Laser Doppler velocimetry and flow visualization studies in the regurgitant leakage flow region of three mechanical mitral valves

Streak line flow visualization and laser Doppler velocimetry (LDV) were conducted in the regurgitant leakage flow region of 3 mechanical heart valve types: CarboMedics, Medtronic Hall, and St. Jude Medical. Streak line flow visualization identified regions of high regurgitant flow, and LDV measurements were focused on those locations. Maximum regurgitant flow velocities after valve closure ranged from 0.7 to 2.6 m/s, and maximum Reynolds shear stress after valve closure ranged from 450 to 3,600 dyne/cm2. These data indicate that leakage flows can generate turbulent jets with elevated Reynolds stresses even in bileaflet valves.

Integrating particle image velocimetry and laser Doppler velocimetry measurements of the regurgitant flow field past mechanical heart valves

This study investigates the transient regurgitant flow downstream of a prosthetic heart valve using both laser Doppler velocimetry (LDV) and particle image velocimetry (PIV). Until now, LDV has been the more commonly used tool in investigating the flow characteristics associated with mechanical heart valves. The LDV technique allows point-by-point velocity measurements and provides enough information about the temporal variations in the flow. The main drawback of this technique is the time consuming nature of the data acquisition process in order to assess an entire flow field area. The PIV technique, on the other hand, allows measurement of the entire flow field in space in a plane at a given instant. In this study, PIV with spatial resolution of 0 (1 mm) and LDV with a temporal resolution of 0 (1 ms) were used to measure the regurgitant flow proximal to the Björk-Shiley monostrut (BSM) valve in the mitral position. With PIV, the ability to measure 2 velocity components over an entire plane simultaneously provides a very different insight into the flow field compared to a more traditional point-to-point technique like LDV. In this study, a picture of the effects of occluder motion on the fluid flow in the atrial chamber is interpreted using an integration of PIV and LDV measurements. Specifically, fluid velocities in excess of 3.0 m/s were recorded in the pressure-driven jet during valve closure, and a 1.5 m/s sustained regurgitant jet was observed on the minor orifice side. Additionally, the effects of the impact and subsequent rebound of the occluder on the flow also were clearly recorded in spatial and temporal detail by the PIV and LDV measurements, respectively. The PIV results provide a visually intuitive way of interpreting the flow while the LDV data explore the temporal variations and trends in detail. This analysis is an integrated flow description of the effects of valve closure and leakage on the pulsatile regurgitation flow field past a tilting-disc mechanical heart valve (MHV). It further reinforces the hypothesis that the planar flow visualization techniques, when integrated with traditional point-to point techniques, provide significantly more insight into the complex pulsatile flow past MHVs.

A cSNP map and database for human chromosome 21

Single nucleotide polymorphisms (SNPs) are likely to contribute to the study of complex genetic diseases. The genomic sequence of human chromosome 21q was recently completed with 225 annotated genes, thus permitting efficient identification and precise mapping of potential cSNPs by bioinformatics approaches. Here we present a human chromosome 21 (HC21) cSNP database and the first chromosome-specific cSNP map. Potential cSNPs were generated using three approaches: (1) Alignment of the complete HC21 genomic sequence to cognate ESTs and mRNAs. Candidate cSNPs were automatically extracted using a novel program for context-dependent SNP identification that efficiently discriminates between true variation, poor quality sequencing, and paralogous gene alignments. (2) Multiple alignment of all known HC21 genes to all other human database entries. (3) Gene-targeted cSNP discovery. To date we have identified 377 cSNPs averaging ~1 SNP per 1.5 kb of transcribed sequence, covering 65% of known genes in the chromosome. Validation of our bioinformatics approach was demonstrated by a confirmation rate of 78% for the predicted cSNPs, and in total 32% of the cSNPs in our database have been confirmed. The database is publicly available at http://csnp.unige.ch or http://csnp.isb-sib.ch. These SNPs provide a tool to study the contribution of HC21 loci to complex diseases such as bipolar affective disorder and allele-specific contributions to Down syndrome phenotypes.

