The animated implantation of the aortic heart valve prosthesis

The transcatheter aortic valve implantation is the non-invasive alternative for the open heart surgery . The percutaneous beating heart interventional procedure for The Medtronic product , The CoreValve Revalving System , is 3D animated by Elite Imaging .

The procedure performed under fluoroscopy in the CathLab lasts for up to 2 - 3 hours . The self expanding multilevel frame containing the tri-leaflet porcine pericardial tissue prosthesis is specifically designed for retrograde percutaneous implantation via the 18Fr catheter .

Video 1 . The presentation of the loading procedure for the bioprosthetic valve
into the delivery catheter

If aortic stenosis is present then a single inflation of the valvuloplasty balloon is performed prior to implantation . The delivery system is advanced retrogradely over the guide wire , from the femoral artery , up to the native failing aortic valve . The catheter circular tip frame is positioned in the aortic valve annulus . The external sheath is progresively retracted . The framed valve is deployed , while pushing aside the native valve leaflets . The new prosthesis is securely anchored by the radial force of the self expanding Nitinol frame . It starts functioning immediately during placement .

Video 2 . The presentaton in detail for the implantation procedure
for the bioprosthetic valve

The side of the frame that expands in the ascending aorta optimises the hemodynamics of the blood flow system . The central level of the frame is calcaved to prevent obstruction of and allow access to the coronary artery ostia . The conforming side of the frame towards the annulus minimises the risk of paravalvular leaks . The tri-level aortic framed bioprosthesis provides secure anchoring , without migration , and with natural valve function , ensuring long term valve durability .

The results for the open heart surgery for aortic valve replacement are compared with the ones for the CoreValve Revalving System , for 795 high risk patients , two years after the clinical procedure . The non-invasive method provides improved outcomes and increased quality of life for the patient .

The robotic surgery procedure for the mitral valve

The leaflet of the mitral valve may prolapse , and lead to an increased fibrous ring . The surgeon may correct each part of the valve in a procedure that is minimally invasive . The robotic arm aids the surgeon to operate more precisely on the region of interest , from the console . The benefits for the patient from a procedure that does not split the breastbone are : less pain after surgery , short hospitalisation time , low risk of infection , quick recovery , and , of course , less marks on the body .

Waiting for the heart transplant

The first cardiac transplant from America took place at The Stanford Health Care . The experts in the same institute nowadays push the boundaries of science to save lives . They suggest that the total artificial heart is an intermediate option for the patients with right or bi - ventricular failure .

The effects on the heart after the replacement for the mitral valve

The echocardiographic investigation of the mitral valve shows which leaflet is degenerated , if the leaflet , and the ring , maintained the integrity , the state of the attachment for the chorda tendinae , the structure of the papillary muscles . Two follow - up studies present the outcome of the mitral valvuloplasty for the elderly patients .

A study presents the clinical findings for a man of 74 years old . He did not have regurgitation of the tricuspid valve before he had a prosthetic replacement for the mitral valve . The left side of the heart stabilised with the surgery . The aortic valve had an unaffected functioning mechanism . The postoperative atrial fibrillation progressed. The postoperative regurgitation of the tricuspid valve made an impact on the right side of the heart .

The rheumatic heart disease ( RHD ) , and the dilated cardiomyopathy ( DCM ) are the causes for the stenosis ( MS ) , and for the regurgitation ( MR ) of the mitral valve ( figure 1 ) . The effects of the increased pressure in the left atrium are the increased size of the left atrium , the atrial fibrillation , and the pulmonary hypertension . The atrial fibrillation produces the dilation for the ring of the tricuspid valve . The pulmonary hypertension generates the dilation of the right ventricle ( RV ) . The regurgitation of the tricuspid valve ( TV ) worsens the tethering of the tricuspid valve , and the dilation of the right ventricle .

Figure 1 . The regurgitation of the tricuspid valve after the mitral valvuloplasty . Copyright ( 2009 ) Journal of The American College of Cardiology .

