Comparative in vitro study of bileaflet and tilting disk valve behavior in the pulmonary position

A study of mechanical heart valve behavior in the pulmonary position as a function of pulmonary vascular resistance is reported for the St. Jude Medical bileaflet (SJMB) valve and the MedicalCV Omnicarbon (OTD) tilting disk valve. Tests were conducted in a pulmonic mock circulatory system and impedance was varied in terms of system pulmonary vascular resistance (PVR). An impedance spectrum was found using instantaneous pulmonary artery pressure and flow rate curves. Both valves fully opened and closed at and above a nominal PVR of 3.0 mmHg/L/min. The SJMB valve was prone to leaflet bounce at closure, but otherwise completely closed, at settings above and below this nominal setting. At PVR values at and below 2.0 mmHg/L/min, the SJMB valve exhibited two types of leaflet aberrant behavior: single leaflet only closure while the other leaflet fluttered, and incomplete closure where both leaflets flutter but neither remain fully closed. The OTD valve fully opened and closed to a PVR value of 1.6 mmHg/L/min. At lower values, the valve did not close. Valves designed for the left heart can show aberrant behavior under normal conditions as pulmonary valves.     

A numerical simulation of mechanical heart valve closure fluid dynamics

A computational fluid dynamics model for the analysis of the bileaflet mechanical heart valve closure process is presented. The objective of the study is to demonstrate the ability of the numerical model to simulate the leaflet motion during the closing phase in order to investigate the closure fluid dynamics and to evaluate the effect of alterations in the leaflet tip geometry. The model has been applied to six different combinations of the leaflet tip geometry and the gap width between the leaflet tip and the housing. The results show that the negative pressure quickly develops on the atrial side of the leaflet tip. The pressure becomes more negative as the leaflet closure progresses and the lowest pressure is reached before the leaflet comes to a stop in the closed position. The flow dynamics at the instant of valve closure is strongly dependent on the leaflet velocity during the closing phase. Decrease of the tip velocity by a factor of three in the last four degrees of leaflet motion leads to a 50% reduction in the negative pressure magnitude.     

Influence of stent height upon stresses on the cusps of closed bioprosthetic valves

A finite element model of a bioprosthetic heart valve was developed to determine the influence of the stent height on leaflet stresses under various pressure loading conditions after valve closure. A nonlinear solution was used to obtain the stresses in the leaflets for stent heights of 14.6 mm, 19.0 mm and 22.0 mm respectively. The basic assumptions included an elliptic-paraboloid for a relaxed leaflet shape, a rigid stent, isotropic leaflet material property with a Poisson's ratio of 0.45, a uniform leaflet thickness and a stress dependent Young's modulus. The model predicted an increase of stresses on the closed leaflets as the stent height was reduced. This observation appears to mitigate, to some extent, the hemodynamic benefits thought to accompany the reduction of stent height of bioprosthetic valves.     

Effects of Age, Water Stress, and 1-Aminocyclopropane-1-carboxylic Acid on Leaflet Movement in Albizzia julibrissin

The movement patterns of Albizzia julibrissin leaflets transferred from light to darkness differ for leaflets of different age: the older the leaflet, the slower and less completely it closes. Water stress, which enhances ethylene synthesis in other plants, and 1-aminocyclopropane-1-carboxylic acid (ACC), precursor of ethylene, both mimic the effect of aging by reducing the rate and extent of dark-induced closure. Brief far-red compared to red irradiation before darkness does not appear to alter the closure of young leaflets, but far-red preirradiation retards the closure of middle-aged and old leaflets floating on water, and middle-aged leaflets treated with ACC. A change in some membrane property and/or cell wall lignification are suggested as possible explanations for the alteration of leaflet movement.     

Guard cell starch concentration quantitatively related to stomatal aperture

Using quantitative histochemical techniques, the carbohydrate levels of guard cells from open and closed stomatal apparatus of Vicia faba L. were compared. To minimize experimental error, all comparisons were between leaflets of the same pair. Stomata on one leaflet were caused to open by light and reduced CO₂. The other leaflet, which was in darkness, had closed stomata. In one experiment, data were also collected on palisade parenchyma, spongy parenchyma, and epidermal cells.     

