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Ex vivo hemodynamic assessment of mechanical aortic valve gradients using a high‐fidelity pressure wire
Author(s) -
Michaels Andrew D.,
Mester David
Publication year - 2011
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22883
Subject(s) - medicine , regurgitation (circulation) , cardiology , aortic valve , hemodynamics , catheter , cardiac catheterization , surgery
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™, CarboMedics, Medtronic Hall™, and Björk‐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 Björk‐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 Björk‐Shiley aortic valve. © 2011 Wiley‐Liss, Inc.