Another follow - up study analyses the clinical outcome for 242 patients who had valvuloplasty for the repair of the mitral valve . The patients are free from the non - trivial regurgitation of the mitral valve in 94 . 3 ± 1 . 6 % after one month , 58 . 6 ± 4 . 9 % after five years , and 27 . 2 ± 8 . 6 % after seven years ( figure 2 ) . The freedom from the severe regurgitation of the mitral valve is 98 . 3 ± 0 . 9 % after one month , 82 . 8 ± 3 . 8 % after five years , and 71 . 1 ± 7 . 4 % after seven years .

Figure 2 . The non - trivial regurgitation of the mitral valve . Copyright ( 2003 ) Circulation .

The dysfunction of the mitral valve is generated by the rheumatic heart disease , by the ischemic heart disease , and by the bacterial endocarditis . The succes of the replacement for the mitral valve is assessed both in the short term , and in the long term effects on the quality of life for the patient .

References :

Flameng W . , Herijgers P . , Bogaers K . ( 2003 ) “ The clinical anatomy and pathology of the human arterial valves : implications for repair or replacement ” , Circulation , 107 , 1609 - 1613 .

Shiran A . , Sagie A . ( 2009 ) “ Tricuspid regurgitation in mitral valve disease : incidence , prognostic implications , mechanism , and management ” , Journal of The American College of Cardiology , 53 ( 5 ) , 401 - 408 .

The anesthetic for valvular regurgitation

The treatment plans are presented for both the aortic and the mitral valve . The acute and chronic phases are presented . The clinical findings for the functioning mechanism are presented through diagrams .The assessment of the functional capacity , the magnetic resonance images , the electrocardiography , the echo - measurements , and the physical examination are described for the preoperative phase . The presence of infective endocarditis is studied . The anesthetic management is outlined for the clinical environment .

The engineering of complex tissue structures

The laboratory of transplantation biology for regenerative medicine at The University of Gothenburg in Sweden . The research group lead by Professor Suchitra Sumitran – Holgersson designed the first engineered vein succesfully transplanted in the hepatic portal circulation of a 10 - year old female , in 2012 . A donated nine centimeters long iliac vein was used in the study . The cells of the donor were cleared from the three dimensional structure of the vein . The stem cells from the bone marrow of the patient were cultured in the laboratory . The differentiated endothelial and smooth muscle cells grew and divided onto the vessel . There was no need for using immunisuppressives .

Professor Holgersson presented her three future research directions in the talk given at Ted^x in 2012 . Her research team redesiged blood vessels and the trachea , and would continue with complicated organs as the liver and the larynx . Two human organs were thrown away , and Professor Holgersson considered they should be recycled : the placenta as filling material in face cheeks and thighs , and the amniotic membrane for wrapping around areas requiring skin grafts . The animal organ , for example the pig heart , was recycled and redesigned , with the challenging task to meet the in vivo requirements .

References :

Olausson M . , Patil P . B . , Kuna V . K . , Chougule P . , Hernandez N . , Methe K . , Kullberg – Lindh C . , Borg H . , Ejnell H . , Sumitran – Holgersson S . ( 2012 ) “ Transplantation of an allogeneic vein bioengineered with autologous stem cells: a proof - of - concept study ” , The Lancet , 380 ( 9838 ) , 230 – 237 .

Options for mitral valve repair from The Society of Thoracic Surgeons

The quality of patient care is improved with research , and dedication . The Society of Thoracic Surgeons examined in detail the mitral valve surgery at the fiftieth annual meeting , in 2013 . The discussion points were :

• the valve calcification ;
• the mitral regurgitation ;
• low ejection fraction and mitral valve surgery , and atriofibrilation ;
• invasive to minimally invasive surgery, and then surgery with the use of robotic components ;
• methods to increase the repair rates to ninety percent for young surgeons .