The case for large-size mutations

There are no laws of physics or chemistry that forbid large mutations. Therefore, the "size" of a random mutation should fit the mathematics of a Poisson point process: The number of mutations (N), versus mutation size (MS), should obey an exponential relationship. Three examples are examined: A simple 15-mutation sequence; actual experimental data involving a sequence of 56,611 random action potentials (rather than mutations); and a synthetic sequence of 65,535 random mutations. In the latter example, with an average MS of 2.22 units, the largest MS is a 25-unit giant that would be associated with major changes.

Observation and quantification of gas bubble formation on a mechanical heart valve

Clinical studies using transcranial Doppler ultrasonography in patients with mechanical heart valves (MHV) have detected gaseous emboli. The relationship of gaseous emboli release and cavitation on MHV has been a subject of debate in the literature. To study the influence of cavitation and gas content on the formation and growth of stable gas bubbles, a mock circulatory loop, which employed a Medtronic-Hall pyrolytic carbon disk valve in the mitral position, was used. A high-speed video camera allowed observation of cavitation and gas bubble release on the inflow valve surfaces as a function of cavitation intensity and carbon dioxide (CO2) concentration, while an ultrasonic monitoring system scanned the aortic outflow tract to quantify gas bubble production by calculating the gray scale levels of the images. In the absence of cavitation, no stable gas bubbles were formed. When gas bubbles were formed, they were first seen a few milliseconds after and in the vicinity of cavitation collapse. The volume of the gas bubbles detected in the aortic track increased with both increased CO2 and increased cavitation intensity. No correlation was observed between O2 concentration and bubble volume. We conclude that cavitation is an essential precursor to stable gas bubble formation, and CO2, the most soluble blood gas, is the major component of stable gas bubbles.

The osmotic swelling characteristics of cardiac valve prostheses

Several types of mechanical cardiac prostheses have been constructed with Delrin occluders, a material that is subject to osmotic swelling. The leaftets are designed to expand to specific tolerances when immersed in blood. The synthetic blood analogs commonly used in vitro contain hydrophilic compounds that can alter the osmotic expansion of the Delrin occluders. A static leak test chamber was employed to illustrate the effects of various test fluids on the sustained regurgitation phase of Delrin valves.

The scaling of the wall pressure fluctuations in polymer-modified turbulent boundary layer flow

Wall pressure fluctuations and integrated skin friction were measured beneath a turbulent boundary layer that was modified by adding drag-reducing polymer to the pure water flow. The measurements were performed on an axisymmetric model, equipped with an isolated cylindrical drag balance section, and placed in the test section of the 0.3048-m-diam water tunnel at ARL Penn State. Data were acquired at a free-stream velocity of 10.7 m/s with pure water and with polymer added to the water at concentrations of 1, 5, 10, and 20 weight parts per million. Nondimensionalization of the wall pressure fluctuation frequency spectra with traditional outer, inner, and mixed flow variables failed to adequately collapse the data. The mean square wall pressure fluctuations were found to scale linearly with the wall shear stress. Polymer addition had little effect on the characteristic time scale of the flow. These properties were used to develop a novel form of the nondimensional wall pressure fluctuation spectrum that provided the best collapse of the measured data.

Fluid dynamics of a pediatric ventricular assist device

The number of pediatric patients requiring some form of mechanical circulatory assistance is growing throughout the world because of new surgical procedures and the success of pediatric cardiac transplantation. However, the salvage rate for those patients requiring circulatory support may be as low as 25%. Despite the fact that Penn State's 70 cc pneumatic ventricular assist device has been used with a success rate of over 90% in more than 250 patients worldwide, efforts to scale down the pump have encountered difficulties. Animal experiments with a 15 cc version were unsuccessful, with explanted pumps showing extensive thrombus deposition within the pumping chamber. The materials used to fabricate the smaller pump as well as the basic operating principles are identical to the successful adult-sized version. It is therefore believed that reducing the size of the pump altered the internal flow field, and that fluid dynamic factors were responsible for the high degree of thrombus observed with the implanted devices. A dimensional analysis was conducted that revealed significant differences in both Reynolds (Re) and Strouhal (St) numbers between the successful and unsuccessful pumps. Two component laser Doppler velocimetry was then used to characterize the internal flow field quantitatively. Comparison with data from the 70 cc pump showed a reduction in wall shear stress and turbulence levels in the 15 cc pump that would yield an environment conducive to clot formation.