Annulus tension of the prolapsed mitral valve corrected by edge-to-edge repair

BackgroundMitral valve (MV) performance after edge-to-edge repair (ETER) without ring annuloplasty is suboptimal. ETER efficacy needs to be evaluated from annulus tension (AT) of a prolapsed MV corrected by ETER to understand annular dilatation.MethodsTen porcine MVs were harvested and mounted on a MV closure test rig. The MV annulus tissue rested on top of a saddle-shaped plastic ring on which the annulus could slide freely. The annulus was held by strings in the periphery during MV closure under a hydrostatic trans-mitral pressure. String tensions were measured and further divided by string spacing to obtain AT. The MVs were then prolapsed by shifting split papillary muscles to simulate mono-leaflet prolapse due to elongation of chords, which insert into a single leaflet. Last, MV prolapse was corrected by ETER applied in the central leaflet region and AT was measured.ResultsAT in both anterior and posterior leaflet prolapse corrected by ETER was less than that of normal MVs. AT in the anterior leaflet prolapse corrected by ETER was less than that in the posterior leaflet prolapse corrected by ETER.ConclusionETER does not restore the normal AT and therefore leads potential of annular dilatation. The anterior leaflet prolapse has a greater potential of annular dilatation than the posterior leaflet prolapse after ETER. Annuloplasty is recommended to maintain long-term ETER efficacy.     

Asymmetric structural features in single supported lipid bilayers containing cholesterol and GM1 resolved with synchrotron X-Ray reflectivity

The cell membrane comprises numerous protein and lipid molecules capable of asymmetric organization between leaflets and liquid-liquid phase separation. We use single supported lipid bilayers (SLBs) to model cell membranes, and study how cholesterol and asymmetrically oriented ganglioside receptor G_M1 affect membrane structure using synchrotron x-ray reflectivity. Using mixtures of cholesterol, sphingomyelin, and 1,2-dioleoyl-sn-glycero-3-phosphocholine, we characterize the structure of liquid-ordered and liquid-disordered SLBs in terms of acyl-chain density, headgroup size, and leaflet thickness. SLBs modeling the liquid-ordered phase are 10 Å thicker and have a higher acyl-chain electron density (〈ρ_chain〉 = 0.33 e⁻/ų) compared to SLBs modeling the liquid-disordered phase, or pure phosphatidylcholine SLBs (〈ρ_chain〉 = 0.28 e⁻/ų). Incorporating G_M1 into the distal bilayer leaflet results in membrane asymmetry and thickening of the leaflet of 4-9 Å. The structural effect of G_M1 is more complex in SLBs of cholesterol/sphingomyelin/1,2-dioleoyl-sn-glycero-3-phosphocholine, where the distal chains show a high electron density (〈ρ_chain〉 = 0.33 e⁻/ų) and the lipid diffusion constant is reduced by ∼50%, as measured by fluorescence microscopy. These results give quantitative information about the leaflet asymmetry and electron density changes induced by receptor molecules that penetrate a single lipid bilayer.     

Computational model of aortic valve surgical repair using grafted pericardium

Aortic valve reconstruction using leaflet grafts made from autologous pericardium is an effective surgical treatment for some forms of aortic regurgitation. Despite favorable outcomes in the hands of skilled surgeons, the procedure is underutilized because of the difficulty of sizing grafts to effectively seal with the native leaflets. Difficulty is largely due to the complex geometry and function of the valve and the lower distensibility of the graft material relative to native leaflet tissue. We used a structural finite element model to explore how a pericardial leaflet graft of various sizes interacts with two native leaflets when the valve is closed and loaded. Native leaflets and pericardium are described by anisotropic, hyperelastic constitutive laws, and we model all three leaflets explicitly and resolve leaflet contact in order to simulate repair strategies that are asymmetrical with respect to valve geometry and leaflet properties. We ran simulations with pericardial leaflet grafts of various widths (increase of 0%, 7%, 14%, 21% and 27%) and heights (increase of 0%, 13%, 27% and 40%) relative to the native leaflets. Effectiveness of valve closure was quantified based on the overlap between coapting leaflets. Results showed that graft width and height must both be increased to achieve proper valve closure, and that a graft 21% wider and 27% higher than the native leaflet creates a seal similar to a valve with three normal leaflets. Experimental validation in excised porcine aortas (n=9) corroborates the results of simulations.     

Motion of both mitral valve leaflets: a cineroentgenographic study in intact dogs.

