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At least 19 recordsLinked to original sources

[Hemolysis indicators in the evaluation of the function of artificial heart valves after heart valve prosthesis].

Hemolysis of blood was studied in two groups of patients: the main group consisted of 75 patients with mitral, aortal and two-valves prostheses; a control group had 15 patients with rheumatic valve defects without prostheses. It was shown that hemolysis was minimal in patients with a satisfactory function of prostheses. It was higher after double prostheses and especially in patients with dysfunction of the valves. Lactate dehydrogenase is thought to be the most important and reliable test for the assessment of the hemolysis degree.

Adult↗

Principal stress analysis in LDA measurement of the flow field downstream of 19-mm Sorin Bicarbon heart valve.

Heart valve replacement has become, since many years, a common surgical practice. Along with the improvement that the patients' health has derived from it, however, a certain amount of risk could not be avoided, bound to the inevitable hemodynamic disturbances that an artificial device generates. A major shortcoming, often reported, is the formation of thrombus on the edge of the prosthetic valve, with a possible obstruction of the orifices through which blood should normally flow undisturbed. Hemolysis is another possible consequence of the implantation of a mechanical heart valve, generally correlated to turbulence downstream of prosthetic heart valves (PHV). As it is agreed upon by many researchers, the risk of thrombogenicity or hemolysis is higher in those valves that are more subject to promote turbulence and flow separation in the flow through them. In the following paper, we present a study of the turbulence-related shear stress downstream of a bileaflet valve of minimum size (19 mm external diameter) Sorin Bicarbon. This size was chosen, accordingly to the Food & Drug Administration (FDA) draft guidance suggestion to investigate the worst case in turbulence promoted by PHVs, in order to have the highest velocity gradients and shear stresses for the FDA-stated cardiac output (6 1/min), related to maximum Reynolds number conditions. Velocity data were collected with the two-dimensional laser Doppler anemometry (LDA) technique; whereas this approach does not investigate directly all three components of the flow field, in the present case (bileaflet valves) it is not a limitation to the assessment of the maximum turbulence shear stress (TSS), thanks to the two-dimensional flow nature downstream of bileaflet models. Data taken in coincident mode were elaborated in order to determine the maximum shear stress in the measured points in the flow field, using the 2D Principal Stress Analysis (PSA). The consequences of a variable principal normal stress direction all along the measured profile will be illustrated in terms of differences between measured and maximum shear stresses. Results show the need to estimate the maximum values for the TSS and the direction along which it is obtained to correctly define the turbulent flow field downstream of PHVs.

Blood Flow Velocity↗

Acellularized porcine heart valve scaffolds for heart valve tissue engineering and the risk of cross-species transmission of porcine endogenous retrovirus.

OBJECTIVE: Acellularized porcine heart valve scaffolds have been successfully used for heart valve tissue engineering, creating living functioning heart valve tissue. However, there is concern about the possibility of porcine endogenous retrovirus transmission. In this study we investigated whether acellularized porcine heart valve scaffold causes cross-species transmission of porcine endogenous retrovirus in a sheep model. METHODS: Acellularized porcine pulmonary valve conduits (n = 3) and in vitro autologous repopulated porcine pulmonary valve conduits (n = 5) were implanted into sheep in the pulmonary valve position. Surgery was carried out with cardiopulmonary bypass support. The animals were killed 6 months after the operation. Blood samples were collected regularly up to 6 months after the operation and tested for porcine endogenous retrovirus by means of polymerase chain reaction and reverse transcriptase-polymerase chain reaction. In addition, explanted tissue-engineered heart valves were tested for porcine endogenous retrovirus after 6 month in vivo. RESULTS: Porcine endogenous retrovirus DNA was detectable in acellularized porcine heart valve tissue. However, 6 months after implantation of in vitro and in vivo repopulated acellularized porcine heart valve scaffolds, no porcine endogenous retrovirus sequences were detectable in heart valve tissue and peripheral blood. CONCLUSION: Acellularized porcine matrix scaffolds used for creation of tissue-engineered heart valves do not transmit porcine endogenous retrovirus.

Animals↗

Glycosaminoglycan-degrading enzymes in porcine aortic heart valves: implications for bioprosthetic heart valve degeneration.

