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El-Nashar H, Sabry M, Tseng YT, Francis N, Latif N, Parker KH, Moore JE, Yacoub MH. Multiscale structure and function of the aortic valve apparatus. Physiol Rev 2024; 104:1487-1532. [PMID: 37732828 DOI: 10.1152/physrev.00038.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
Whereas studying the aortic valve in isolation has facilitated the development of life-saving procedures and technologies, the dynamic interplay of the aortic valve and its surrounding structures is vital to preserving their function across the wide range of conditions encountered in an active lifestyle. Our view is that these structures should be viewed as an integrated functional unit, here referred to as the aortic valve apparatus (AVA). The coupling of the aortic valve and root, left ventricular outflow tract, and blood circulation is crucial for AVA's functions: unidirectional flow out of the left ventricle, coronary perfusion, reservoir function, and support of left ventricular function. In this review, we explore the multiscale biological and physical phenomena that underlie the simultaneous fulfillment of these functions. A brief overview of the tools used to investigate the AVA, such as medical imaging modalities, experimental methods, and computational modeling, specifically fluid-structure interaction (FSI) simulations, is included. Some pathologies affecting the AVA are explored, and insights are provided on treatments and interventions that aim to maintain quality of life. The concepts explained in this article support the idea of AVA being an integrated functional unit and help identify unanswered research questions. Incorporating phenomena through the molecular, micro, meso, and whole tissue scales is crucial for understanding the sophisticated normal functions and diseases of the AVA.
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Affiliation(s)
- Hussam El-Nashar
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Malak Sabry
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Yuan-Tsan Tseng
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nadine Francis
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Najma Latif
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - James E Moore
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Magdi H Yacoub
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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2
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Aggarwal A, Mortensen P, Hao J, Kaczmarczyk Ł, Cheung AT, Al Ghofaily L, Gorman RC, Desai ND, Bavaria JE, Pouch AM. Strain estimation in aortic roots from 4D echocardiographic images using medial modeling and deformable registration. Med Image Anal 2023; 87:102804. [PMID: 37060701 PMCID: PMC10358753 DOI: 10.1016/j.media.2023.102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/30/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
Even though the central role of mechanics in the cardiovascular system is widely recognized, estimating mechanical deformation and strains in-vivo remains an ongoing practical challenge. Herein, we present a semi-automated framework to estimate strains from four-dimensional (4D) echocardiographic images and apply it to the aortic roots of patients with normal trileaflet aortic valves (TAV) and congenital bicuspid aortic valves (BAV). The method is based on fully nonlinear shell-based kinematics, which divides the strains into in-plane (shear and dilatational) and out-of-plane components. The results indicate that, even for size-matched non-aneurysmal aortic roots, BAV patients experience larger regional shear strains in their aortic roots. This elevated strains might be a contributing factor to the higher risk of aneurysm development in BAV patients. The proposed framework is openly available and applicable to any tubular structures.
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Affiliation(s)
- Ankush Aggarwal
- Glasgow Computational Engineering Centre, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8LT, Scotland, United Kingdom
| | - Peter Mortensen
- Glasgow Computational Engineering Centre, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8LT, Scotland, United Kingdom
| | - Jilei Hao
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Łukasz Kaczmarczyk
- Glasgow Computational Engineering Centre, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8LT, Scotland, United Kingdom
| | - Albert T Cheung
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Lourdes Al Ghofaily
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nimesh D Desai
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison M Pouch
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.