Flow visualization in mechanical heart valves: occluder rebound and cavitation potential

High density particle image velocimetry, with spatial resolution of O(1 mm), was used to measure the effect of occluder rebound on the flow field near a Bjork-Shiley Monostrut tilting-disk mitral valve. The ability to measure two velocity components over an entire plane simultaneously provides a very different insight into the flow compared to the more traditional point to point techniques (like Laser Doppler Velocimetry) that were utilized in previous investigations of the regurgitant flow. A picture of the effects of occluder rebound on the fluid flow in the atrial chamber is presented. Specifically, fluid velocities in excess of 1.5 m/s traveling away from the atrial side were detected 3 mm away from the valve seat in the local low pressure region created by the occluder rebound on the major orifice side where cavitation has been observed. This analysis is the first spatially detailed flow description of the effects of occluder rebound on the flow field past a tilting-disk mechanical heart valve and further reinforces the hypothesis that the rebound effect plays a significant role in the formation of cavitation, which has been implicated in the hemolysis and wear associated with tilting-disk valves in vivo.

Hb Iraq-Halabja beta10 (A7) Ala-->Val (GCC-->GTC): a new beta-chain silent variant in a family with multiple Hb disorders

A patient originating from Iraq was referred to our laboratory upon suspicion of a hemoglobinopathy. Routine hematological tests revealed a microcytic and slightly anemic phenotype with an elevated HbA2 suggestive of beta-thalassemia. Samples were obtained for several members of the family which upon examination revealed highly heterogeneous phenotypes that prompted us to investigate the case further. Sequencing of the beta-globin gene and alpha cluster mapping in the propositus and his brother showed a previously undescribed beta-globin variant:Hb Iraq-Halabja, beta10(A7) Ala-->Val (GCC-->GTC), associated with beta0-thalassemia IVS-2 nt1 G-->A and either alpha-thal-2-3.7 kb deletion (brother), or alpha-globin gene triplication anti-3.7 kb type (propositus). Detailed functional studies of the variant gave a normal oxygenation curve, a normal heterotopic action of 2,3 DPG, and normal heat stability and isopropanol precipitation tests. The variant shows a clear difference in migration properties compared to normal beta-chain only when run on PAGE urea Triton. As expected, alpha/beta-globin mRNA ratios were influenced by the concomitant presence of an alpha-globin gene pathology and the beta0 thalassemia and not by the presence of the beta-globin variant which apparently is clinically silent.

Severe inclusion body beta-thalassaemia with haemolysis in a patient double heterozygous for beta(0)-thalassaemia and quadruplicated alpha-globin gene arrangement of the anti-4.2 type

We describe a new case of an association of alpha-globin gene quadruplication of the anti-4.2 type with beta(0)-thalassaemia. The patient, a young woman of mixed Brazilian-Portuguese origin, suffered from chronic haemolytic anaemia with splenomegaly. Bone marrow supravital staining with brilliant cresyl blue and electron microscopy studies showed large inclusion bodies in about 3% of erythroblasts. Upon immunofluorescent staining these inclusions reacted with a monoclonal antibody to alpha- but not to beta-globin. Analysis of alpha-globin cluster by Southern blotting showed the presence of pathologic fragments specific for the anti-4.2 alpha-globin gene quadruplication. Alpha/beta mRNA ratio was higher than in cases combining alpha-globin triplication and beta(0)-thalassaemia or in cases of beta(0)-thalassaemia heterozygous state alone (18, 14.7 and 10.1 respectively). Our data confirmed the hypothesis that the clinically detectable haemolysis in this beta(0)-thalassaemic patient was due to an unusually high amount of precipitated alpha-globin in erythroid precursors. This considerable excess of alpha-globin chains was due partly to the beta-globin deficit caused by the presence of the beta(0)-thalassaemic gene, but also to the presence of 6 active alpha-globin genes resulting from alpha-globin gene quadruplication in one chromosome.

