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Review
. 2019 Aug 15;1(3):e190004.
doi: 10.1148/ryct.2019190004. eCollection 2019 Aug.

Bioprosthetic Heart Valve Degeneration and Dysfunction: Focus on Mechanisms and Multidisciplinary Imaging Considerations

Stephanie L Sellers  1 , Philipp Blanke  1 , Jonathon A Leipsic  1
Affiliations
Review

Bioprosthetic Heart Valve Degeneration and Dysfunction: Focus on Mechanisms and Multidisciplinary Imaging Considerations

Stephanie L Sellers et al. Radiol Cardiothorac Imaging. .

Abstract

Bioprosthetic heart valves (BPHVs) have fundamentally changed the treatment of valvular heart disease. Despite the continuous progress of BPHVs, from early valve designs for use in surgical replacement to the rapidly evolving use of transcatheter replacement techniques and designs, valve dysfunction and degeneration remain fundamental issues. Current guidelines and proposed standard definitions of BPHV dysfunction and degeneration outline the importance of imaging. Imaging plays a key role in understanding valve degeneration, including clinical imaging to identify transvalvular gradients, leaflet thickening, thrombosis, calcification, and restricted or reduced leaflet motion. Similarly, translational imaging approaches-including micro-CT, high-speed video, computational modeling, and high-resolution microscopy-and histologic analysis are crucial to understanding mechanisms of valve degeneration and factors that may contribute to valve dysfunction. This article provides an overview of valve dysfunction and degeneration and the role of imaging. © RSNA, 2019.

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Conflict of interest statement

Disclosures of Conflicts of Interest: S.L.S. disclosed no relevant relationships. P.B. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Circle Cardiovascular Imaging and has grants/grants pending with Abbott, Edwards Lifesciences, Medtronic, and Neovasc; institution received research support from Edwards. Other relationships: disclosed no relevant relationships. J.A.L. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Circle Cardiovascular Imaging and HeartFlow; institution has grants/grants pending with Abbott, Edwards Lifesciences, Medtronic, and Neovasc; institution received research support from Edwards. Other relationships: disclosed no relevant relationships.

Figures

Figure 1:
Figure 1:
Image shows overview of bioprosthetic heart valves used in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Manufacturer information is as follows: MitroFlow (Sorin, USA), MagnaEase (Edwards Lifesciences, USA), Sapien 3 and Sapien XT (Edwards Lifesciences), Epic (St. Jude Medical, USA), Core Valve (Medtronic, USA), and J-Valve (JC Medical, USA). PPM = patient prosthesis mismatch, SHV = surgical heart valve, THV = transcatheter heart valve.
Figure 2:
Figure 2:
Images show examples of features of bioprosthetic heart valves (BPHVs) pathology seen at gross examination at explant. BPHV explants demonstrate, A, large amounts of fibrosis with areas of thrombus on aortic aspect of surgical heart valve (SHV) with pericardial leaflets; B, fibrosis on ventricular aspect on SHV with pericardial leaflets; and calcified SHVs with, C, leaflet tears in valves with porcine and, D, pericardial leaflets.
Figure 3:
Figure 3:
Definitions of bioprosthetic heart valve dysfunction and degeneration. EACTS = European Association for Cardio-Thoracic Surgery, EAPCI = European Association of Percutaneous Cardiovascular Interventions, ESC = European Society of Cardiology.
Figure 4:
Figure 4:
Image shows clinical imaging approaches for bioprosthetic heart valve (BPHV) degeneration and dysfunction. EOA = effective orifice area, PPM = patient prosthesis mismatch, SVD = structural valve degeneration.
Figure 5:
Figure 5:
Image shows translational and fundamental scientific imaging approaches to study bioprosthetic heart valve (BPHV) degeneration. A, Histologic cross-section of pericardial BPHV leaflet (left) and porcine leaflet (right) from explanted valves. B, Confocal microscopy and scanning electron microscopy of transcatheter heart valve (THV) leaflets to evaluate collagen structure within leaflet. C, Micro-CT of calcified explanted surgical heart valve (SHV) (left) and micro-CT of THV frame (right). D, Representative images of THV undergoing bench testing to assess hemodynamics in pulse duplicator.
See this image and copyright information in PMC

References

    1. Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol 2014;30(9):962–970. - PubMed
    1. Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol 2011;8(3):162–172. - PubMed
    1. Moore M, Chen J, Mallow PJ, Rizzo JA. The direct health-care burden of valvular heart disease: evidence from US national survey data. Clinicoecon Outcomes Res 2016;8:613–627. - PMC - PubMed
    1. Borer J. The challenge: about the Heart Valve Society of America. Heart Valve Society of America. http://www.heartvalvesocietyofamerica.org/more.html. Published 2017. Accessed July 1, 2017.
    1. van Geldorp MW, Heuvelman HJ, Kappetein AP, et al. Quality of life among patients with severe aortic stenosis. Neth Heart J 2013;21(1):21–27. - PMC - PubMed

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