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3
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Biomechanics of Pulmonary Autograft as Living Tissue: A Systematic Review. Bioengineering (Basel) 2022; 9:bioengineering9090456. [PMID: 36135002 PMCID: PMC9495771 DOI: 10.3390/bioengineering9090456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: The choice of valve substitute for aortic valve surgery is tailored to the patient with specific indications and contraindications to consider. The use of an autologous pulmonary artery (PA) with a simultaneous homograft in the pulmonary position is called a Ross procedure. It permits somatic growth and the avoidance of lifelong anticoagulation. Concerns remain on the functionality of a pulmonary autograft in the aortic position when exposed to systemic pressure. Methods: A literature review was performed incorporating the following databases: Pub Med (1996 to present), Ovid Medline (1958 to present), and Ovid Embase (1982 to present), which was run on 1 January 2022 with the following targeted words: biomechanics of pulmonary autograft, biomechanics of Ross operation, aortic valve replacement and pulmonary autograph, aortic valve replacement and Ross procedure. To address the issues with heterogeneity, studies involving the pediatric cohort were also analyzed separately. The outcomes measured were early- and late-graft failure alongside mortality. Results: a total of 8468 patients were included based on 40 studies (7796 in pediatric cohort and young adult series and 672 in pediatric series). There was considerable experience accumulated by various institutions around the world. Late rates of biomechanical failure and mortality were low and comparable to the general population. The biomechanical properties of the PA were superior to other valve substitutes. Mathematical and finite element analysis studies have shown the potential stress-shielding effects of the PA root. Conclusion: The Ross procedure has excellent durability and longevity in clinical and biomechanical studies. The use of external reinforcements such as semi-resorbable scaffolds may further extend their longevity.
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4
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Saisho H, Scharfschwerdt M, Schaller T, Sadat N, Aboud A, Ensminger S, Fujita B. Ex vivo evaluation of the Ozaki procedure in comparison with the native aortic valve and prosthetic valves. Interact Cardiovasc Thorac Surg 2022; 35:6650697. [PMID: 35895002 PMCID: PMC9443990 DOI: 10.1093/icvts/ivac199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Tim Schaller
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research—Partner Site Hamburg/Kiel/Lübeck) , Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research—Partner Site Hamburg/Kiel/Lübeck) , Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research—Partner Site Hamburg/Kiel/Lübeck) , Germany
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5
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Lu P, Wang P, Wu B, Wang Y, Liu Y, Cheng W, Feng X, Yuan X, Atteya MM, Ferro H, Sugi Y, Rydquist G, Esmaily M, Butcher JT, Chang CP, Lenz J, Zheng D, Zhou B. A SOX17-PDGFB signaling axis regulates aortic root development. Nat Commun 2022; 13:4065. [PMID: 35831318 PMCID: PMC9279414 DOI: 10.1038/s41467-022-31815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 06/30/2022] [Indexed: 11/08/2022] Open
Abstract
Developmental etiologies causing complex congenital aortic root abnormalities are unknown. Here we show that deletion of Sox17 in aortic root endothelium in mice causes underdeveloped aortic root leading to a bicuspid aortic valve due to the absence of non-coronary leaflet and mispositioned left coronary ostium. The respective defects are associated with reduced proliferation of non-coronary leaflet mesenchyme and aortic root smooth muscle derived from the second heart field cardiomyocytes. Mechanistically, SOX17 occupies a Pdgfb transcriptional enhancer to promote its transcription and Sox17 deletion inhibits the endothelial Pdgfb transcription and PDGFB growth signaling to the non-coronary leaflet mesenchyme. Restoration of PDGFB in aortic root endothelium rescues the non-coronary leaflet and left coronary ostium defects in Sox17 nulls. These data support a SOX17-PDGFB axis underlying aortic root development that is critical for aortic valve and coronary ostium patterning, thereby informing a potential shared disease mechanism for concurrent anomalous aortic valve and coronary arteries.
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Affiliation(s)
- Pengfei Lu
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ping Wang
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Bingruo Wu
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yidong Wang
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Center, School of Basic Medical Sciences, Jiaotong University, Xi'an, Shanxi, China
| | - Yang Liu
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wei Cheng
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xuhui Feng
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xinchun Yuan
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
- The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Miriam M Atteya
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Haleigh Ferro
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Yukiko Sugi
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Grant Rydquist
- School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Mahdi Esmaily
- School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | | | - Ching-Pin Chang
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jack Lenz
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
- Departments of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Deyou Zheng
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA.
- Departments of Neurology and Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Bin Zhou
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA.
- Departments of Pediatrics and Medicine (Cardiology), Albert Einstein College of Medicine, Bronx, NY, USA.
