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Assessing the Impact of Cardiac Output and Valve Orientation on Bioprosthetic Pulmonary Valve Hemodynamics Using In Vitro 4D-Flow MRI and High-Speed Imaging

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Abstract

Purpose

Pulmonary valve replacement (PVR) using bioprosthetic valves is a common procedure performed in patients with repaired Tetralogy of Fallot and other conditions, but these valves frequently become dysfunctional within 15 years of implantation. The causes for early valve failure are not clearly understood. The purpose of this study was to explore the impact of changing cardiac output (CO) and valve orientation on local hemodynamics and valve performance.

Methods

A 25 mm bioprosthetic valve was implanted in an idealized 3D-printed model of the right ventricular outflow tract (RVOT). The local hemodynamics at three COs and two valve orientations were assessed using 4D-Flow MRI and high-speed camera imaging.

Results

Noticeable differences in jet asymmetry, the amount of recirculation, leaflet opening patterns, as well as the size and location of reversed flow regions were observed with varying CO. Rotation of the valve resulted in drastic differences in reversed flow regions, but not forward flow.

Conclusion

Flow features observed in the valve with low CO in this study have previously been correlated with calcification, hemolysis, and leaflet fatigue, indicating their potential negative impact on local hemodynamics and leaflet performance.

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Acknowledgements

The authors thank their funding sources: Stanford’s Maternal and Child Health Research Institute, the American Heart Association, the Stanford Bio-X Bowes Fellowship, and the National Science Foundation Graduate Research Fellowship.

Author information

Author notes

  1. Nicole K. Schiavone and Priya J. Nair contributed equally to this work.

Authors and Affiliations

  1. Department of Mechanical Engineering, Stanford University, Stanford, CA, USA

    Nicole K. Schiavone, Christopher J. Elkins & John K. Eaton

  2. Department of Bioengineering, Stanford University, Stanford, CA, USA

    Priya J. Nair & Alison L. Marsden

  3. Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA

    Doff B. McElhinney

  4. Department of Pediatrics, Stanford University, Stanford, CA, USA

    Doff B. McElhinney & Alison L. Marsden

  5. Department of Radiology, Stanford University, Stanford, CA, USA

    Daniel B. Ennis

  6. Division of Radiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA

    Daniel B. Ennis

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Corresponding author

Correspondence to Alison L. Marsden.

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Conflict of interest

N.K. Schiavone, P.J. Nair, C.J. Elkins, D.B. Ennis, J.K. Eaton, and A.L. Marsden declare they have no conflict of interest. D.B. McElhinney is a proctor and consultant for Medtronic, which is not directly relevant to this study.

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Associate Editor Keefe B. Manning, PhD. oversaw the review of this article.

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Schiavone, N.K., Nair, P.J., Elkins, C.J. et al. Assessing the Impact of Cardiac Output and Valve Orientation on Bioprosthetic Pulmonary Valve Hemodynamics Using In Vitro 4D-Flow MRI and High-Speed Imaging. Cardiovasc Eng Tech 16, 138–153 (2025). https://doi.org/10.1007/s13239-024-00762-x

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