In vitro study of flow regulation for pulmonary insufficiency.

Given the tolerance of the right heart circulation to mild regurgitation and gradient, we study the potential of using motionless devices to regulate the pulmonary circulation. In addition, we document the flow performance of two mechanical valves. A motionless diode, a nozzle, a mechanical bileaflet valve, and a tilting disk valve were tested in a pulmonary mock circulatory system over the normal human range of pulmonary vascular resistance (PVR). For the mechanical valves, regurgitant fractions (RFs) and transvalvular pressure gradients were found to be weak functions of PVR. On the low end of normal PVR, the bileaflet and tilting disk valves fluttered and would not fully close. Despite this anomaly, the regurgitant fraction of either valve did not change significantly. The values for RF and transvalvular gradient measured varied from 4 to 7% and 4 to 7 mm Hg, respectively, at 5 lpm for all tests. The diode valve was able to regulate flow with mild regurgitant fraction and trivial gradient but with values higher than either mechanical valve tested. Regurgitant fraction ranged from 2 to 17% in tests extending from PVR values of 1 to 4.5 mm Hg/lpm at 5 lpm and with concomitant increases in gradient up to 17 mm Hg. The regurgitant fraction for the nozzle increased from 2 to 23% over the range of PVR with gradients increasing to 18 mm Hg. The significant findings were: (1) the mechanical valves controlled regurgitation at normal physiological cardiac output and PVR even though they failed to close at some normal values of PVR and showed leaflet flutter; and (2) it may be possible to regulate the pulmonary circulation to tolerable levels using a motionless pulmonary valve device.

On the hemolytic and thrombogenic potential of occluder prosthetic heart valves from in-vitro measurements.

An experimental investigation was conducted to determine the magnitude of shear stresses and areas of stasis of several types of prosthetic occluder heart valves. These experiments were performed in a steady-flow test loop using an axisymmetric aortic-shaped test chamber and an aqueous-glycerine solution. The flow loop produced a low-turbulence intensity and uniform mean velocity profile upstream of the test chamber. Tests were performed on a Kay-Shiley disk, a Bjork-Shiley tilting disk and Starr-Edwards Models 1260 and 2320 ball prostheses at Reynolds numbers between 2000 and 6200. Momentum transfer and turbulence data were obtained both around and distal to the valve occluders using laser Doppler and hot-film anemometry. The region directly surrounding the valve occluders contained the largest stresses measured. Aortic wall shear measurements revealed magnitudes potentially damaging to the vessel lining. Regions of slowly moving separated flow found to exist in these occluder valve flow fields correlated with clinical findings of thrombus formation.