Abstract
The Starr-Edwards ball valve has been one of the more commonly used aortic valve prostheses. In the study reported here, in vitro velocity, shear-stress and pressure drop measurements were made under steady-flow conditions and used to interpret some of the failure modes of this prosthesis as observed at autopsy. The findings show that some failure modes can be explained by the nature of the values for velocities and shears in the near vicinity of the valve.
Our results indicate that the Starr-Edwards ball valve has major fluid dynamic drawbacks such as: (a) relatively large pressure drop (17.3 to 31.0 mm Hg at a flow rate of 417 cm3 /sec), (b) hydrodynamically unstable poppet, (c) regions of flow separation at the base of each of the three struts, (d) region of flow stagnation at the apex of the cage (~7 to 15 mm in diameter) (e) large wall-shear stresses (~500–2000 dynes/cm2) and bulk turbulent shear stresses (on the order of 100–5000 dynes/cm2) in the immediate downstream vicinity of the valve, and (f) large shear stresses adjacent to the poppet surface and struts (on the order of 102–103 dynes/cm2).
The observed stagnation zone could encourage thrombus formation on the apex of the cage, while the observed regions of flow separation could lead to thrombus formation and tissue overgrowth at the base and upwards along the struts. The observed wall shear could lead to damage of endothelial tissue in the proximal ascending aorta, to hemolysis, and to thrombus formation. In addition, the elevated shears adjacent to the struts and the surface of the poppet could lead to increased hemolysis with those Starr-Edwards ball valves having cloth covered struts.
Examinations have been made at the USC-LA County Medical Center of 13 Starr-Edwards aortic ball valves recovered during autopsy. Thrombus formation and tissue overgrowth were observed at various locations on the recovered valves. The locations of thrombus formation and tissue overgrowth correlate well with those predicted by the in vitro fluid dynamic data. In addition, endothelial damage and tissue proliferation in the proximal ascending aorta were observed in some cases. Similar pathologic findings have also been observed by other investigators.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Blackshear, P.L. (1972a) Hemolysis at prosthetic surfaces. Chemistry of Biosurfaces (Edited by Hair, M.L.) Vol. 2. pp. 523–561. Marcel Dekker, New York.
Blackshear, P.L. (1972b) Mechanical hemolysis in flowing blood. Biomechanics - Its Foundations and Objectives (Edited by Fung, Y.C.,Perrone, N. and Anliker, M), pp. 501528. Prentice - Hall, Englewood Cliffs.
Crawford, F.A., Sethi, G.K. Scott, S.M., and Takaro, T. (1973) Systemic emboli due to cloth wear in a Starr-Edwards model 2320 aortic prosthesis. Ann Thorac. Surg 16, 614–619.
Davey, T.B., Kaufaman, B., and Smeloff, E.A (1966) Pulsatile flow studies of prosthetic heart valves. J. Thorac, Cardiovasc. Surg. 51, 264–267.
Davila, J.C., Palmer, T.E., Sethi, R.S., DeLaurentis, D.A., Enriquez, F., Rincorn,N., and Lautsch, E.V. (1966) The problem of thrombosis in artificial cardiac valves. Heart Substitutes: Mechanical and Transplant(Edited by Brest, A.N.), pp. 25–36. Charles C. Thomas, Springfield.
Eyster, E., Rothchild, J., and Mychajliw, 0. (1971) Chronic intravascular hemolysis after aortic valve replacement. Circulation XLIV 657–665.
Figliola, R.S. (1976). A study of the hemolytic potential of prosthetic heart valve flows based on local in vitro stress measurements. M.S. thesis, University of Notre Dame.
Figliola, R.S. (1979) In Vitro Velocity and Shear Stress Measurements in the Vicintiy of Prosthetic Heart Valves Using Laser Doppler and Hot-Film Anemometry. Ph.D. thesis, University of Notre Dame.
Fry, D.L. (1968) Acute vascular endothelial changes associated with increased blood velocity gradients. Circ. Res. 22, 165–197.
Fry, D.L. (1969) Certain histological and chemical responses of the vascular interface to acutely induced mechanical stress in the aorta of the dog. Circ. Res. 24, 93–108.
Hamby, R.I., Lee, R.L., Aintablian, A., Wisoff, B.G., and Hartstein, M.L. (1974) Cinefluorographic study of the aortic ball-cage prosthetic valve. Am.J. Cardiol. 34, 276–283.
Hellums, J.D., and Brown III, C.H. (1977) Blood cell damage by mechanical forces. Cardiovascular Fluid Dynamics (Edited by Hwang, N.H.C. and Normann, N.A.),pp. 799–823. University Park Press, Baltimore.