Motion and position of both mitral leaflets were studied in five normal dogs 1-11 wk after radiopaque markers were sutured on the valve cusps and on the mitral annulus. Cinefluorograms and cineangiograms (100-120 frames/s) of left atrium and left ventricle were used to study cusp motion and intraventricular flow patterns, and to detect mitral regurgitation during sinus rhythm (42-184 beats/min) and during isolated atrial or ventricular contractions. Time-motion of both leaflets was similar throughout diastole with the exception of delayed posterior cusp opening. Peak opening and closing speeds, opening and closing times, and time of complete closure, measured from the Q wave of the ECG, were not significantly affected by the variations in heart rate. Diastolic leaflet closure began immediately after opening, while the ventricular cavity was small, and was caused by flow eddies behind the cusps. Isolated ventricular contractions closed the valve leaflets completely and symmetric valve closure was ensured by the different rates of leaflet edge approximation. In contrast, atrial closure was slow, partial, and of very short duration.     

In vitro dynamic strain behavior of the mitral valve posterior leaflet

Knowledge of mitral valve (MV) mechanics is essential for the understanding of normal MV function, and the design and evaluation of new surgical repair procedures. In the present study, we extended our investigation of MV dynamic strain behavior to quantify the dynamic strain on the central region of the posterior leaflet. Native porcine MVs were mounted in an in-vitro physiologic flow loop. The papillary muscle (PM) positions were set to the normal, taut, and slack states to simulate physiological and pathological PM positions. Leaflet deformation was measured by tracking the displacements of 16 small markers placed in the central region of the posterior leaflet. Local leaflet tissue strain and strain rates were calculated from the measured displacements under dynamic loading conditions. A total of 18 mitral valves were studied. Our findings indicated the following: (1) There was a rapid rise in posterior leaflet strain during valve closure followed by a plateau where no additional strain (i.e., no creep) occurred. (2) The strain field was highly anisotropic with larger stretches and stretch rates in the radial direction. There were negligible stretches, or even compression (stretch < 1) in the circumferential direction at the beginning of valve closure. (3) The areal strain curves were similar to the stretches in the trends. The posterior leaflet showed no significant differences in either peak stretches or stretch rates during valve closure between the normal, taut, and slack PM positions. (4) As compared with the anterior leaflet, the posterior leaflet demonstrated overall lower stretch rates in the normal PM position. However, the slack and taut PM positions did not demonstrate the significant difference in the stretch rates and areal strain rates between the posterior leaflet and the anterior leaflet. The MV posterior leaflet exhibited pronounced mechanically anisotropic behavior Loading rates of the MV posterior leaflet were very high. The PM positions influenced neither peak stretch nor stretch rates in the central area of the posterior leaflet. The stretch rates and areal strain rates were significantly lower in the posterior leaflet than those measured in the anterior leaflet in the normal PM position. However, the slack and taut PM positions did not demonstrate the significant differences between the posterior leaflet and the anterior leaflet. We conclude that PM positions may influence the posterior strain in a different way as compared to the anterior leaflet.     

Histochemical Approach to Properties of Vicia faba Guard Cell Phosphoenolpyruvate Carboxylase

Properties of phosphoenolpyruvate carboxylase in guard cells dissected from frozen-dried Vicia faba L. leaflets were studied using quantitative histochemical techniques. Control experiments with palisade cells and whole leaflet extract proved that the single cell approach was valid. Most characteristics of enzyme activity in guard cells were identical to those in the leaflet extract. The activities were highly dependent on temperature, with maximum activity at 25 to 35 C. Half-maximum activity (with 1 millimolar phosphoenolpyruvate [PEP]) was observed at 0.1 millimolar Mg²⁺. Two-hundred millimolar NaCl inhibited the reaction by 50%. With frozen-dried leaflet extract, the apparent K_m(PEP) was 0.15 millimolar at pH 7.7; with guard cells, the values were 1.49, 0.5 to 0.8, and 0.24 millimolar in three successive experiments. Additional experiments showed that apparent K_m(PEP) of guard cell activity from plants within a single growth lot was reproducible and did not change during stomatal opening. Mixed extract experiments proved that soluble compounds were not responsible for the difference observed between leaflet and guard cell activities. The differences in apparent K_m(PEP) of guard cell activity could not be unambiguously interpreted. The physiological implications of the properties of this enzyme in guard cells are discussed.     

DIASTOLIC OPENING OF THE AORTIC VALVE (AV) IN A CASE OF AORTIC INSUFFICIENCY DUE TO AV FENESTRATION

A patient with severe aortic insufficiency due to fenestration of the non-coronary aortic valve leaflet is described. A preoperative echocardiogram demonstrated early closure of the mitral valve and early diastolic separation of the aortic valve leaflets. These findings disappeared after partial surgical correction and subsequent hemodynamic improvement. Premature opening of the aortic valve is common in severe aortic insufficiency.     

Regional stiffening of the mitral valve anterior leaflet in the beating ovine heart

Left atrial muscle extends into the proximal third of the mitral valve (MV) anterior leaflet and transient tensing of this muscle has been proposed as a mechanism aiding valve closure. If such tensing occurs, regional stiffness in the proximal anterior mitral leaflet will be greater during isovolumic contraction (IVC) than isovolumic relaxation (IVR) and this regional stiffness difference will be selectively abolished by β-receptor blockade. We tested this hypothesis in the beating ovine heart. Radiopaque markers were sewn around the MV annulus and on the anterior MV leaflet in 10 sheep hearts. Four-dimensional marker coordinates were obtained from biplane videofluoroscopy before (CRTL) and after administration of esmolol (ESML). Heterogeneous finite element models of each anterior leaflet were developed using marker coordinates over matched pressures during IVC and IVR for CRTL and ESML. Leaflet displacements were simulated using measured left ventricular and atrial pressures and a response function was computed as the difference between simulated and measured displacements. Circumferential and radial elastic moduli for ANNULAR, BELLY and EDGE leaflet regions were iteratively varied until the response function reached a minimum. The stiffness values at this minimum were interpreted as the in vivo regional material properties of the anterior leaflet. For all regions and all CTRL beats IVC stiffness was 40–58% greater than IVR stiffness. ESML reduced ANNULAR IVC stiffness to ANNULAR IVR stiffness values. These results strongly implicate transient tensing of leaflet atrial muscle during IVC as the basis of the ANNULAR IVC–IVR stiffness difference.     

A circadian rhythm in oxygen uptake by samanea pulvini

The rate of O₂ uptake by excised Samanea pulvini oscillates with a circadian rhythm during 52 hours of darkness. Rates of respiration increase during pulvinar opening and decrease prior to and during closure, consistent with the concept that opening requires a greater expenditure of energy. Externally supplied sucrose, necessary for perpetuation of the leaflet movement rhythm, has a small promotive effect on the rate of respiration.     

PHYTOCHROME CONTROLLED NYCTINASTY IN ALBIZZIA JULIBRISSIN. I. ANATOMY AND FINE STRUCTURE OF THE PULVINULE

Under appropriate experimental conditions, phytochrome controls leaflet closure in Albizzia by regulating differential turgor changes in motor cells of the pulvinule. Closure occurs when subepidermal dorsal cells expand and ventral cells become compressed; reopening involves the reverse changes. The internal cells surrounding the vascular core remain relatively unchanged during leaflet movement. Fine structural studies revealed several unusual features of the motor cells including: (1) fibrils oriented parallel to one another in the cytoplasmic matrix; (2) numerous spherosomes that appear to coalesce and enlarge to form vacuoles; and (3) a multivacuolate condition.     

Patent ductus arteriosus in adults

Patent ductus arteriosus (PDA) is a congenital heart defect in which the ductus arteriosus, a vascular structure between the pulmonary artery and the aorta that normally closes shortly after birth, remains open. We present two cases of adults with PDA. A 28-year-old lady had a small PDA without any symptoms or left heart overload. The PDA was closed for endocarditis prevention using a coil. In a 37-year-old lady with palpitations, collapse, dyspnoea and left heart overload caused by a large PDA, percutaneous closure of the PDA was performed with an Amplatzer device. Transcatheter closure has been established to be the method of choice for treating a PDA in adults. (Neth Heart J 2008;16:255-9.)     

Role of boron in the far-red delay of nyctinastic closure of albizzia pinnules

Boron has been found to be necessary for the delaying action of 710 nanometer irradiation on the nyctinastic closing of Albizzia julibrissin pinnules. It is effective only over a narrow micromolar range. In contrast, the delaying action of 470 nanometer irradiation on closure is inhibited by boron. The effect of boron on leaflet closing occurs rapidly. Boron is suggested to be involved in a phytochrome action that precedes and is required for a delaying effect on pinnule closing subsequently induced by an unknown far-red absorbing pigment.     

