We sought to understand how leaflet forces change in response to annular dilation
and leaflet tethering (LT) in single ventricle physiology. Explanted fetal bovine
tricuspid valves were sutured onto image-derived annuli and ventricular mounts. Control
valves (CON) were secured to a size-matched hypoplastic left heart syndrome (HLHS)-type
annulus and compared to: (1) normal tricuspid valves secured to a size-matched saddle-shaped
annulus, (2) HLHS-type annulus with LT, (3) HLHS-type annulus with annular dilation
(dilation valves), or (4) a combined disease model with both dilation and tethering
(disease valves). The specimens were tested in a systemic heart simulator at various
single ventricle physiologies. Leaflet forces were measured using optical strain sensors
sutured to each leaflet edge. Average force in the anterior leaflet was 43.2% lower
in CON compared to normal tricuspid valves (P < 0.001). LT resulted in a 6.6% increase in average forces on the anterior leaflet
(P = 0.04), 10.7% increase on the posterior leaflet (P = 0.03), and 14.1% increase on the septal leaflet (P < 0.001). In dilation valves, average septal leaflet forces increased relative to the
CON by 42.2% (P = 0.01). In disease valves, average leaflet forces increased by 54.8% in the anterior
leaflet (P < 0.001), 37.6% in the posterior leaflet (P = 0.03), and 79.9% in the septal leaflet (P < 0.001). The anterior leaflet experiences the highest forces in the normal tricuspid
annulus under single ventricle physiology conditions. Annular dilation resulted in
an increase in forces on the septal leaflet and LT resulted in an increase in forces
across all 3 leaflets. Annular dilation and LT combined resulted in the largest increase
in leaflet forces across all 3 leaflets.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
AV (atrioventricular valve), CO (cardiac output), CON (control valve), NTV (normal tricuspid valve), LT (leaflet tethering valve), DIL (dilation valve), DIS (disease valve), HLHS (hypoplastic left heart syndrome), HR (heart rate), MAP (mean arterial pressure), RV (right ventricle), SCP (septal circumferential percentage), SV (single ventricle), SVP (single ventricle physiology), TR (tricuspid regurgitation), TV (tricuspid valve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 28, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Read at the AATS 101st Annual Meeting: Featuring Aortic Symposium and Mitral Conclave, A Virtual Learning Experience, April 30-May 2, 2021.
This work was presented at the American Association of Thoracic Surgeon's 101st Meeting, Virtual, April 2021.
The authors have no conflicts of interest.
Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR003143) and the Stanford Maternal & Child Health Research Institute Pilot Grant Program. This work was also supported in part by the National Institutes of Health (NIH R01 HL089315-01, Y.J.W.). Part of this work was performed at the Stanford Nano Shared Facilities (SNSF), supported by the National Science Foundation (ECCS-1542152).
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