In vitro studies of gas bubble formation by mechanical heart valves

BACKGROUND AND AIM OF THE STUDY

Recent clinical research using transcranial Doppler ultrasonography has shown the presence of emboli in the cranial circulation of some mechanical heart valve patients. Due to the high-intensity signals produced by these emboli, it has been suggested that they are small gas bubbles. Meanwhile, transesophageal echocardiography of mechanical heart valve patients has shown images of bright, mobile particles (also considered to be gas bubbles) near the valve. Motivated by these reports, a series of in vitro studies was performed to investigate the relationship between dissolved gas concentration and the incidence of bubble formation after valve closure.

METHODS

A mock circulatory loop was used to study a Medtronic Hall tilting disc valve in the mitral position of the Penn State Electrical Ventricular Assist Device (EVAD). The valve was videotaped as it operated in saline with various levels of dissolved CO2. A Doppler ultrasound probe served as a bubble detector on the outflow side of the EVAD. Measurements of vaporous cavitation intensity with a high-fidelity pressure transducer were also made. Similar experiments were then performed in porcine blood, using an imaging ultrasound transducer to detect bubbles.

RESULTS

Bubbles were seen moving off the valve in the retrograde direction just after closure. The ultrasound probe detected these bubbles downstream, indicating a bubble lifetime on the order of seconds. It was observed with high-speed video that bubble formation and cavitation are separate events and occur at different times during valve closure. Bubbles were more likely to be observed when CO2 levels were higher. Experiments in blood provided images of bubbles near the valve, predominantly at higher CO2 levels and high valve loading conditions.

CONCLUSIONS

These results show that stable gas bubbles can form during mechanical heart valve operation. The bubbles likely form from the combined effects of gaseous nuclei formed by cavitation, low-pressure regions associated with regurgitant flow, and the presence of CO2, a highly soluble gas.

A comparison of the cavitation potential of prosthetic heart valves based on valve closing dynamics

BACKGROUND AND AIMS OF THE STUDY

This study compares the cavitation potential of prosthetic heart valves based on valve closing dynamics.

METHODS

A laser sweeping technique measured valve closing dynamics (average closing velocity and deceleration) immediately before valve closure. A high-fidelity, piezoelectric pressure transducer was mounted proximal to the mitral valve and measured the high-frequency pressure fluctuations caused by cavitation bubble formation and collapse after valve closure. The band-pass filtered root mean squared (RMS) value of the mitral pressure signal was used as a measure of cavitation intensity. The combination of these two techniques allowed the direct correlation of valve dynamics and cavitation intensity for each valve closure. The effects of three parameters on prosthetic heart valve dynamics and cavitation were examined: valve geometry (Medtronic Hall and Björk-Shiley Monostrut), occluder material (pyrolytic carbon and Delrin), and gap width between the occluder and housing. A dimensional analysis was also performed to investigate the general form of the relationship between valve dynamics and cavitation intensity.

RESULTS

For all of the valves investigated in this study, the RMS pressure increased (signifying an increase in cavitation) as the average closing velocity and deceleration increased. In order to compare the cavitation potential of the valves, the RMS pressure was estimated at specific closing velocities using the linear regression of RMS pressure versus average closing velocity for each valve. The effects of valve geometry, occluder material and gap width were then examined at high valve loading conditions (closing velocity of 4.0 m/s). For both pyrolytic carbon and Delrin, the Medtronic Hall valves had significantly higher RMS pressures than did the Björk-Shiley Monostrut valves. For a given valve geometry, the pyrolytic carbon occluder had a significantly higher RMS pressure than the Delrin occluder. The valve gap width did not have a significant effect on RMS pressure. The dimensional analysis revealed the general relationship among average closing velocity, occluder material properties and cavitation intensity.

