14, 217–229 (2023). https://doi.org/10.1007/s13239-022-00648-w

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