Abstract
Current paediatric valve replacement options cannot compensate for somatic growth, leading to an obstruction of flow as the child outgrows the prosthesis. This often necessitates an increase in revision surgeries, leading to legacy issues into adulthood. An expandable valve concept was modelled with an inverse relationship between annulus size and height, to retain the leaflet geometry without requiring additional intervention. Parametric design modelling was used to define certain valve parameter aspect ratios in relation to the base radius, Rb, including commissural radius, Rc, valve height, H and coaptation height, x. Fluid-structure simulations were subsequently carried out using the Immersed Boundary method to radially compress down the fully expanded aortic valve whilst subjecting it to diastolic and systolic loading cycles. Leaflet radial displacements were analysed to determine if valve performance is likely to be compromised following compression. Work is ongoing to optimise valvular parameter design for the paediatric patient cohort.
Highlights
Congenital heart disease (CHD) affects eight in every 1000 live births
Existing mechanical and bioprosthetic valves designed for the adult patient cohort cannot compensate for somatic growth, leading to complications associated with patient-prosthesis size mismatch including thrombo-embolism, stenosis, endocarditis and accelerated calcification.[1,2,3,4]
A degree of leaflet buckling is observed during diastolic loading, which was noticeable when the valve compressed to an 18 mm diameter annulus or less
Summary
Congenital heart disease (CHD) affects eight in every 1000 live births It is commonly complex in nature and often involves valvular lesions such as severe stenosis and atresia, contributing to cyanotic heart disease and poor prognosis if untreated. Existing mechanical and bioprosthetic valves designed for the adult patient cohort cannot compensate for somatic growth, leading to complications associated with patient-prosthesis size mismatch including thrombo-embolism, stenosis, endocarditis and accelerated calcification.[1,2,3,4] Growth of paediatric valvular prostheses is not a novel idea; the Ross procedure, is the most favourable treatment option in children as it facilitates aortic root growth, with actuarial patient survival rates of 86%–93% at 10 years.[5,6] progressive root dilation of the pulmonary autograft is a commonly reported problem.[7,8] More recently, tissue engineered heart valves have garnered a lot of excitement due to their potential to ‘grow with the child’. Compounded by multiple revision surgeries needed to correct complex cardiac defects, and age-specific impaired quality of life, this can lead to far reaching legacy issues in adulthood.[11]
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