Mechanical Prosthetic Valves




Key Points





  • Mechanical prostheses are evident on chest radiography. Their position is readily determined.



  • Older models of mechanical prostheses were radiographically obvious due to the greater ferrous metal content. More contemporary models contain less ferrous metal and are less apparent. The occluder elements of older models are also more readily seen; occluder elements of newer mechanical prostheses are less evident but are apparent if seen end-on.





Mechanical Prostheses


Most often, mechanical valve prostheses ( Table 9-1 ) are inserted into the aortic and the mitral positions. Many different models have been made over the 40 years of valve replacement surgery, but currently the great majority that are inserted are bileaflet hemidisk models. However, there are many older types and models still in situ, and therefore it is necessary to have an appreciation of the different types. Mechanical prostheses are evident principally because of their radiopaque sewing rings, and for some models, radiographically evident struts, cages, or occluders. The more ferrous or other metallic material within the prosthesis, the more radiographically evident the prosthesis; current mechanical prostheses contain little ferrous or metallic material and are much less radiographically evident by comparison.



TABLE 9-1

Mechanical Prosthetic Heart Valves






































































































































































































VALVES OCCLUDERS HOUSING/SEWING RING
Bileaflet Occluders
Sorin
CarboMedics Standard Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 78°; Closing: 35° Radiopaque titanium pyrolytic carbon over graphite ring/thick sewing ring
CarboMedics Aortic “R” series Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 78°; Closing: 35° Radiopaque titanium pyrolytic carbon over graphite ring
CarboMedics Top Hat Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 78°; Closing: 35° Supra-annular/radiopaque titanium pyrolytic carbon over graphite ring
CarboMedics Mitral mechanical Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 78°; Closing: 35° Radiopaque titanium pyrolytic carbon over graphite ring/very thick sewing ring
CarboMedics Optiform Mitral Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 78°; Closing: 35° Radiopaque titanium pyrolytic carbon over graphite ring
Monoleaflet Allcarbon Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 60°; Closing: 0° Radiopaque titanium pyrolytic carbon over graphite ring
Bicarbon Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 80° Radiopaque titanium pyrolytic carbon over graphite ring
Bicarbon Slimline Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 80° Radiopaque titanium pyrolytic carbon over graphite ring
Bicarbon Overline Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 80° Supra-annular/radiopaque titanium pyrolytic carbon over graphite ring
Medtronic
Medtronic-Hall (mechanical prosthesis) Radiopaque tungsten-containing single tilting disk with a central hole. Central curved radiopaque titanium guidepost. Opening: 70-75° Radiopaque titanium-containing housing ring
Medtronic-Hall Easy-Fit Radiopaque tungsten-containing single tilting disk with a central hole. Central curved radiopaque titanium guidepost. Opening: 70-75° Supra-annular/radiopaque titanium-containing housing ring
Advantage Bileaflet, radiopaque occluders. Opening: 86° NA
Advantage Supra Bileaflet, radiopaque occluders. Opening: 86° Supra-annular
(Carpentier) Edwards
Edwards Mira (mechanical prosthesis) Bileaflet occluders Opacity not known. Opening: 80° Radiopaque tungsten-titanium
St. Jude Medical Biocor
Standard Bileaflet, radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 85°; closing: 35° Nonradiopaque pyrolytic carbon over graphite ring/thick sewing ring
Masters Radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 85°; closing: 35° Nonradiopaque pyrolytic carbon over graphite ring/thick sewing ring
Masters HP (Hemodynamic Plus) Radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 85°; closing: 35° Supra-annular, nonradiopaque pyrolytic carbon over graphite ring/thick sewing ring
Regent Radiopaque tungsten-impregnated pyrolytic carbon over graphite. Opening: 85°; closing: 35° Supra-annular, nonradiopaque pyrolytic carbon over graphite ring/thick sewing ring
Bileaflet (Other)
Triflo (mecahnical prosthesis) Bileaflet NA
CarboMedics Orbis Universal NA NA
St. Jude Medical Masters NA NA
St. Jude Medical HP NA NA
CarboMedics “R” Series Aortic NA NA
Sorin Bicarbon NA NA
ATS Open Pivot (mechanical bileaflet) Bileaflet, nonradiopaque pyrolytic carbon. Opening: 85° Nonradiopaque pyrolytic carbon
On-X Bileaflet, nonradiopaque pyrolytic carbon. Opening: 85° Nonradiopaque pyrolytic carbon
Single (Nontilting) Disk
Beall-Surgitool Nonopaque flat plastic occluders NA
Cooley-Cutter Radiopaque single faceted domed disk Densely radiopaque housing with four densely radiopaque pronglike struts that do not close at the top
Single Tilting Disk
Björk-Shiley Single tilting disk with a central radiopaque rim. Opening: 60°; closing: 0° Densely radiopaque housing with two densely radiopaque bridgelike struts
Björk-Shiley Convexoconcave (BCC60) Single tilting disk with a central radiopaque rim. Opening: 60°; closing: 0° Densely radiopaque housing with two densely radiopaque bridgelike struts
Björk-Shiley Convexoconcave (BCC70) Single tilting disk with a central radiopaque rim. Opening: 70°; closing: 0° Densely radiopaque housing with two densely radiopaque bridgelike struts
Björk-Shiley Monostrut Single tilting disk with a central radiopaque rim. Opening: 60°; closing: 0° Densely radiopaque housing with two densely radiopaque struts; one bridge shaped and the other a post
Omnicarbon Single tiling disk; pyrolytic carbon/graphite. Opening: 80°; closing: 0° Radiopaque titanium, includes small struts/flanges that hold the occluder and are visible
Koehler Ultracor Radiopaque single tilting disks. Aortic with opening of 73° and mitral with opening of 68°; closing angle unknown NA
Lillehei-Kaster Radiopaque single tilting disk Radiopaque housing with two radiopaque fanglike struts
Omniscience Radiopaque single tilting disk Radiopaque housing and flanges
Aortech UltraCor Radiopaque single tilting disk Radiopaque housing and wire struts
Bicer Single tilting disk Radiopaque housing and wire struts
Sorin Monocast Single tilting disk Radiopaque housing and wire struts
Ball-in-Cage
Starr-Edwards Radiopaque (barium-containing) silastic ball; radiopaque alloy cage Radiopaque post; cage domed at the top
Smeloff-Cutter Silastic ball Radiopaque post; cage (open at the top)
McGovern-Crombie Silastic ball Radiopaque post; cage (open at the top)
Debakey-Surgitool Radiopaque steel ball Radiopaque post; cage domed at the top

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Apr 10, 2019 | Posted by in CARDIOVASCULAR IMAGING | Comments Off on Mechanical Prosthetic Valves
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