Post-operative ventricular flow dynamics following atrioventricular valve surgical and device therapies: A review

Nguyen, Yen Ngoc; Ismail, Munirah; Kabinejadian, Foad; Tay, Edgar; Leo, Hwa Liang

doi:10.1016/j.medengphy.2018.01.007

Cited by 10 publications

(6 citation statements)

References 90 publications

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“…These post-surgical deviations may cause hemodynamic dysfunction and/or aberrant blood flow, which have been considered to play an important role in the process of cardiac remodeling. [ 15 ] Studies showed that patients with left-ventricular valve repair have a greater survival advantage than patients with replacement surgery. This survival advantage was shown to become more significant over time.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies suggested that the anatomical structure and position of the prosthetic valve were different from those of the original valve. These post-surgical deviations may cause hemodynamic dysfunction and/or aberrant blood flow, which have been considered to play an important role in the process of cardiac remodeling [15] . Studies showed that patients with left-ventricular valve repair have a greater survival advantage than patients with replacement surgery.…”

Section: Discussionmentioning

confidence: 99%

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Long-term cardiac remodeling associated with heart failure following left-ventricular valve replacement surgery

Yao

Wang

et al. 2021

Medicine

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To investigate long-term cardiac remodeling and prognosis of patients post-left-ventricular valve replacement, and explored related risk factors of heart failure and management strategies.Retrospective cohort of patients with left-ventricular valve replacement between 2005 and 2007. Major adverse cardiac events were recorded, including death, hospitalization, stroke, and New York Heart Association (NYHA) functional classifications. Cardiac remodeling was assessed by comparing pre-operative, post-operative, and follow-up echocardiographic images.Two hundred fifty-seven patients who received left-ventricular mitral, aortic, or double-valve replacement surgery were followed up for 10.4 ± 1.5 years with an all-cause mortality rate 18.7% and an incidence of heart failure that significantly restricted daily life (NYHA III or IV) 21.3%.There were no significant differences in classic cardiac-remodeling variables between baseline and long-term follow-up, such as left-ventricular diameter (47.9 ± 8.3 vs 49.9 ± 8.0 mm, P = .14) and left-ventricular ejection fraction (58.6 ± 9.6% vs 57.0 ± 10.3%, P = .34), whereas there were significant differences in terms of left-atrial anteroposterior diameter (LA) (39.7 ± 9.5 vs 49.0 ± 14.3 mm, P < .001) and tricuspid regurgitation (TR) (1.4 ± 1.0 vs 2.2 ± 1.2, P < .001). Multivariable logistic regression analysis showed that LA ≥ 50 mm (P = .011) and more than moderate tricuspid regurgitation (TR > 2) (P = .012) were associated with poor prognoses for long-term consequences of heart failure. Both LA and TR progressed with the length of time after surgery.LA enlargement and TR after left-ventricular valve replacement surgery were time-dependent events, which represented cardiac remodeling and were closely related to post-operative long-term consequences of heart failure. It is important to be cognizant of and to explore long-term preventive and treatment strategies for adverse cardiac events in patients following left-ventricular valve replacement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-term cardiac remodeling associated with heart failure following left-ventricular valve replacement surgery

Yao

Wang

et al. 2021

Medicine

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“…Vortex detection by Q-criterion. Q-criterion was used to identify vortical structures in the RV to eliminate the contributions of high shear boundary region, as described previously (35,36). Velocity gradient tensor ٌv is decomposed into rate-of-strain tensor S and vorticity tensor ⍀:…”

Section: Discussionmentioning

confidence: 99%

“…Alterations of LV vortex and flow patterns after different MV therapies have been reported (36). Especially, MV ETER, which alters MV configuration into double orifice geometry, led to complete alteration of LV vortex pattern (9,21).…”

Section: Vortex and Flow Analysismentioning

confidence: 96%

Ventricular vortex loss analysis due to various tricuspid valve repair techniques: an ex vivo study