BACKGROUND AND AIM OF THE STUDY: Glutaraldehyde (GA)-fixed aortic valves used in heart valve replacement surgery have limited durability due to tissue degeneration and calcification. Despite their structural and functional importance, very little is known about the fate of glycosaminoglycans (GAGs) within the extracellular matrix of bioprosthetic heart valves. The study aim was to investigate the stability of GAGs in GA-fixed tissues and to identify enzymatic mechanisms that may be responsible for GAG degeneration. METHODS: Porcine aortic valve cusps were fixed with GA and implanted subdermally in rats for 21 days. Fresh, fixed and explanted cusps were analyzed for GAG content by hexosamine determination, and GAG-degrading enzyme activity was evaluated using zymography. GAG classes in fresh cusps were also assessed by flurorophore-assisted carbohydrate electrophoresis. Fresh and GA-fixed cusps were also exposed in vitro to hyaluronidase and chondroitinase in order to test the susceptibility of cusp GAGs towards enzymatic degradation. RESULTS: Native aortic cusps contained -3.5% GAGs by dry weight, consisting of hyaluronic acid, chondroitin sulfate and dermatan sulfate. Significantly lower GAG levels were found in aortic cusps after fixation with GA, and even lower levels were found after subdermal implantation in rats. GAG levels in GA-fixed cusps were also significantly reduced by in-vitro incubation with hyaluronidase and chondroitinase. Novel GAG-degrading enzymes were detected in considerable levels in native cusps, in lower levels in GA-fixed cusps and significantly increased levels after subdermal implantation of GA-fixed cusps. CONCLUSION: The combined action of active GAG-degrading enzymes and the failure of GA to stabilize GAGs towards enzymatic digestion may contribute significantly to bioprosthetic heart valve degeneration and subsequent structural failure.

Animals↗

Age-dependent changes of heart valves and heart size.

The mode and extent of the regressions of heart valves, valvular rings, and tendon chords, as well as the size of atria and ventricles in 316 hearts of different age groups (macroscopically normal at autopsy), were studied. With increasing age, the valves showed marked thickening and loss of elasticity. Deposition of lipoids and calcification occur to a variable extent in the valvular tissue and rings; Valve size shows a change of minor degree, but tendon chords and papillary muscles shorten in old age. The diameters of the atria, mitral, tricuspid, pulmonary, and aortic rings increase continuously up to the 9th decade of life. The width and length of the ventricles show minor alterations in size. In old age, heart weight increases.

Adolescent↗

Spectral analysis of heart valve sound for detection of prosthetic heart valve diseases.

The spectral analysis of heart valve sound is a noninvasive diagnostic method known to be useful in evaluating the state of the heart valve function. This may provide early detection of valve calcification, thrombus or destruction, since previous studies have shown that the dominant frequency peak moved to a high frequency area when natural heart valve leaflets were calcified, stiffened or destroyed. However, it is important for a heart valve sound diagnostic system to find a proper spectral analysis method on phonocardiography. Until now, conventional frequency analyses such as the Fourier transform or autoregressive spectral estimation technique have been used to estimate spectral components of a phonocardiogram, but they are inappropriate because the signal frequency is assumed to remain constant during the transform interval. To overcome this problem, in this study, FOS (Fast Orthogonal Search) & MUSIC (MUltiple SIgnal Classification), which both appeared suitable for the analysis of biological data, were applied to prosthetic heart valve sound as the new heart valve sound spectral analysis methods. Five subjects with normally functioning mechanical heart valves and a patient with a malfunctioning one were selected to collect the heart valve sound signals. As a result, the second dominant peak frequency proved to be important along with the first dominant peak frequency in identifying the valve function. This study showed that the new heart valve sound spectral analysis method presented in this paper may be an effective method in heart valve sound analysis. Further study using this system in a large population of patients will aid in providing a diagnostic method in the early detection of valve failure.

Female↗

[beta-Thromboglobulin in plasma in patients with heart-valve diseases and with prosthetic heart valves (author's transl)].

In each 50 patients with rheumatic heart valve diseases and after implantation of prosthetic heart valves and in 20 patients with bioprostheses, beta-thromboglobulin (beta-TG) in plasma was determined. In all cases beta-TG was significantly elevated above the normal range. The levels of beta-TG lay in patients with bioprostheses lower than in the other groups. Bioprostheses are less damaging the thrombocytes than prosthetic heart valves.

