Ropcke Diana M, Jensen Morten O J, Jensen Henrik, Hejslet Tine, Nielsen Sten L
J Heart Valve Dis. 2014 Nov;23(6):788-94.
The use of extracellular matrix (ECM) from the porcine small intestinal submucosa has shown promising results in reconstructive heart surgery. The study aim was to compare native and ECM tricuspid valves with regards to tricuspid leaflet coaptation geometry and force development in the three papillary muscles, under normal ventricular pressures.
Six native porcine tricuspid valves and five ECM valves were examined in a static pressure right-heart simulator. Water was used in the ventricular chamber to induce adequate pressure changes (from 5 to 40 mmHg). Dedicated force transducers were used to measure force development in the three papillary muscles in parallel with ventricular pressure measurements. Relative leaflet area was defined as the percentage that one leaflet area comprised of the whole orifice area. The estimated peak leaflet pressure force was defined as leaflet area x peak ventricular pressure, and peak leaflet tethering force was calculated as the average of two adjacent papillary muscles forces. Valve competence and leaflet areas were documented using digital photography.
The relative leaflet area of the anterior leaflet was significantly smaller (0.4 versus 0.5, p < 0.01) and that of the posterior leaflet was significantly larger (0.3 versus 0.2; p < 0.001) in ECM tube grafts compared to native valves. No difference was found between septal leaflet relative areas (p > 0.1). Accordingly, estimated peak leaflet pressure forces were greater in anterior leaflets and smaller in the posterior leaflets of native valves compared to ECM valves (p < 0.01). However, peak papillary muscle forces and peak leaflet tethering forces did not differ significantly between the valves.
A competent and functional tricuspid valve can be constructed in vitro from ECM. In spite of different leaflet area distributions, the force distribution and tethering forces were not significantly different between the two valve types, indicating that a physiologically functioning tricuspid valve can be constructed from ECM.
猪小肠黏膜下层细胞外基质（ECM）在心脏重建手术中的应用已显示出有前景的结果。本研究旨在比较天然三尖瓣和ECM三尖瓣在正常心室压力下三尖瓣叶贴合几何形状以及三个乳头肌中的力发展情况。
在静态压力右心模拟器中检查六个天然猪三尖瓣和五个ECM瓣膜。在心室腔中使用水来诱导足够的压力变化（从5至40 mmHg）。使用专用力传感器并行测量三个乳头肌中的力发展情况以及心室压力。相对瓣叶面积定义为一个瓣叶面积占整个瓣口面积的百分比。估计的瓣叶峰值压力力定义为瓣叶面积×心室峰值压力，瓣叶峰值牵拉力量计算为两个相邻乳头肌力的平均值。使用数码摄影记录瓣膜功能和瓣叶面积。
与天然瓣膜相比，ECM管状移植物中前叶的相对瓣叶面积显著更小（0.4对0.5，p < 0.01），而后叶的相对瓣叶面积显著更大（0.3对0.2；p < 0.001）。隔膜叶相对面积之间未发现差异（p > 0.1）。因此，与ECM瓣膜相比，天然瓣膜前叶的估计瓣叶峰值压力力更大，后叶的更小（p < 0.01）。然而，瓣膜之间乳头肌峰值力和瓣叶峰值牵拉力量没有显著差异。
可以使用ECM在体外构建功能正常的三尖瓣。尽管瓣叶面积分布不同，但两种瓣膜类型之间的力分布和牵拉力量没有显著差异，表明可以使用ECM构建具有生理功能的三尖瓣。