CONCLUSIONS

The results presented here contribute to our fundamental understanding of cavitation on mechanical heart valves.

Mean velocity and Reynolds stress measurements in the regurgitant jets of tilting disk heart valves in an artificial heart environment

Laser Doppler velocimetry, with a high temporal resolution (1 ms time windows), was used to measure the flow field in two regions (major and minor orifices) near the aortic and mitral valves (Bjork Shiley monostrut Nos. 25 and 27, respectively) of the Penn State artificial heart. The motion of each valve was also investigated using a 1000 frame/s video camera in order to estimate the valve's closing velocity. Fluid velocities in excess of and opposite to valve closing velocity were detected near the valve, providing evidence of "squeeze flow." Maximum Reynolds shear stresses of approximately 20,000 dyn/cm2 and time-averaged Reynolds shear stresses of approximately 2000 dyn/cm2 were observed during the regurgitant flow phase. These elevated Reynolds shear stresses suggest that regurgitant jets play a role in the hemolysis and thrombosis associated with tilting disk heart valves in an artificial heart environment.

Three-component laser Doppler velocimetry measurements in the regurgitant flow region of a Björk-Shiley monostrut mitral valve

Three-dimensional laser Doppler velocimetry measurements were acquired in a mock-circulatory loop proximal to a Björk-Shiley monostrut valve in the mitral position, and synchronous ensemble-averaging was applied to form an "average" beat. Two axial locations in the regurgitant flow region of the valve (in the minor orifice) were mapped, and maximum Reynolds shear stresses were calculated. A large spike in regurgitant flow was noted at the beginning of systole, which may be the squeeze flow phenomenon computed by other researchers. A region of sustained regurgitant flow 50 msec later was the focus of this study. Maximum velocities of approximately 3.7 mps were noted, and maximum Reynolds shear stresses of approximately 10,000 dyne/cm2 were calculated. Comparisons were made of two-dimensional (ignoring tangential component) versus three-dimensional shear stresses, and, in this case, in regions of high stress, the differences were insignificant. This suggests that the tangential component of velocity can probably be ignored in similar measurements where the tangential velocity is likely to be small.

Effects of tilting disk heart valve gap width on regurgitant flow through an artificial heart mitral valve

While many investigators have measured the turbulent stresses associated with forward flow through tilting disk heart valves, only recently has attention been given to the regurgitant jets formed as fluid is squeezed through the gap between the occluder and housing of a closed valve. The objective of this investigation was to determine the effect of gap width on the turbulent stresses of the regurgitant jets through a Björk-Shiley monostrut tilting disk heart valve seated in the mitral position of a Penn State artificial heart. A 2 component laser-Doppler velocimetry system with a temporal resolution of 1 ms was used to measure the instantaneous velocities in the regurgitant jets in the major and minor orifices around the mitral valve. The gap width was controlled through temperature variation by taking advantage of the large difference between the thermal expansion coefficients of the Delrin occluder and the Stellite housing of Björk-Shiley monostrut valves. The turbulent shear stress and mean (ensemble averaged) velocity were incorporated into a model of red blood cell damage to assess the potential for hemolytic damage at each gap width investigated. The results revealed that the minor orifice tends to form stronger jets during regurgitant flow than the major orifice, indicating that the gap width is not uniform around the circumference of the valve. Based on the results of a red blood cell damage model, the hemolytic potential of the mitral valve decreases as the gap width increases. This investigation also established that the hemolytic potential of the regurgitant phase of valve operation is comparable to, if not greater than, the hemolytic potential of forward flow, consistent with experimental data on hemolysis.

