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Stuck Mitral Bio-Prosthetic Valve

Transthoracic echocardiography demonstrating increased flow velocity across the mitral bioprosthesis (A), with prolongation of pressure half-time and elevated mean pressure gradient (B); two-dimensional transesophageal echocardiography showing marked thickening of two of the three mitral leaflets (C systolic frame, D diastolic frame).

particularly for bioprosthesis at mitral position.

Transthoracic echocardiography demonstrating increased flow velocity across the mitral bioprosthesis (A), with prolongation of pressure half-time and elevated mean pressure gradient (B); two-dimensional transesophageal echocardiography showing marked thickening of two of the three mitral leaflets (C systolic frame, D diastolic frame).

Assessment of mitral bioprosthesis - YouTube

Falahatpisheh is helping develop the first bileaflet bioprosthetic mitral valve ..

Follow-up two-dimensional transesophageal echocardiography showing normal flow velocity (A) and mean pressure gradient (B) across the mitral bioprosthesis.

Follow-up two-dimensional transesophageal echocardiography showing normal flow velocity (A) and mean pressure gradient (B) across the mitral bioprosthesis.

Balloon valvoplasty of mitral bioprosthesis - ScienceDirect

in stenotic mitral bioprosthesis.

MDCT plays an essential role in planning transcatheter mitral valve implantation, to determine the true internal diameter of the dysfunctional bioprosthesis, select the correct size of the replacement valve and prevent periprocedural complications such as the valve becoming wedged against the stent posts, paravalvular leak or valve migration.

Based on our experience with three cases of transcatheter double valve (aortic and mitral) implantation by a transapical approach, we describe the essential steps in preprocedural planning using multidetector computed tomography (MDCT). The first step is to identify the brand and size of the previously implanted bioprosthesis. The true internal diameter of this valve is then determined by MDCT (mean of major and minor axes, ), which is usually less than the labeled prosthesis size. The true internal diameter should be confirmed by referring to conversion tables or software apps such as ViV (Valve-In-Valve). The internal diameter between the stent posts of the bioprosthesis is then measured (), since if this is less than the true internal diameter due to deformation of the stent posts, it can prevent transcatheter valve-in-valve implantation. This information is then used to select the correct size of the valve to be implanted and the procedure can commence.

Beta Blocker Therapy in Patients After Mitral Valve Bioprosthesis Replacement
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Pannus Ingrowth Mitral Bioprosthesis

A 73-year-old woman presented to the emergency department with a two-month history of progressive dyspnea on exertion. Fifteen months earlier she had undergone mitral valve replacement with a bioprosthesis due to severe mitral regurgitation. Her postoperative treatment included antiplatelet therapy with aspirin and oral anticoagulation, but both medications were discontinued six months after the surgery. Transthoracic echocardiography showed prolongation of mitral pressure half-time suggestive of prosthesis dysfunction (A and B, Video 1). Transesophageal echocardiography (TEE) revealed thickening of two of the three prosthetic mitral leaflets, with restricted mobility. The anterior leaflet opened normally, resulting in severe stenosis with a total effective area of 0.81 cm calculated by three-dimensional (3D) planimetry (C and D, A–C, Videos 2–4). Diuretics, aspirin and anticoagulation were initiated and the patient was discharged home on day 3 with a presumptive diagnosis of prosthetic valve thrombosis. Follow-up TEE performed two months later showed normal thickness of the three leaflets with normal opening and an effective area of 1.7 cm assessed by 3D echocardiography (D–F, , Videos 5 and 6). This case demonstrates the utility of 3D TEE to define the anatomy of the obstructed prosthesis and how the thrombus impairs leaflet function. In addition, it illustrates the potential benefit of maintaining antiplatelet therapy in patients with a bioprosthetic mitral valve and no other risk factors for thromboembolism, as recommended in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease.

Dabigatran Versus Warfarin After Mitral and/or Aortic Bioprosthesis …

Heart valves play an important role in directing blood flow and preventing back flow in the heart. Design and development of bioprosthetic heart valves has been a major focus of research in the field of cardiovascular engineering as they are a better replacement for natural diseased valves than mechanical heart valves. However, one of the major problems facing bioprosthetic heart valves involves excessive stress around the tip of the leaflet which can lead to calcification. Reducing this stress can potentially increase the valve.s longevity and will result in a lower risk of fatigue and leaflet tearing, and ultimately minimize the chance of valve degeneration and failure.

This project is focused on the assessment of mechanical behavior and optimization of a bi-leaflet bioprosthetic mitral valve by using Finite Element Analysis. The latest constitutive law for the tissue is employed, which takes into account the tissue's dependency on fiber direction. The framework of this study can be easily used to design, analyze, and optimize all types of bioprosthetic heart valves.

To model the stress distribution over the valve.s leaflets using the finite element method, the solid geometry of the Nitinol framework and the leaflets were developed independently and then imported into a computational analysis software environment. We used CATIA V5R19 (Dassault Systès, Lowell, MA) as our mechanical design software and ABAQUS 6.9-EF1 (SIMULIA, Warwick, RI) for computational analysis. Material behavior of the Nitinol framework was modeled as a superelastic material. The constitutive models for the mitral leaflets were adopted from May-Newman and Yin. A user-defined code has been written to apply this strain energy function using UMAT user subroutine in ABAQUS. ABAQUS/STANDARD was used for this simulation. Results show the saddle annulus motion of the valve mitigates the stress over the leaflets, and can potentially reduce the chance of leaflet mechanical failure. This is due to the dynamic saddle annulus which adapts a configuration with the lowest energy.

Mitral bioprosthesis hypertrophic scaring and native …

Reoperation after mitral valve surgery due to bioprosthesis dysfunction is associated with high morbidity and mortality. A possible alternative for patients at high surgical risk is transcatheter implantation of a prosthesis in reverse position using the valve-in-valve technique.

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