Beta-Globulins↗

[Similarities in morphologic changes in heart valves in acquired heart defects of noninflammatory etiology and in damaged menisci without a history of trauma].

Histologic, histochemical and ultrastructural analyses were performed of the leaflets of all four heart valves in 50 subjects with acquired heart defects of noninflammatory etiology and 88 surgically removed damaged menisci without trauma anamnesis. On the basis of the detailed analysis some morphologic similarities were found in the heart valves and menisci such as myxomatous degeneration as the main pathologic lesion, lack of blood vessels in the altered tissues which point to noninflammatory nature of the lesion, similarity in nourishment by diffusion, degradation of the collagenous fibres which present the main histologic structure and the increased accumulation of acid mucopolysacharrides at the site of their degradation as well as the increased number of fibroblasts, that is, chondroid cells which are considered to excrete acid mucopolysacharrides. Sometimes these changes are hardly identify clinically, especially in meniscal diseases which could simulate rheumatic disease.

Adolescent↗

The failure modes of biological prosthetic heart valves.

Bioprosthetic heart valves have been used since the 1960s, starting with the use of homograft aortic valves obtained from human cadavers. Today prosthetic heart valves are used widely, and bioprostheses account for close to 40% of all heart-valve replacements. Although most bioprosthesis are still stented porcine aortic valves, the introduction of stentless valves and the increasing use of cryopreserved homograft valves has led to an upsurge of interest in bioprosthesis. There have been significant changes in the handling and fixation of porcine aortic valves; however, their modes of failure remain virtually unchanged, although many bioprosthetic valves now last for considerably longer periods. This article reviews the modes of failure of bioprosthetic heart valves.

Animals↗

Periodate-mediated glycosaminoglycan stabilization in bioprosthetic heart valves.

Bioprosthetic heart valves (BPHVs) derived from glutaraldehyde-crosslinked porcine aortic valves are frequently used in heart valve replacement surgeries. However, the majority of bioprostheses fail clinically because of calcification and degeneration. We have recently shown that glycosaminoglycan (GAG) loss may be in part responsible for degeneration of glutaraldehyde-crosslinked bioprostheses. In the present studies, we used a mild reaction of periodate-mediated crosslinking to stabilize glycosaminoglycans in the bioprosthetic tissue. We demonstrate the feasibility of periodate reaction by crosslinking major components of extracellular matrix of bioprosthetic heart valve tissue, namely type I collagen and hyaluronic acid (HA). Uronic acid assay of periodate-fixed HA-collagen matrices showed 48% of HA disaccharides were bound to collagen. Furthermore, we show that such reactions are also feasible to fix glycosaminoglycans present in the middle spongiosa layer of bioprosthetic heart valves. The periodate reactions were compatible with conventional glutaraldehyde crosslinking and showed adequate stabilization of extracellular matrix as demonstrated by thermal denaturation temperature and collagenase assays. Moreover, uronic acid assays of periodate-fixed BPHV cusps showed 36% reduction in the amount of unbound GAG disaccharides as compared with glutaraldehyde-crosslinked cusps. We also demonstrate that calcification of BPHV cusps was significantly reduced in the periodate-fixed group as compared with the glutaraldehyde-fixed group in 21-day rat subdermal calcification studies (periodate-fixed tissue Ca 72.01 +/- 5.97 microg/mg, glutaraldehyde-fixed tissue Ca 107.25 +/- 6.56 microg/mg). We conclude that periodate-mediated GAG fixation could reduce structural degeneration of BPHVs and may therefore increase the useful lifetime of these devices.

Animals↗

[Using chemical methods to crosslink xenogeneic heart valves: the progress of bioprosthetic heart valves].

Glutaraldehyde clinically is the most commonly accepted crosslinking reagent for bioprosthetic valves preparation. Glutaraldehyde-treated tissue is stable against chemical and enzymatic degradation; however, its calcification and cytotoxicity are severe. Dye-mediated photooxidation is an alternative tissue preservation method that oxidizes the protein with visible light in the presence of a suitable photosensitizer. This article reviews chemical mechanism, research progress, clinical applications future development of these two methods.

Animals↗