Nucleotide Activation of the Ca-ATPase

We have used fluorescence spectroscopy, molecular modeling, and limited proteolysis to examine structural dynamics of the sarcoplasmic reticulum Ca-ATPase (SERCA). The Ca-ATPase in sarcoplasmic reticulum vesicles from fast twitch muscle (SERCA1a isoform) was selectively labeled with fluorescein isothiocyanate (FITC), a probe that specifically reacts with Lys-515 in the nucleotide-binding site. Conformation-specific proteolysis demonstrated that FITC labeling does not induce closure of the cytoplasmic headpiece, thereby assigning FITC-SERCA as a nucleotide-free enzyme. We used enzyme reverse mode to synthesize FITC monophosphate (FMP) on SERCA, producing a phosphorylated pseudosubstrate tethered to the nucleotide-binding site of a Ca²⁺-free enzyme (E2 state to prevent FMP hydrolysis). Conformation-specific proteolysis demonstrated that FMP formation induces SERCA headpiece closure similar to ATP binding, presumably due to the high energy phosphoryl group on the fluorescent probe (ATP·E2 analog). Subnanosecond-resolved detection of fluorescence lifetime, anisotropy, and quenching was used to characterize FMP-SERCA (ATP·E2 state) versus FITC-SERCA in Ca²⁺-free, Ca²⁺-bound, and actively cycling phosphoenzyme states (E2, E1, and EP). Time-resolved spectroscopy revealed that FMP-SERCA exhibits increased probe dynamics but decreased probe accessibility compared with FITC-SERCA, indicating that ATP exhibits enhanced dynamics within a closed cytoplasmic headpiece. Molecular modeling was used to calculate the solvent-accessible surface area of FITC and FMP bound to SERCA crystal structures, revealing a positive correlation of solvent-accessible surface area with quenching but not anisotropy. Thus, headpiece closure is coupled to substrate binding but not active site dynamics. We propose that dynamics in the nucleotide-binding site of SERCA is important for Ca²⁺ binding (distal allostery) and phosphoenzyme formation (direct activation).     

Straightening of curved pattern of collagen fibers under load controls aortic valve shape

The network of collagen fibers in the aortic valve leaflet is believed to play an important role in the strength and durability of the valve. However, in addition to its stress-bearing role, such a fiber network has the potential to produce functionally important shape changes in the closed valve under pressure load. We measured the average pattern of the collagen network in porcine aortic valve leaflets after staining for collagen. We then used finite element simulation to explore how this collagen pattern influences the shape of the closed valve. We observed a curved or bent pattern, with collagen fibers angled downward from the commissures toward the center of the leaflet to form a pattern that is concave toward the leaflet free edge. Simulations showed that these curved fiber trajectories straighten under pressure load, leading to functionally important changes in closed valve shape. Relative to a pattern of straight collagen fibers running parallel to the leaflet free edge, the concave pattern of curved fibers produces a closed valve with a 40% increase in central leaflet coaptation height and with decreased leaflet billow, resulting in a more physiological closed valve shape. Furthermore, simulations show that these changes in loaded leaflet shape reflect changes in leaflet curvature due to modulation of in-plane membrane stress resulting from straightening of the curved fibers. This effect appears to play an important role in normal valve function and may have important implications for the design of prosthetic and tissue engineered replacement valves.     

PHYTOCHROME CONTROLLED NYCTINASTY IN ALBIZZIA JULIBRISSIN. II. POTASSIUM FLUX AS A BASIS FOR LEAFLET MOVEMENT

Excised Albizzia leaflet pairs exposed to red (R) light close within 30–90 min after transfer to darkness. Interruption of darkness by far-red (FR) light at any time after R inhibits closure within ca. 10 min. Similarly, irradiation with R at any time after prior FR promotes closure within ca. 10 min, and the increased rate of closure is independent of the time lapse between the FR and R irradiations. Closure in the dark is inhibited by NaN₃ and DNP (5 X 10^–4 m ), by anaerobic conditions and by externally applied salts of monovalent cations, especially K; it is also temperature sensitive. Pulvinule cells are very high in K. Electron microprobe analysis of cryostated, lyophilized pulvinules reveals that during closure, K is lost from ventral cells and enters dorsal cells. FR before darkness inhibits the former but not the latter process. Thus, K flux appears to control the changes in volume of the pulvinule cells that control leaflet movement. While leaflet closure normally requires a dark period, salts of organic acids such as sodium acetate, propionate, and butyrate cause closure in the light.