Key result
Severe prosthetic stenosis resulted in a two-fold increase in peak jet velocity and a three-fold increase in peak turbulence kinetic energy compared to moderate stenosis in an in vitro model.
Why the study?
Bioprosthetic aortic valve leaflets deteriorate over time due to calcification, but the hemodynamics induced by prosthetic stenosis are complicated and not fully understood.
In vitro modeling demonstrates that severe prosthetic aortic valve stenosis significantly increases peak jet velocity and turbulence kinetic energy compared to moderate stenosis, potentially increasing the risk of platelet activation.
May elevate platelet activation risk in severe prosthetic stenosis; hypothesis-generating, requiring in vivo validation before practice change.
Bioprosthetic valves are widely used for aortic valve replacements for patients with severe aortic diseases. However, tissue-engineered leaflets normally deteriorate over time due to calcification, leading to life-threatening conditions that would require re-operation. The hemodynamics induced by a prosthetic stenosis is complicated and not fully understood. This in vitro experimental study focuses on the fluid dynamics of two aortic valve models with different prosthetic stenosis conditions. An in vitro cardiovascular flow simulator was utilized to provide the pulsatile physiological flow conditions. Phase-locked particle image velocimetry (PIV) and high-frequency pressure sensors were employed to measure the flow fields and pressure waveforms. Pressure data were evaluated for the two models representing moderate and severe stenosis conditions, respectively. The severe prosthetic stenosis induced a prolonged ejection period and increased acceleration time ratio. PIV results suggest the severe prosthetic stenosis resulted in a two-fold increase in peak jet velocity and a three-fold increase in peak turbulence kinetic energy compared to the moderate stenosis case. The severe stenosis also caused rapid expansion of the jet downstream of the valve orifice and increased eccentricity of the jet flow. The maximum Reynolds shear stress in the severe stenosis case was found similar to the bileaflet mechanical valve reported by previous literature, which was below the risk threshold of blood cell damage but could potentially increase the risks of platelet activation and aggregation.
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Zhang et al. (2020) studied Prosthetic aortic valve stenosis. Severe prosthetic stenosis model vs. Moderate prosthetic stenosis model was evaluated on Fluid dynamics (peak jet velocity, peak turbulence kinetic energy, Reynolds shear stress). Severe prosthetic stenosis resulted in a two-fold increase in peak jet velocity and a three-fold increase in peak turbulence kinetic energy compared to moderate stenosis in an in vitro model.
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