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6
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Shao Z, Tao T, Xu H, Chen C, Lee I, Chung S, Dong Z, Li W, Ma L, Bai H, Chen Q. Recent progress in biomaterials for heart valve replacement: Structure, function, and biomimetic design. VIEW 2021. [DOI: 10.1002/viw.20200142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ziyu Shao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University Hangzhou 310006 China
- State Key Laboratory of Chemical Engineering College of Chemical and Biological Engineering Zhejiang University Hangzhou China
| | - Tingting Tao
- Department of Cardiovascular Surgery The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang Province China
| | - Hongfei Xu
- Department of Cardiovascular Surgery The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang Province China
| | - Cen Chen
- College of Life Sciences and Medicine Zhejiang Sci‐Tech University Hangzhou China
| | - In‐Seop Lee
- College of Life Sciences and Medicine Zhejiang Sci‐Tech University Hangzhou China
- Institute of Natural Sciences Yonsei University Seoul Republic of Korea
| | - Sungmin Chung
- Biomaterials R&D Center GENOSS Co., Ltd. Suwon‐si Republic of Korea
| | - Zhihui Dong
- State Key Laboratory of Chemical Engineering College of Chemical and Biological Engineering Zhejiang University Hangzhou China
| | - Weidong Li
- Department of Cardiovascular Surgery The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang Province China
| | - Liang Ma
- Department of Cardiovascular Surgery The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang Province China
| | - Hao Bai
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University Hangzhou 310006 China
- State Key Laboratory of Chemical Engineering College of Chemical and Biological Engineering Zhejiang University Hangzhou China
| | - Qianming Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University Hangzhou 310006 China
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7
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Mazine A, El-Hamamsy I, Verma S, Peterson MD, Bonow RO, Yacoub MH, David TE, Bhatt DL. Ross Procedure in Adults for Cardiologists and Cardiac Surgeons. J Am Coll Cardiol 2018; 72:2761-2777. [DOI: 10.1016/j.jacc.2018.08.2200] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/19/2018] [Indexed: 01/07/2023]
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8
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Zhang J, Du J, Xia D, Liu J, Wu T, Shi J, Song W, Jin D, Mo X, Yin M. Preliminary study of a novel nanofiber-based valve integrated tubular graft as an alternative for a pulmonary valved artery. RSC Adv 2016. [DOI: 10.1039/c6ra16292d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A tri-leaflet valve integrated tubular scaffold was obtained using a 3D printing mold by TIPS. After testing its valuvalar performance via computational fluid dynamics, the biocompatibility of resultant valve scaffold was evaluated in vivo.
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9
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Stanger O, Bleuel I, Gisler F, Göber V, Reineke S, Gahl B, Aymard T, Englberger L, Carrel T, Tevaearai H. The Freedom Solo pericardial stentless valve: Single-center experience, outcomes, and long-term durability. J Thorac Cardiovasc Surg 2015; 150:70-7. [DOI: 10.1016/j.jtcvs.2015.01.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/08/2015] [Accepted: 01/24/2015] [Indexed: 11/30/2022]
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10
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11
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de Heer LM, Budde RP, van Prehn J, Mali WP, Bartels LW, Stella PR, van Herwerden LA, Kluin J, Vincken KL. Pulsatile Distention of the Nondiseased and Stenotic Aortic Valve Annulus: Analysis With Electrocardiogram-Gated Computed Tomography. Ann Thorac Surg 2012; 93:516-22. [DOI: 10.1016/j.athoracsur.2011.08.068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 10/14/2022]
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12
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Izumi C, Miyake M, Takahashi S, Hayashi H, Miyanishi T, Matsutani H, Hashiwada S, Kuwano K, Sakamoto J, Nakagawa Y. Usefulness of real-time three-dimensional echocardiography in evaluating aortic root diameters during a cardiac cycle. J Echocardiogr 2012; 10:8-14. [DOI: 10.1007/s12574-011-0104-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 11/28/2010] [Accepted: 12/02/2010] [Indexed: 10/14/2022]
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13
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Torii R, Xu XY, El-Hamamsy I, Mohiaddin R, Yacoub MH. Computational biomechanics of the aortic root. ACTA ACUST UNITED AC 2011. [DOI: 10.5339/ahcsps.2011.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ryo Torii
- 1Qatar Cardiovascular Research Center, Doha,
Qatar
- 2Harefield Heart Science Centre, Imperial College London, Harefield,
UK
- 5Department of Chemical Engineering,
Imperial College London, London, UK
| | - Xiao Yun Xu
- 5Department of Chemical Engineering,