Nguyen

Tay

Kabinejadian

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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The deteriorating nature of severe functional tricuspid regurgitation (FTR) has led to the heightened interest in this pathology. However, therapies are heterogeneous and an ideal technique is uncertain. The hemodynamic impact on the cardiac chamber following therapeutic repairs has not been well studied, while its analysis could be used to predict the treatment success. In this study, the hemodynamics of the right ventricle (RV) after 1) clover edge-to-edge tricuspid repair, and 2) double orifice tricuspid repair was evaluated in three right heart models using an ex vivo pulsatile platform emulating severe FTR with the aid of stereoscopic particle image velocimetry. Although all repairs substantially reduced tricuspid regurgitant area, they resulted in a more than 50% reduction in diastolic tricuspid valve (TV) opening area. Splitting the TV orifice into multiple smaller orifices by both repairs eliminated the ring-shaped vortical structure inside the RV observed in FTR cases. Postrepair RV domain was mostly occupied with irregular vortical features and isolated vortex residuals. Moreover, vortical features varied among repair samples, indicating enhanced sensitivity of RV flow to postrepair TV morphology. Compared with clover repair, double orifice subjected the RV to enhanced swirling motions and exposed more regions to vortical motions, potentially indicating better rinsing and lower risk of mural thrombus formation. Double orifice repair increased the levels of RV mean kinetic energy and viscous energy loss than those observed in clover repair, although the impact of these on the cardiac efficiency remains unclear. These preliminary insights could be used to improve future treatment design and planning. NEW & NOTEWORTHY While clover and double orifice tricuspid repairs markedly improved leaflet coaptation, they substantially reduced diastolic tricuspid opening area. Postrepair right ventricle (RV) exhibited specific hemodynamic traits, including the loss of ring-shaped vortical structure and the enhanced sensitivity of RV flow to postrepair tricuspid valve morphology. Compared with clover technique, double orifice repair led to higher swirling motions in the RV domain, which could indicate lower risk of mural thrombus formation.

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“…With advances in in vivo imaging methods, 1,2 recent clinical studies have established that the presence of a large asymmetric clockwise vortex observed in a healthy left ventricle (LV) is vital for the minimization of energy loss and overall cardiac efficiency. A vortex can be described as a group of fluid particles with a swirling motion around a common axis 3 and typically arises in the heart due to separation of boundary layers 4,5 . Such physiological vortex pattern achieves these by fluidly diverting the incoming filling jet from the mitral annulus to the left ventricular outflow track via the apex as the LV contracts 3,6,7 .…”

Section: Introductionmentioning

confidence: 99%

An in vitro investigation into the hemodynamic effects of orifice geometry and position on left ventricular vortex formation and turbulence intensity

et al. 2020

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With advances in in vivo imaging methods, 1,2 recent clinical studies have established that the presence of a large asymmetric clockwise vortex observed in a healthy left ventricle (LV) is vital for the minimization of energy loss and overall cardiac efficiency. A vortex can be described as a group of fluid particles with a swirling motion around a common axis 3 and typically arises in the heart due to separation of boundary layers. 4,5 Such physiological vortex pattern achieves these by fluidly diverting the incoming filling jet from the mitral annulus to the left ventricular outflow track via the apex as the LV contracts. 3,6,7 However, it has been observed that the mitral implantation of artificial heart valves, 6,8 mitral repair procedures, 9 and the occurrence of certain cardiac diseases such as dilated cardiomyopathy 10-12 can result in the alteration of

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Post-operative ventricular flow dynamics following atrioventricular valve surgical and device therapies: A review

Cited by 10 publications

References 90 publications

Long-term cardiac remodeling associated with heart failure following left-ventricular valve replacement surgery

Long-term cardiac remodeling associated with heart failure following left-ventricular valve replacement surgery

Ventricular vortex loss analysis due to various tricuspid valve repair techniques: an ex vivo study

An in vitro investigation into the hemodynamic effects of orifice geometry and position on left ventricular vortex formation and turbulence intensity

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