Orientation of tilting disc and bileaflet aortic valve substitutes for optimal hemodynamics Joachim Laas, MD, Peter Kleine, MD, Michael J Hasenkam, MD,

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Orientation of tilting disc and bileaflet aortic valve substitutes for optimal hemodynamics Joachim Laas, MD, Peter Kleine, MD, Michael J Hasenkam, MD, Hans Nygaard The Annals of Thoracic Surgery Volume 68, Issue 3, Pages 1096-1099 (September 1999) DOI: 10.1016/S0003-4975(99)00780-8

Fig 1 Angle between the longitudinal axis of the left ventricle and the aorta as defined in 40 patients with different diagnoses (10 patients with aortic stenosis, 10 patients with aortic insufficiency, 10 patients with normotensive coronary artery disease, and 10 patients with hypertensive coronary artery disease. The Annals of Thoracic Surgery 1999 68, 1096-1099DOI: (10.1016/S0003-4975(99)00780-8)

Fig 2 Distribution of flow velocities in the aortic root in a patient with a normal aortic valve (1). At the peak of systole, the area of highest flow velocities is located close to the posterior wall (P); with ongoing systole, this area of major flow rotates 90° counterclockwise along the noncoronary leaflet. (L = left; R = right; A = anterior.) The Annals of Thoracic Surgery 1999 68, 1096-1099DOI: (10.1016/S0003-4975(99)00780-8)

Fig 3 Schematic drawing (A) and surgeon’s view (B) of the aortic valve from the ascending aorta. The area (region) of major flow is located along the noncoronary cusp; the arrow indicates the counterclockwise rotation during each heart cycle. (RCA = right coronary artery; LCA = left coronary artery; NCC = noncoronary cusp.) The Annals of Thoracic Surgery 1999 68, 1096-1099DOI: (10.1016/S0003-4975(99)00780-8)

Fig 4 Optimal orientation of the tilting disc valve (Medtronic Hall). The large valve orifice is directed toward the area of major flow at the noncoronary leaflet (NCC). (RCA = right coronary artery; LCA = left coronary artery.) The Annals of Thoracic Surgery 1999 68, 1096-1099DOI: (10.1016/S0003-4975(99)00780-8)

Fig 5 Optimal orientation of the bileaflet valve (St. Jude Medical). Distribution of the area of major flow is to all three openings with one leaflet facing the right coronary cusp. (RCA = right coronary artery; LCA = left coronary artery; NCC = noncoronary cusp.) The Annals of Thoracic Surgery 1999 68, 1096-1099DOI: (10.1016/S0003-4975(99)00780-8)

Fig 6 Regression of left ventricular hypertrophy is accelerated in patients receiving Medtronic Hall (MH) valves compared with patients receiving St. Jude Medical (SJM) valves with respect to the interventricular septum. ∗p < 0.05. (IVSsyst = interventricular septum at systole; IVSdiast = interventricular septum at diastole; preop = preoperative period.) The Annals of Thoracic Surgery 1999 68, 1096-1099DOI: (10.1016/S0003-4975(99)00780-8)