Wium Elsmari, Jordaan Christiaan Johannes, Botes Lezelle, Smit Francis Edwin
Robert WM Frater Cardiovascular Research Centre, Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
Department of Mechanical and Mechatronic Engineering, Faculty of Engineering, Stellenbosch University, Stellenbosch, South Africa.
Asian Cardiovasc Thorac Ann. 2020 Sep;28(7):431-443. doi: 10.1177/0218492319891255. Epub 2019 Nov 21.
Due to the prevalence of rheumatic heart disease in the developing world, mechanical heart valves in the younger patient population remain the prostheses of choice if repair is not feasible. Despite their durability, mechanical valves are burdened by coagulation and thromboembolism. Modern design tools can be utilized during the design process of mechanical valves, which allow a more systematic design approach and more detailed analysis of the blood flow through and around valves. These tools include computer-aided design, manufacturing, and engineering, such as computational fluid dynamics and finite element analysis, modern manufacturing techniques such as additive manufacturing, and sophisticated in-vitro and in-vivo tests. Following this systematic approach, a poppet valve was redesigned and the results demonstrate the benefits of the method. More organized flow patterns and fewer complex fluid structures were observed. The alternative trileaflet valve design has also been identified as a potential solution and, if a similar design approach is adopted, it could lead to the development of an improved mechanical heart valve in the future. It is imperative that researchers in developing countries continue their search for a mechanical heart valve with a reduced thromboembolic risk, requiring less or no anticoagulation.
由于发展中世界风湿性心脏病的流行，如果修复不可行，年轻患者群体中的机械心脏瓣膜仍然是首选的假体。尽管机械瓣膜耐用，但却受到凝血和血栓栓塞问题的困扰。现代设计工具可在机械瓣膜的设计过程中加以利用，这使得设计方法更具系统性，对瓣膜内外血流的分析也更加详细。这些工具包括计算机辅助设计、制造和工程，如计算流体动力学和有限元分析，增材制造等现代制造技术，以及精密的体外和体内测试。遵循这种系统方法，对一种提动阀进行了重新设计，结果证明了该方法的益处。观察到了更有序的流动模式和更少的复杂流体结构。替代的三叶瓣瓣膜设计也已被确定为一种潜在的解决方案，如果采用类似的设计方法，未来可能会开发出改进的机械心脏瓣膜。发展中国家的研究人员必须继续寻找血栓栓塞风险降低、抗凝需求减少或无需抗凝的机械心脏瓣膜。
