Fragmentation of Different Calcification Growth Patterns in Bicuspid Valves During Balloon Valvuloplasty Procedure

Adi Morany, Karin Lavon, Rotem Halevi, Nora Haj-Ali, Danny Bluestein, Ehud Raanani, Ashraf Hamdan, Rami Haj-Ali*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

This study focuses on the calcification development and routes of type-1 bicuspid aortic valves based on CT scans and the effect of the unique geometrical shapes of calcium deposits on their fragmentation under balloon valvuloplasty procedures. Towards this goal, the novel Reverse Calcification Technique (RCT), which can predict the calcification progression leading to the current state based on CT scans, is utilized for n = 26 bicuspid aortic valves patients. Two main calcification patterns of type-1 bicuspid aortic valves were identified; asymmetric and symmetric with either partial or full arcs and circles. Subsequently, a calcification fragmentation biomechanical model was introduced to study the balloon valvuloplasty procedure prior to transcatheter aortic valve replacement implantation that allows better device expansion. To achieve this goal, six representative stenotic bicuspid aortic valves of different calcification patterns were investigated. It was found that the distinct geometrical shape of the calcium deposits had a significant effect on the cracks' initiations. Full or partial circle deposits had stronger resistance to fragmentation and mainly remained intact, yet, arc-shaped pattern deposits resulted in multiple cracks in bottleneck regions. The proposed biomechanical computational models could help assess calcification fragmentation patterns toward improving treatment approaches in stenotic bicuspid aortic valve patients, particularly for the off-label use of transcatheter aortic valve replacement.

Original languageEnglish
Pages (from-to)1014-1027
Number of pages14
JournalAnnals of Biomedical Engineering
Volume51
Issue number5
DOIs
StatePublished - May 2023

Funding

FundersFunder number
Bioengineering Research PartnershipsU01, EB026414
Polynova Cardiovascular Inc.
National Institutes of Health
Edwards Lifesciences
Council for Higher Education

    Keywords

    • Balloon valvuloplasty procedure
    • Bicuspid aortic valve (BAV)
    • Calcific aortic valve disease (CAVD)
    • Calcification fragmentation
    • Reverse Calcification Technique (RCT)

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