Heart Valves

Presentation by
Dr.S.Rajan
Topics to Be Discussed:

 Introduction: How the Heart/Heart Valves

Work
 Brief History of Artificial Heart Valves
 Types of Artificial Valves
(Examples,Materials Used)
 Heart valves
Heart/Heart Valves
Heart consists of:
Right Atrium and Ventricle
Atrium
Left Atrium and Ventricle

Two Types of Valves:

Atrioventricular Valve:
separates the atrium from
the ventricle
Semi-Lunar Valve: separates
the ventricles from the
outgoing blood vessels
Heart/Heart Valves
Right Atrioventricular Valve:
Tricuspid Valve
Left Atrioventricular Valve:
Bicuspid or Mitral Valve

Right Semi-Lunar Valve:

Pulmonary Valve
Left Semi-Lunar Valve:
Aortic Valve
Purpose of Valves: Prevent
backflow, or flow of blood back
into chamber from which it came
Heart/Heart Valves
When Ventricle expands:
atrioventricular valve allows blood
to flow forward to the atrium into
the ventricle while the semilunar
valve prevents blood from flowing
back in heart
When Ventricle contracts:
atrioventricular valve closes to
prevent backflow while semilunar
valve allows blood to body or lungs
Prevention of backflow: ensures the
proper direction of flow and
reduces amount of work heart must
do to pump blood
When Heart Valves Stop Working

 Heart Valve diseases fall into two categories:

1.stenosis- hardening of the valve
2.incompetence- permittence of backflow

 Three causes of Heart Valve Diseases:

1.Rheumatic Fever: stiffens valve tissue, causing stenosis
2.Congenitally defective valves: do not form properly as the
heart develops, but often go unnoticed until childhood
3.Bacterial infection: causes inflammation of valves, tissue
scarring, and permanent degradation
Evolution of Prosthetic Heart Valves

The development of the

original ball-and-cage valve
design can be attributed to
the bottle stopper in 1858

In the early 1950’s, it led to

the idea of a prosthetic
heart valve consisting of a
cage with a mobile spherical
poppet
Evolution of Prosthetic Heart Valves

This first heart valve was

made of a Plexiglass(methyl
methacylate)cage
surrounding a silicone-
coated nylon poppet

First implanted in a human in a

closed procedure in
September of 1952
(descending thoracic aorta)
Evolution of Prosthetic Heart Valve

 Significant advances were made soon after to help

the development of the heart valve:
In 1953, marked successful use of the heart and
lung machine, paving the way for the 1st open heart
Surgery.
The idea of using blood from another patient to
oxygenate the blood of the patient was developed
New methods were came for protecting the
heart at the time of surgery.
New materials (Plexiglass, Teflon, and Dacron)
Evolution of the Prosthetic Heart Valve

 On July 22, 1955, at the City General Hospital in

Sheffield, England, Judson Chesterman implanted
the first successful heart valve
 The patient lived 14 hours after the valve was
placed, but died when the poppet twisted out of
position
 Valve was made of Perspex, an outer cage, a poppet,
and 2 buttons to fasten the valve to the outside of
the heart
Evolution of the Prosthetic Heart Valve

 Starr-Edwards valve was

first successful long-term
valve created
 It was implanted in its first
8 patients in 1961 (6 of 8
survived
 Ball-and-Cage design
 Devised important “Nine
Commandments” in
developing a prosthetic
heart valve
Evolution of Prosthetic Heart Valves

 “Nine Commandments”:
1.Embolism Prevention
2.Durability
3.Ease and Security of Attachment
4.Preservation of Surrounding Tissue Function
5.Reduction of Turbulance
6.Reduction of Blood Trauma
7.Reduction of Noise
8.Use of Materials Compatible with Blood
9.Development of Methods of Storage and Sterilization
Evolution of the Prosthetic Heart Valve

 Since this time, over 30

mechanical heart designs
have been marketed in the
U.S. and abroad
 These valves have
progressed from the simple
caged ball valves, to strut-
and-leaflet valves and the
modern bi-leaflet valves, to
human and animal tissue
Artificial Heart Valve Types
Mechanical Valves:
Ball Valves

 This design uses a spherical occluder, or blocking

device, held in place by a welded metal cage
Problem and Why failed: Natural heart valves allow
blood to flow straight through the center of the
valve (central flow)
Caged-ball valves completely blocked central flow and
collisions with the occluder ball caused damage to
blood cells
Finally, these valves stimulated thrombosis, or
formation of blood clots
Starr-Edwards Ball Valve
Model: Starr-Edwards
Type: Aortic Caged Ball
Materials: Silicone Rubber ball
with 2% barium sulfate,
cage-Stellite alloy No. 21,
sewing ring- knitted Teflon
and polypropelene cloth