Electromagnetic field cancer scares

The internal electric current or power levels that a human is likely to encounter in a typical electromagnetic field environment are calculated. At 60 Hz, a reasonable value for maximum permissible exposure is an internal current density of 1 microA cm(-2). At this frequency, a 600 V m(-1) electric field results in a current density of 0.0002 microA cm(-2), while a 200 microT magnetic field results in 0.6 microA cm(-2). This should be compared with an action potential, which is associated with a current density of 800 microA cm(-2). The ANSI/IEEE C95.1-1991 standards, whose frequency range is 3 kHz to 300 GHz, are examined. Epidemiological studies are briefly considered. The conclusion is that it is highly unlikely that there is a link between electromagnetic fields and cancer.

In vivo observation of cavitation on prosthetic heart valves

In this study, a method to determine the existence of prosthetic heart valve cavitation in vivo is presented. Pennsylvania State University Left Ventricular Assist Devices (LVADs) were implanted in two separate calves for this study. Björk-Shiley Monostrut (Irvine, CA) 27 mm and 25 mm valves with Delrin occluders were used in the mitral and aortic positions, respectively. A high fidelity, piezoelectric pressure transducer was mounted approximately 1.25 cm proximal to the mitral valve and measured the high frequency pressure fluctuations caused by cavitation bubble formation and collapse after valve closure. The root mean square (RMS) value of the mitral pressure signal during a 5 ms interval after valve closure was used as a measure of cavitation intensity. The pressure signals observed in vivo were similar to ones observed in vitro with the same type of pressure transducer and were associated with the visually observed cavitation. The percentage of beats with cavitation increased from 20.3% to 67.7% when pump filling was decreased by increasing beat rate. A blood test conducted during post-operative days 1-3 showed a significant increase in plasma hemoglobin during the low filling condition. However, blood tests conducted later (post-operative days 7-44) did not show a significant change in plasma hemoglobin during low filling conditions.

Mitral heart valve cavitation in an artificial heart environment

BACKGROUND AND AIMS OF THE STUDY

The formation and subsequent collapse of vaporous cavities in the fluid around mechanical heart valves at valve closure can create stresses large enough to damage both the valve itself and blood cells. Improved understanding of cavitation mechanisms should lead to a reduction in the cavitation potential of future valve designs.

MATERIALS AND METHODS

This study compares eight mechanical mitral valves of two different geometries (Monostrut and Medtronic Hall), occluder housing gaps (tight, medium, and leaky), and occluder materials (Delrin and pyrolytic carbon). The valves were evaluated in a model ventricle of the Penn State Electric Ventricular Assist Device (EVAD) operating within a mock circulatory loop. The EVAD represents one half of a total artificial heart. The mock loop consisted of silicone tubing connected to elements designed to mimic the compliant and resistant properties of the natural circulation. Cavitation was controlled by varying the degree of filling of the ventricle: low filling caused higher valve closing velocities resulting in greater cavitation intensities than complete filling of the ventricle. The intensity of cavitation was quantified using a parameter derived from the high frequency fluctuations in the mitral pressure that occur around the valve during cavitation events. The shape of the cavitation pressure signature and that of the power spectrum of the cavitation pressure signature were used in addition to the cavitation intensity parameter to make comparisons between valves.

RESULTS

Of the three valve characteristics studied, occluder material showed the most significant influence on cavitation intensity: valves with pyrolytic carbon occluders demonstrated greater cavitation than did those with Delrin discs.

CONCLUSION

It is hypothesized that the dominant form of cavitation on the valves studied is related to vortex formation and that occluder material influences the intensity of cavitation through the strength of the tension wave generated at valve closure, while geometry and gap have only secondary effects. Future studies are planned to incorporate this technique in an in vivo environment.