Imperial College London, London, UK
| | - Ismail El-Hamamsy
- 4Department of Cardiac Surgery, Montreal
Heart Institute, Montreal, Canada
| | - Raad Mohiaddin
- 3Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital and
Imperial College London, London, UK
| | - Magdi H. Yacoub
- 1Qatar Cardiovascular Research Center, Doha,
Qatar
- 2Harefield Heart Science Centre, Imperial College London, Harefield,
UK
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14
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de Heer LM, Budde RPJ, Mali WPTM, de Vos AM, van Herwerden LA, Kluin J. Aortic root dimension changes during systole and diastole: evaluation with ECG-gated multidetector row computed tomography. Int J Cardiovasc Imaging 2011; 27:1195-204. [PMID: 21359833 PMCID: PMC3230759 DOI: 10.1007/s10554-011-9838-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 02/16/2011] [Indexed: 10/27/2022]
Abstract
Cardiac pulsatility and aortic compliance may result in aortic area and diameter changes throughout the cardiac cycle in the entire aorta. Until this moment these dynamic changes could never be established in the aortic root (aortic annulus, sinuses of Valsalva and sinotubular junction). The aim of this study was to visualize and characterize the changes in aortic root dimensions during systole and diastole with ECG-gated multidetector row computed tomography (MDCT). MDCT scans of subjects without aortic root disease were analyzed. Retrospectively, ECG-gated reconstructions at each 10% of the cardiac cycle were made and analyzed during systole (30-40%) and diastole (70-75%). Axial planes were reconstructed at three different levels of the aortic root. At each level the maximal and its perpendicular luminal dimension were measured. The mean dimensions of the total study group (n = 108, mean age 56 ± 13 years) do not show any significant difference between systole and diastole. The individual dimensions vary up to 5 mm. However, the differences range between minus 5 mm (diastolic dimension is greater than systolic dimensions) and 5 mm (vice versa). This variability is independent of gender, age, height and weight. This study demonstrated a significant individual dynamic change in the dimensions of the aortic root. These results are highly unpredictable. Most of the healthy subjects have larger systolic dimensions, however, some do have larger diastolic dimensions.
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Affiliation(s)
- Linda M de Heer
- Department of Cardio-Thoracic Surgery, Division of Heart and Lungs, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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15
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Song JM. Aortic root volume and geometry: ready for clinical application? J Cardiovasc Ultrasound 2011; 19:126-7. [PMID: 22073321 PMCID: PMC3209590 DOI: 10.4250/jcu.2011.19.3.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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16
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Characterization of Mitral Valve Annular Dynamics in the Beating Heart. Ann Biomed Eng 2011; 39:1690-702. [DOI: 10.1007/s10439-011-0272-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 02/04/2011] [Indexed: 11/25/2022]
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17
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Bowles CT, New SEP, Van Loon R, Dreger SA, Biglino G, Chan C, Parker KH, Chester AH, Yacoub MH, Taylor PM. Hydrodynamic Evaluation of a Bioreactor for Tissue Engineering Heart Valves. Cardiovasc Eng Technol 2010. [DOI: 10.1007/s13239-010-0007-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Yacoub MH, El-Hamamsy I, Said K, Magdi G, Abul Enein F, George R, Rossi A, Olivotto I, Cecchi F. The left ventricular outflow in hypertrophic cardiomyopathy: from structure to function. J Cardiovasc Transl Res 2009; 2:510-7. [PMID: 20560010 DOI: 10.1007/s12265-009-9153-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 11/04/2009] [Indexed: 10/20/2022]
Abstract
Left ventricular outflow tract obstruction (LVOTO) is one of the defining features of hypertrophic cardiomyopathy (HCM) and one of the main determinants of prognosis. Although the importance of obstruction was recognized since the original description by Teare and Brock, its exact cause and methods for its relief are still being hotly debated. We believe that a rational approach to solving these issues depends on thorough understanding of the specific structure and functions of the left ventricular outflow tract (LVOT) in health and disease. There is now compelling evidence that the LVOT performs a series of vital sophisticated functions which are mediated by the design characteristics, structure, and biological properties of its component parts and that dysregulation of one or more of these functions results in obstruction and other abnormalities. We here review the integrated functions of the LVOT, its structural and functional relationships, with particular reference to its component parts (the major players) and their role in HCM. This knowledge is essential to evolve tailored restorative techniques for treating HCM.
