The use of isolated heart models and anatomic specimens as means to enhance the design and testing of cardiac valve therapies

In recent years the use of perfusion-fixed cadaveric specimens and isolated heart models has helped develop an improved understanding of the device-tissue interface and contributed to the rapid evolution of surgically and percutaneously delivered valve therapies. This chapter describes a novel series of techniques utilized within the Visible Heart® laboratory by engineers, scientists, and anatomists to visualize and analyze the form and function of the four cardiac valves and assess potential repair or replacement therapies. The study of reanimated large mammalian hearts (including human) and specially prepared anatomical specimens using various clinical and nonclinical imaging modalities has provided feedback for both design engineers and clinicians that seek to develop and/or employ valve repair approaches for patients with acquired or congenital heart valve defects.

[1]  J B Seward,et al.  Standardized nomenclature and anatomic basis for regional tomographic analysis of the heart. , 1981, Mayo Clinic proceedings.

[2]  Ottavio Alfieri,et al.  Mitral leaflet anatomy revisited. , 2009, The Journal of thoracic and cardiovascular surgery.

[3]  P J Kilner,et al.  Cardiovascular cavities cast in silicone rubber as an adjunct to post-mortem examination of the heart. , 1989, International journal of cardiology.

[4]  K. A. Merendino,et al.  An anatomical comparison of human pig, calf, and sheep aortic valves. , 1969, The Annals of thoracic surgery.

[5]  J J O'Sullivan,et al.  Survival with congenital heart disease and need for follow up in adult life , 2001, Heart.

[6]  Jason L. Quill,et al.  Design of a Novel Perfusion System to Perform MR Imaging of an Isolated Beating Heart , 2009 .

[7]  H Honjo,et al.  Computer Three-Dimensional Reconstruction of the Sinoatrial Node , 2005, Circulation.

[8]  Paul A Iaizzo,et al.  Cardiac device testing enhanced by simultaneous imaging modalities: the Visible Heart®, fluoroscopy and echocardiography , 2008, Expert review of medical devices.

[9]  Paul A Iaizzo,et al.  In vitro studies of human hearts. , 2005, The Annals of thoracic surgery.

[10]  Robert A Levine,et al.  Geometric Determinants of Functional Tricuspid Regurgitation: Insights From 3-Dimensional Echocardiography , 2006, Circulation.

[11]  R. Tubbs,et al.  Chiari’s network: review of the literature , 2010, Surgical and Radiologic Anatomy.

[12]  R. Mobini,et al.  Longitudinal myocardial contraction improves early during titration with metoprolol CR/XL in patients with heart failure , 2002, Heart.

[13]  Jeroen J. Bax,et al.  Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. , 2008, JACC. Cardiovascular imaging.

[14]  O. Langendorff,et al.  Untersuchungen am überlebenden Säugethierherzen , 1895, Archiv für die gesamte Physiologie des Menschen und der Tiere.

[15]  D. Sigg,et al.  Role of δ-opioid receptor agonists on infarct size reduction in swine , 2002 .

[16]  Warren J Manning,et al.  Gender differences and normal left ventricular anatomy in an adult population free of hypertension. A cardiovascular magnetic resonance study of the Framingham Heart Study Offspring cohort. , 2002, Journal of the American College of Cardiology.

[17]  Toshiaki Akita,et al.  Pressure-volume relationship in isolated working heart with crystalloid perfusate in swine and imaging the valve motion. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[18]  Amit R. Patel,et al.  Accuracy of aortic annular measurements obtained from three-dimensional echocardiography, CT and MRI: human in vitro and in vivo studies , 2012, Heart.

[19]  Gabriele Borelli,et al.  Percutaneous Mitral Annuloplasty: An Anatomic Study of Human Coronary Sinus and Its Relation With Mitral Valve Annulus and Coronary Arteries , 2006, Circulation.

[20]  Fabien Hyafil,et al.  Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. , 2010, Journal of the American College of Cardiology.

[21]  Paul A. Iaizzo,et al.  Comparative Cardiac Anatomy , 2005 .

[22]  A. Thomas,et al.  The demonstration of cardiac pathology using perfusion‐fixation , 1985, Histopathology.

[23]  D J Hagler,et al.  Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Technique, image orientation, structure identification, and validation. , 1978, Mayo Clinic proceedings.

[24]  Paul A. Iaizzo,et al.  Venous valves within left ventricular coronary veins , 2008, Journal of Interventional Cardiac Electrophysiology.

[25]  Michael Eggen,et al.  Analysis of fiber orientation in normal and failing human hearts using diffusion tensor MRI , 2009, 2009 IEEE International Symposium on Biomedical Imaging: From Nano to Macro.

[26]  P. Iaizzo,et al.  Isolated four-chamber working swine heart model. , 2000, The Annals of thoracic surgery.

[27]  Kumaraswamy Nanthakumar,et al.  Optical mapping of Langendorff-perfused human hearts: establishing a model for the study of ventricular fibrillation in humans. , 2007, American journal of physiology. Heart and circulatory physiology.

[28]  Robert H. Anderson,et al.  The Heart: Structure in Health and Disease , 1992 .

[29]  Michael Bateman,et al.  MRI assessment of pacing induced ventricular dyssynchrony in an isolated human heart , 2010, Journal of Magnetic Resonance Imaging.

[30]  Marco Stijnen,et al.  Images in cardiovascular medicine. Direct endoscopic visual assessment of a transcatheter aortic valve implantation and performance in the Physioheart, an isolated working heart platform. , 2010, Circulation.

[31]  A. Cook,et al.  Attitudinally correct nomenclature , 2002, Heart.

[32]  Michael Bateman,et al.  Comparative imaging of cardiac structures and function for the optimization of transcatheter approaches for valvular and structural heart disease , 2011, The International Journal of Cardiovascular Imaging.

[33]  H. Alkadhi,et al.  Assessment of coronary sinus anatomy between normal and insufficient mitral valves by multi-slice computertomography for mitral annuloplasty device implantation. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[34]  K. Roberts,et al.  Anatomy of the Human Heart , 2005 .

[35]  Silvia Schievano,et al.  Variations in right ventricular outflow tract morphology following repair of congenital heart disease: implications for percutaneous pulmonary valve implantation. , 2007, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[36]  Gregory D. Buckner,et al.  A Dynamic Heart System to Facilitate the Development of Mitral Valve Repair Techniques , 2009, Annals of Biomedical Engineering.

[37]  Jason L. Quill,et al.  Images in cardiovascular medicine. Direct visualization of a transcatheter pulmonary valve implantation within the visible heart: a glimpse into the future. , 2007, Circulation.

[38]  Robert H. Anderson,et al.  Computer Three‐Dimensional Anatomical Reconstruction of the Human Sinus Node and a Novel Paranodal Area , 2011, Anatomical record.

[39]  Michael Bateman,et al.  Methods to Prepare Perfusion Fixed Cardiac Specimens for Multimodal Imaging: The Use of Formalin and Agar Gels , 2011 .