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Effect of three-dimensional valve shape on the hemodynamics of aortic stenosis

Three-dimensional echocardiographic stereolithography and patient studies

Dan Gilon, MD, FACC^*,*, Edward G. Cape, PhD, Mark D. Handschumacher, BS^*, Jae-Kwan Song, MD, FACC, Joan Solheim, Michael VanAuker, BS, Mary Etta E. King, MD, FACC^* and Robert A. Levine, MD, FACC^*

^* Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Children’s Hospital, School of Medicine and Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Santin Engineering, Peabody, Massachusetts, USA

View larger version (25K): [in a new window]   Figure 1 Convergence of flow beyond the anatomic orifice to form the effective orifice area is determined by the convergence pattern established by valve shape. Ao = aorta; Cc = coefficient of contraction; LV = left ventricle.

View larger version (81K): [in a new window]   Figure 2 Parasternal long-axis two-dimensional echo views showing the clinical spectrum of leaflet shapes from flattest (upper left) to intermediate (upper right) to most doming (below). The arrows perpendicular to the leaflet surface emphasize the transition from individually flatter to most curved shapes. Ao = aorta; LA = left atrium; LV = left ventricle.

View larger version (205K): [in a new window]   Figure 3 (A) Three-dimensional (3D) reconstruction of the flattest valve studied, in a long-axis perspective viewed from the aorta, with the fitted valve surface (yellow) superimposed on the traces of valve (green) and left ventricular (LV) outflow tract (pink). (B) Corresponding stereolithography model. (C) 3D reconstruction of a doming valve of intermediate shape, with fitted valve surface (yellow) superimposed on valve traces, and the LV outflow tract to the left. (D) Corresponding stereolithography model. (E and F) 3D reconstruction of the valve with the longest dome (compare Fig. 2 bottom), with associated model.

View larger version (13K): [in a new window]   Figure 4 Coefficients of contraction according to valve shape and orifice size.