1 of 4 Starr-Edwards models
developed are still used
today, and is the only ball
valve currently used in U.S.
Magovern-Cromie Ball Valve

Model: Magovern-Cromie
valve
Type:Aortic Caged Ball

Materials: Ball-Silicone
rubber with barium,
cage-titanium, sewing
ring-none, Cage open at
top
Smeloff-Suttor Ball Valve
Model: Smeloff-Suttor valve
Type: Aortic, Mitral, Tricuspid
caged ball

Materials: Ball-Silicone rubber,

cage-titanium,
sewing ring-Teflon
Problems: Ball Variance,
swelling of ball from lipid
absorbtion, can cause
sticking of ball in inflow
orifice
Mechanical Valves:
Single Leaflet Disc Valves
 Uses a tilting occluder disk
to better mimic natural flow
patterns through the heart
 tilting pattern allow more
central flow while still
preventing backflow
 Some damage still occurs to
blood cells
 Reduces thrombosis and
infection, but does not
eliminate either problem
Bjork-Shiley Standard Aortic Valve

Model: Bjork-Shiley
Standard
Type: Aortic Tilting Disc

Materials: Disk-Pyrolytic
Carbon, cage-Haynes
25, sewing ring-Teflon
Medtronic-Hall Valve

Model: Medtronic-Hall
A7700 (aortic), M7700
(mitral)
Type: Aortic and Mitral
Tilting Disk
Materials: Cage-titanium,
Disk-Pyrolytic carbon,
sewing ring-knitted
teflon
Other Single Leaflet Disc Valves
 Another similar valve is
the caged disc valve

 Examples are Starr-

Edward Model 6500
and the Kay-Shiley
Model
Mechanical Valves:
Bileaflet Disc Heart Valves
 Consists of two semicircular
leaflets that pivot on hinges
integrated onto the flange
 Carbon leaflets and flange
exhibit high strength and
excellent biocompatibility
 Provide closest
approximation to central
flow
 Allows small amount of
backflow as leaflets cannot
close completely
St. Jude Bileaflet Valve

Model: St. Jude Valve

Standard
Design :Mitral, Aortic,
Tricuspid Bileaflet
Valve
Materials-Cage and disk-
pyrolytic carbon,
sewing ring-double
velour knitted
polyester
Animal Tissue Valves
 Heterograft or
Xenograft Valves
 Most commonly used
tissues are the porcine
(pig) valve tissue and
Bovine (cow) pericardial
tissue
Porcine (pig) Valves
 Two major brands of porcine
available today, Hancock and
Carpentier-Edwards
 Has good durability and and
good hemodynamics
Materials: Porcine valve tissue,
stents made of wire,
Elgiloy(cobalt-nickel alloy),
sewing ring-knitted Teflon
Pericardial (cow) Valves
 Lasts as long as standard
porcine valves at 10 years
 The pericardial valve has
excellent hemodynamics,
even in smaller sizes(19mm
to 21mm)and has gained a
large market share (about
40% of US tissue valves) in
this group of patients
Stentless Porcine Valve
 Stentless valves are made
by removing the entire
aortic root and adjacent
aorta as a block from the
pig
 Drawbacks: Valve is more
difficult to to implant and
requires special
measurements for
successful implantation
Homografts(Human to Human)
 Homografts are valves transplanted from
one human to another
 After donation, valves are preserved in
liquid nitrogen(cyropreserved) until needed
 Since the valve must be thawed overnight,
the patient’s size must be known beforehand
 As with heart transplants, homograft
availability is limited by donor availability
Autografts (Ross Procedure)
 Autografts are valves taken from the same patient in
which the valve is implanted
 Used for patients with diseased aortic valves
 Advantages: patient receives a living valve in the aortic
position
Better durability and hemodynamics
Disadvantages: difficult procedure for the surgeon and
involves considerable skill and time
most common problem is leakage of the valve (aortic
regurgitation)
Animal Tissue Valves vs. Mechanical Valves

 With the animal tissue, patients do not need lifelong

anticoagulant therapy required with mechanical
valves
 Animal tissue is also inexpensive and mass-produced
 However, animal tissue has uncertain durability (5-
15 years )that will inevitably require a risky re-
operation
 Mechanical valves can also fail suddenly and
catastrophically
 Have serious problem with thromboembolism
 Advice for Valve Patients

 Anticoagulation
 Avoid Infections
 Care at the time of Dental Procedures
 Stress free Life style
 Follow-Ups at least once a year
Q & A
Thanks