Hung, T.C., Hochmuth, R.M., Joist, J.H., and Sutera, S.P. (1976) Shear-induced aggregation and lysis of platelets. Trans. Am. Soc. Artis. Intern. Organs 22, 285–290.
Lamberti, J.J., Das Gupta, D.D., Falicov, R., and Anagnostopoulos, C.E. (1977) An unusual form of late stenosis after aortic valve replacement with cloth-covered Starr-Edwards and prosthesis. Chest 71, 680–684.
Lefemine, A.A., Miller, M„ and Pinder, G,C, (1974) J, Thorac, Cardiovasc. Surg. 67, 857–862.
Mohandas, N., Hochmuth, R.M., and Spaeth, E.E. (1974) Adhesion of red cells to foreign surfaces in the presence of flow. J. Biomech. Mat. Res. 8, 119–136.
Nevaril, C.G., Hellums, J.D., Alfey Jr., C.P. and Lynch, E.C. (1969) Physical effects in red blood cell trauma. A. I. ChE. J. 15, 707–711.
Ramstack, J.M. Zuckerman, L., and Mockros, L.F. (1979) Shear induced activation of platelets. J. Biomech. 12, 113–125 (1979).
Roberts, W.C., and Morrow, A.G. (1979) Anatomic studies of hearts containing caged-ball prosthetic valves. Johns Hopkins Med. J. 121, 271–295.
Roberts, W.C., and Morrow, A.G. (1967b) Late post-operative pathological findings after cardiac valve replacement. Circ, Suppl. (1) 35-36, 48–62.
Roberts, W.C. (1976) Choosing a substitute cardiac valve: type, size, surgeon. Am. J. Cardiol. 38, 633–644.
Santinga, J.T., and Kirsh, M.M. (1972) Hemolytic anemia in series 2300 and 2310 Starr-Edwards prosthetic valves. Ann Thorac. Surg. 14, 539–544.
Santinga, J.T., Kirsh, N.N., and Batsakis, J.T. (1973) Hemolysis in different series of the Starr-Edwards aortic valve prostheses. Chest 63, 905–908.
Smeloff, E.A., Huntley, A.C., Davey, T.B., Kaufman, B., and Gerbode, F. (1966) Camparative study of prosthetic heart valves. J. Thorac. Cardiovasc. Surg. 52, 841–846.
Smithwick III, W., Kouchoukos, N.T., Karp, R.B., Pacifico,:D., and Kirklin, J.W. (1975) Late stenosis of Starr-Edwards cloth-covered prostheses. 20, 249–255.
Stein, D.W., Rahimtoola, S.H., Kloster, F.E., Selden, R., and Starr, A. (1976). J. Thorac. Cardiovasc. Surg. 71, 680–684.
Weiting, D.W. (1969) Dynamic Flow Characteristics of Heart Valves. Ph.D. thesis, University of Texas, Austin.
Yoganathan, A.P. (1978) Cardiovascular Fluid Mechanics. Ph.D. thesis, California Institute of Technology, Passadena.
Yoganathan, A.P., Corcoran, W.H., Carl, J.R., and Harrison, E.C. (1978). The Bjork-Shiley aortic prosthesis: flow characteristics, thrombus formation and tissue overgrowth. Circulation 58, 70–76.
Yoganathan, A.P. Reamer, H.H. Corcoran, W.H., and Harrison, E.C. (1979a) A laser-Doppler anemometer to study velocity fields in the vicinity of prosthetic heart valves. Med. Biol. Engng. Computing 17, 38–44.
Yoganathan, A.P., Corcoran, W.H., and Harrison, E.C. (1979b) In vitro velocity measurements in the vicinity of aortic prostheses. J. Biomech. 12, 135–152.
Yoganathan, A.P., Corcoran, W.H., and Harrison, E.C. (1979c) Pressure drops across prostletic aortic heart vlaves under steady and pulsatile flow–in vitro measurements. J. Biomech. 12, 153–164.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1980 Springer Science+Business Media New York
About this chapter
Cite this chapter
Yoganathan, A.P., Reamer, H.H., Corcoran, W.H., Harrison, E.C., Shulman, I.A., Parnassus, W. (1980). The Starr-Edwards Aortic Ball Valve: Flow Characteristics, Thrombus Formation and Tissue Overgrowth. In: Schneck, D.J. (eds) Biofluid Mechanics · 2. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-4610-5_14
Download citation
DOI: https://doi.org/10.1007/978-1-4757-4610-5_14
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4757-4612-9
Online ISBN: 978-1-4757-4610-5
eBook Packages: Springer Book Archive