International Journal of Cardiology

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International Journal of Cardiology Quantitative assessment of paravalvular leakage after transcatheter aortic valve replacement using a patient-specific pulsatile flow model Yutaka Tanaka, Shigeru Saito, Saeko Sasuga, Azuma Takahashi, Yusuke Aoyama, Kazuto Obama, Mitsuo Umezu, Kiyotaka Iwasaki International Journal of Cardiology Volume 258, Pages 313-320 (May 2018) DOI: 10.1016/j.ijcard.2017.11.106 Copyright © 2017 The Authors Terms and Conditions

Fig. 1 Patient-specific models with apulsatile circulation simulator and assessment of transcatheter valve hemodynamics. A, Aortic root with left ventricular outflow tract. B, The thoracic aorta, abdominal aorta, and iliofemoral arteries. C, Pulsatile circulation system. D, Representative hemodynamic waveforms of left ventricular pressure (red line), aortic pressure (blue line), flow rate (green line), and definition of closing volume and PVL (red and yellow areas). PVL=paravalvular leakage. International Journal of Cardiology 2018 258, 313-320DOI: (10.1016/j.ijcard.2017.11.106) Copyright © 2017 The Authors Terms and Conditions

Fig. 1 Patient-specific models with apulsatile circulation simulator and assessment of transcatheter valve hemodynamics. A, Aortic root with left ventricular outflow tract. B, The thoracic aorta, abdominal aorta, and iliofemoral arteries. C, Pulsatile circulation system. D, Representative hemodynamic waveforms of left ventricular pressure (red line), aortic pressure (blue line), flow rate (green line), and definition of closing volume and PVL (red and yellow areas). PVL=paravalvular leakage. International Journal of Cardiology 2018 258, 313-320DOI: (10.1016/j.ijcard.2017.11.106) Copyright © 2017 The Authors Terms and Conditions

Fig. 2 Transcatheter valve hemodynamics based on the HR and mAP and valve opening/closing images. A, Influence of HR on PVL, closing volume, total regurgitation, forward flow, and regurgitant fraction. B, Influence of mAP on PVL, closing volume, total regurgitation, forward flow, and regurgitant fraction. C, Valve opening/closing images taken with a high-speed camera. Red arrow indicates a central coaptation defect. HR=heart rate; mAP=mean aortic pressure; PVL=paravalvular regurgitation. International Journal of Cardiology 2018 258, 313-320DOI: (10.1016/j.ijcard.2017.11.106) Copyright © 2017 The Authors Terms and Conditions

Fig. 3 Gap area between the aortic valve annulus and the stent frame. A, The red volumes indicate a gap between the aortic root and the valve. The areas surrounded by the yellow line indicate a minimal gap area. B, Correlation between the minimal gap area between the aortic root and the valve and PVL. Scatter plots, linear fittings (dotted line), and 95% confidence intervals are shown for the fitting (gray ribbon) of PVL and the minimal gap area. C, Z-axis indicates the height from the annulus plane. Post-TAVR CT in models, post-TAVR CT in patients, post-TAVR TEE in patients, and pre-TAVR CT in patients at the level of plane with the minimal gap are shown. The red areas in the post-TAVR CT (models) indicate the minimal gap area and red arrows in post-TAVR TEE (patients) indicate the corresponding sites. CT=computed tomography; PVL=paravalvular leakage; TAVR=transcatheter aortic valve replacement; TEE=transesophageal echocardiography. International Journal of Cardiology 2018 258, 313-320DOI: (10.1016/j.ijcard.2017.11.106) Copyright © 2017 The Authors Terms and Conditions