Stress analysis of porcine bioprosthetic heart valves in vivo.

During the normal functioning of aortic porcine bioprosthetic valves, the leaflets undergo complex configurational changes which can produce stresses large enough to damage the leaflets. Stress analyses of these valves in vivo have not been performed before. We investigated the behavior of aortic bioprostheses in vivo in calves by placing radiopaque markers on the valves and observing them under x-ray. Based upon the behavior of the leaflets, a method of stress analysis is proposed. Membrane stresses were associated with a pressure gradient across the leaflet and bending stresses with a change in the leaflet curvature. Total stresses were obtained by summation of the two stresses. A model of leaflet deformation at its attachment is proposed and the stresses determined. In diastole, the total stresses in the leaflet were tensile. In systole, the total stresses at the leaflet attachment were large and compressive on the aortic surface. Since the leaflet is unable to sustain compressive stresses, it is concluded that large compressive stresses cause structural damage at the leaflet attachment. This may explain the clinical observation that bioprosthetic leaflets detach or calcify in this region.