关键词:
mechanical heart valve
hemodynamics
cardiac catheterization
pressure wire
摘要:
Objectives: Accurate assessment of prosthetic mechanical valve malfunction is challenging for non-invasive and invasive techniques. We evaluated a 0.014-inch pressure-sensing coronary guidewire to assess mechanical valve dysfunction. Background: Several case reports have shown that transaortic pressure gradients can be recorded using a 0.014-inch guidewire during cardiac catheterization. Methods: We performed an ex vivo study measuring the effects of sequentially crossing the center of each valve with a 6 French coronary angiographic catheter, a 0.035-inch guidewire, and a 0.014-inch pressure-sensing guidewire on valve dysfunction using the following 23 mm bileaflet and tilting-disc aortic valves: St. Jude Regent (TM), CarboMedics, Medtronic Hall (TM), and Bjork-Shiley Monostut. A left heart model pulse duplicator recorded 10 consecutive cycles. Results: For all valves, the greatest increase in valve regurgitation occurred with the 6 French catheter, causing a reduction in aortic valve back pressure and cardiac output, with an increase in leakage rate, regurgitant fraction, and energy loss. In comparison to the 0.035-inch guidewire, the 0.014-inch guidewire had greater regurgitation for St. Jude, lower for Medtronic Hall, and equivalent for CarboMedics and Bjork-Shiley valves. For the CarboMedics valve, the 0.035-inch guidewire caused a significant increase in regurgitant fraction and energy loss, while the pressure wire had no change compared to baseline. Conclusions: The degree of regurgitation caused by the 0.014-inch guidewire varies with the type of mechanical aortic valve. While prior case reports have shown that valve hemodynamics may be measured using a pressure-sensing guidewire, valve regurgitation occurs when crossing a St. Jude, Medtronic Hall, or Bjork-Shiley aortic valve. (C) 2011 Wiley-Liss, Inc.