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Affiliation(s)
- Magdi H Yacoub
- Harefield Heart Science Center, Harefield Hospital, London, UK.
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19
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Hjortnaes J, Bouten CV, Van Herwerden LA, Gründeman PF, Kluin J. Translating Autologous Heart Valve Tissue Engineering from Bench to Bed. TISSUE ENGINEERING PART B-REVIEWS 2009; 15:307-17. [DOI: 10.1089/ten.teb.2008.0565] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jesper Hjortnaes
- Division of Heart & Lungs, Department of Clinical and Experimental Cardio-Thoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlijn V.C. Bouten
- Division of Heart & Lungs, Department of Clinical and Experimental Cardio-Thoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Cell & Tissue Engineering Laboratory, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Lex A. Van Herwerden
- Division of Heart & Lungs, Department of Clinical and Experimental Cardio-Thoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul F. Gründeman
- Division of Heart & Lungs, Department of Clinical and Experimental Cardio-Thoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jolanda Kluin
- Division of Heart & Lungs, Department of Clinical and Experimental Cardio-Thoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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20
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Emilsson K, Egerlid R, Magnuson A, Nygren BM. Comparison between aortic, mitral and tricuspid annular velocities measured with quantitative two-dimensional color Doppler tissue imaging in healthy subjects. Clin Physiol Funct Imaging 2007; 27:275-83. [PMID: 17697023 DOI: 10.1111/j.1475-097x.2007.00748.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the systolic, early and late diastolic velocities of the aortic, mitral and tricuspid annuli in healthy subjects and to study the intraobserver and interobserver reproducibility (IIOR) of measuring the velocities at the aortic annulus. METHODS Twenty healthy subjects with mean age 28 years were investigated with quantitative two-dimensional color Doppler tissue imaging and the systolic, early and late diastolic velocities were measured at the aortic, mitral and tricuspid annuli. RESULTS The mitral annulus had significant higher systolic velocity and early diastolic velocity than the aortic annulus. The late diastolic velocity was significant lower at the aortic annulus compared with the both other annuli. At the different sites of the annuli the highest systolic velocity and early diastolic velocity were measured at the lateral site of the mitral annulus, whereas the lowest systolic velocity was measured at the septal site of the same annulus. The lowest early diastolic velocity was found at the septal site of the aortic annulus. The highest late diastolic velocity was measured at the lateral site of the tricuspid annulus and the lowest at the lateral site of the aortic annulus. CONCLUSIONS The mitral annulus has statistical significant higher systolic and early diastolic velocities than the aortic annulus. There are significant differences in velocities between several of the different sites of the annuli. IIOR of measuring the systolic and early diastolic velocities of the aortic annulus is good.
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Affiliation(s)
- K Emilsson
- Department of Clinical Physiology, Orebro University Hospital, SE-701 85 Orebro, Sweden.
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Luciani GB, Santini F, Mazzucco A. Autografts, homografts, and xenografts: overview on stentless aortic valve surgery. J Cardiovasc Med (Hagerstown) 2007; 8:91-6. [PMID: 17299289 DOI: 10.2459/01.jcm.0000260208.98246.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Stentless valves, either human (autografts, homografts) or animal (porcine xenografts), were historically among the first substitutes to be used to replace the diseased aortic valve. Forty years after those pioneering days and 15 years after revival of such valves, stentless grafts have become a mainstay in aortic surgery. Although limitations associated with the use of autografts, homografts and xenografts remain, stentless valves have profoundly improved quality of life after aortic valve/root replacement. In addition, stentless surgery has greatly advanced the understanding of aortic root anatomy, physiology and pathology among surgeons.
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Affiliation(s)
- Magdi H Yacoub
- Imperial College School of Medicine, Heart Science Centre, Harefield Research Foundation, Harefield, Middlesex, UK.
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