CINERADIOGRAPHIC EVALUATION OF ATS OPEN PIVOT BILEAFLET VALVES

Background and aims of the study: Echocardiography and cineradiography are both valuable for the evaluation of prosthetic valve function, es pecially of mechanical valves. Although Doppler echocardiography data are available for the recently developed ATS valve, cineradiographic e valuation of leaflet movement of the valve has not been performed. Mat erials ann methods: Five patients received aortic and another five mit ral valve replacement with the open pivot ATS bileaflet prosthetic val ve. There were three men and seven women; mean patient age was 58.8 ye ars. Cineradiographic and Doppler echocardiographic evaluations of the ATS valve were performed early after surgery in all 10 patients. Resu lts: There were no early deaths after surgery or after discharge from the hospital. No valve-related complications were seen, and no clinica l symptoms or signs of prosthetic malfunction were observed during the follow up period. Doppler-derived values of the ATS valve were compar able with those previously reported; however, cineradiography of the v alve demonstrated that the mean angle enclosed by the two open leaflet s was 37.6 degrees (range: 34 degrees to 44 degrees) in the aortic pos ition and 29.7 degrees (range: 20 degrees to 35 degrees) in the mitral position. Mean leaflet mobility was 93.0 degrees (range: 86 degrees t o 96 degrees) in the aortic position and 100.0 degrees (range: 92 degr ees to 110 degrees) in the mitral position. Thus, the opening of the n ormally functioning ATS valves in vivo was less than that observed in vitro and reported by the manufacturer. Conclusions: These results sug gest that unevenly distributed blood flows with different velocities t hrough the two side orifices and the central orifice may result in inc omplete opening of the ATS leaflets, which respond with great sensitiv ity to localized blood flow. Our findings appear to be important to av oid the removal of a normally functioning ATS valve only because the l eaflet opening appears to be 'restricted'.