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

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.