Alterations in brain monoamines and GABAA receptors in transgenic mice overexpressing TGF alpha

This study investigated the possibility that overexpression of transforming growth factor alpha (TGF alpha) changes those neurotransmitter systems that have been associated with behaviors found to be altered in the transgenic TGF alpha CD-1 mice. The female TGF alpha mice showed elevated levels of norepinephrine (NE) in the hypothalamus and serotonin (5-HT) in the cortex and brain stem when compared with nontransgenic CD-1 females. The concentrations of monoamines were not altered in the male transgenic brain. The 5-hydroxyindoleacitic acid (5-HIAA)/5-HT ratio was significantly reduced in the brain stem of the male TGF alpha mice and frontal cortex in the female transgenics. The binding of the [3H]GBR 12935-labeled DA transporter was lower in the frontal cortex in the transgenic male TGF alpha mice than in the female TGF alpha mice. No gender difference in dopamine (DA) transporter binding was noted between the nontransgenic male and female mice. Serotonin and GABAA receptors were measured only in males. No differences in the number of 5-HT1A and 5-HT2 receptors were found in the cortex or hippocampus. Maximal GABA stimulation of [3H]flunitrazepam binding in the forebrain hemispheres and cerebellar binding of an imidazobenzodiazepine, [3H]Ro 15-4513, were not different between transgenic and nontransgenic male mice. However, forebrain [35S]TBPS binding in male TGF alpha mice was less affected by the blockade of the GABA agonist sites by the specific GABAA antagonists SR 95531 and bicuculline than the binding of the controls, suggesting either altered endogenous GABA concentrations or a change in receptor populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Luteal phase defects and ectopic pregnancy

OBJECTIVE

To determine whether luteal phase defect (LPD) may be an etiologic factor in ectopic pregnancy (EP).

DESIGN

All patients who were seen over a 6-year period with the chief complaint of infertility underwent an extensive infertility workup and were followed prospectively. The diagnoses of the causes of infertility were assigned retrospectively.

SETTING

Two hospital-based tertiary care reproductive endocrine-infertility units.

PATIENTS

A total of 1,077 infertility patients were evaluated. Of the 633 who became pregnant, the infertility had been due to LPD in 51 and to anovulation in 210.

MAIN OUTCOME MEASURES

All the infertility patients who became pregnant were followed to determine whether they miscarried, developed an EP, or had a viable birth. The incidence of EP and miscarriage in the patients whose infertility was found to be due to LPD were compared with a control group in whom the infertility was due to anovulation.

RESULTS

The EP rate in the patients with LPD was significantly higher than in a control group whose infertility was due to anovulation (6 of 51 pregnancies versus 6 of 210 pregnancies, respectively). The spontaneous abortion rate in LPD cases also was highly significantly greater than in the control group (19 of 51 pregnancies versus 12 of 210 pregnancies, respectively). The EP and spontaneous abortion rates also were higher in patients with LPD who were untreated than in those who were treated.

CONCLUSIONS

This study suggests that there is a significantly increased incidence of tubal EP in patients with LPD and that when patients with LPD become pregnant early ultrasound should be performed to rule out EP. The study also indicated that spontaneous abortion occurs in a significantly high percentage of LPD cases.

A method for real-time in vitro observation of cavitation on prosthetic heart valves

A method for real-time in vitro observation of cavitation on a prosthetic heart valve has been developed. Cavitation of four blood analog fluids (distilled water, aqueous glycerin, aqueous polyacrylamide, and aqueous xanthan gum) has been documented for a Medtronic/Hall prosthetic heart valve. This method employed a Penn State Electrical Ventricular Assist Device in a mock circulatory loop that was operated in a partial filling mode associated with reduced atrial filling pressure. The observations were made on a valve that was located in the mitral position, with the cavitation occurring on the inlet side after valve closure on every cycle. Stroboscopic videography was used to document the cavity life cycle. Bubble cavitation was observed on the valve occluder face. Vortex cavitation was observed at two locations in the vicinity of the valve occluder and housing. For each fluid, cavity growth and collapse occurred in less than one millisecond, which provides strong evidence that the cavitation is vaporous rather than gaseous. The cavity duration time was found to decrease with increasing atrial pressure at constant aortic pressure and beat rate. The area of cavitation was found to decrease with increasing delay time at a constant aortic pressure, atrial pressure, and beat rate. Cavitation was found to occur in each of the fluids, with the most cavitation seen in the Newtonian fluids (distilled water and aqueous glycerin).