Asynchronous closure and leaflet impact velocity of bileaflet mechanical heart valves

The effect of gravitational field on the asynchronous closure of four different types of bileaflet heart valves (BHV) were investigated in an in vitro mock circulation system. The experimental study involved the 29 mm St. Jude Medical Standard, 29 mm CarboMedics, 29mm Edwards-Duromedics and 29 mm Edwards-Tekna BHVs. The valves were tested in the mitral position on an inclined 45 degrees plane of the pulsatile mock flow loop. The test valves were orientated with their pivotal axis horizontal so that the gravitational vectors on the two leaflets were clearly disparate. Using a specially designed laser optical system, the time difference at which the closing leaflets made their first contacts with the valve housing was measured. The closing velocity of each leaflet was measured separately by the laser sweeping technique (LST). The experiments were conducted under physiologic ventricular and aortic pressures at the heart rates of 70, 90, and 120 beats/minute with the corresponding flow rates of 5.0, 6.0, and 7.5 liters/minute. Asynchronous closing motions were registered in all four tested BHVs. The leaflet closing motions were random in nature, but indicated clear dependency on the orientations with respect to the gravitational field. The lower leaflet which makes a generally level swing to close, was assisted initially by the gravity and was always found to close earlier than the upper leaflet, which swing upward to close. The initial closure of the upper leaflet was against the gravity which delayed the leaflet motion. Depending on the BHV designs, the time delays between the two leaflets were found to vary from beat to beat but to follow certain probability distributions. In general, the leaflet/housing contact time between the two valve leaflets exhibited the clear trend of decreasing delay time at closure with the increase of the heart rate. For each of the valves tested, the average impact velocity of the first closing leaflet was found always smaller than that of the second closing leaflet at all three heart rates tested. The impact velocities of both the BHV leaflets were found to increase with the heart rate. The difference in the closing velocities between the two leaflets decreases with the increase of the heart rate and is generally proportional to the impact time delay between the two leaflets.