Tomasz A. Timek, MDa, David T. Lai, FRACSa, Frederick A

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Hemodynamic performance of an unstented xenograft mitral valve substitute Tomasz A. Timek, MDa, David T. Lai, FRACSa, Frederick A. Tibayan, MDa, Paul Dagum, MD, PhDa, George T. Daughters, MSa,b, David Liang, MD, PhDc, Neil B. Ingels, PhDa,b, D.Craig Miller, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 124, Issue 3, Pages 541-552 (September 2002) DOI: 10.1067/mtc.2002.124390 Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 A, Schematic representation of the annular and leaflet marker array used in the study. Annular markers are shown as circles, and leaflet markers are shown as squares. ACOM, anterior commissure; PCOM, posterior commissure. B, Intraoperative photograph of the implanted stentless PMV bioprosthetic mitral valve. AML with attached gold markers is visible through the valve orifice. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 541-552DOI: (10.1067/mtc.2002.124390) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Group mean MAAs (in square centimeters, top panel) and septal anulus elevation (in centimeters, bottom panel) throughout the cardiac cycle for control animals (filled squares) and PMV animals (open squares). Data are centered at end-diastole (t = 0), with a 650-ms time window shown. Error bars equal 1 SEM. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 541-552DOI: (10.1067/mtc.2002.124390) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Group mean data for the 3-D reconstruction of the mitral anulus (squares) and PM tips (triangles) in control (filled symbols) and PMV (open symbols) animals. Drop lines in all 3 planes (PMs only) are shown for clarity. Midseptal (1) and midlateral (5) annular markers are labeled for orientation. ACOM, Anterior commissure; PCOM, posterior commissure; APM, anterior PM; PPM, posterior PM. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 541-552DOI: (10.1067/mtc.2002.124390) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Group mean data for angular displacement of anterior (top panel) and posterior (bottom panel) mitral leaflet edge angle throughout the cardiac cycle for native mitral leaflets (filled symbols) and PMV leaflets (open symbols). Data are centered at end-diastole (t = 0), with a 650-ms time window displayed. Error bars indicate 1 SEM. Note the cyclic motion of ϕAML but essentially fixed value of ϕPML in the PMV animals. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 541-552DOI: (10.1067/mtc.2002.124390) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 Two-dimensional reconstruction of mitral leaflet shape during valve closure (from 34 ms before end-diastole to 67 ms after end-diastole) in the native ovine valve (top panel) and the porcine mitral xenograft (bottom panel). Each reconstruction represents mean data from 5 animals at each time point. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 541-552DOI: (10.1067/mtc.2002.124390) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 Postmortem atrial view of the PMV valve 4 months after implantation. The PMV annular sewing ring is well endothelialized and completely incorporated into the native mitral anulus. AML with implanted markers is visible through the PMV orifice. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 541-552DOI: (10.1067/mtc.2002.124390) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions