**Meet the editors**

Dr. Ying-Fu Chen was born in Changhua, Taiwan, in 1946. He received an MD degree from Kaohsiung Medical College, Kaohsiung, Taiwan, in 1973, and a PhD degree from Graduate Institute of Medicine, Kaohsiung Medical University, in 1992.

In 1983, Dr. Chen was a clinical fellow at the Heart Institute of Japan, Tokyo Women Medical University in 1983,

before moving to Durham, North Carolina in 1985, where he worked as a research fellow at the Duke University Medical Center. He was appointed Professor of Surgery at the Kaohsiung Medical University in 1992, and is currently appointed Professor of Graduate Institute of Medicine as well, also at the Kaohsiung Medical University. His main research interests include stem cells and inflammation in basic studies, and thoracic aorta aneurysms/ dissections in clinical fields. He has served as an editor of 2 books and is also an editorial member of several national and international journals. Currently, he also serves as a managing editor of Frontiers of Bioscience.

Dr. Chwan-Yau Luo received his MD degree from Kaohsiung Medical University, Kaohsiung, Taiwan, in 1986, and his Master of Science in Experimental Surgery, under the supervision of Prof. Ray C-J Chiu, from McGill University, Montreal, Canada, in 2004. He was trained in thoracic organ transplantation at Papworth Hospital at Cambridge University, England, in 1999. Currently, he is the Chief of

the Cardiovascular Surgery Department, Director of the Heart Transplantation and Mechanical Circulatory Assisted Device Programs, and an active cardiovascular surgeon at National Cheng Kung University Hospital in Tainan, Taiwan. Moreover, he is also an Associate Professor and a Fellow of the Cardiovascular Research Center at National Cheng Kung University. His current clinical research interest is focused on the surgical treatment of heart failure, including heart transplantation, mechanically assisted support and post-transplantation therapeutic immunosuppressive drug monitoring. In addition, his basic research interest is concentrated on angiogenesis therapies for peripheral artery occlusive disease.

Contents

**Preface IX** 

Chapter 1 **Rapid Quantitation of Aortic Valve Flow** 

Chapter 2 **State-Of-The-Art Methods for the** 

**Part 3 Infective Endocarditis 71** 

Chapter 4 **Aortic Valve Endocarditis 73** 

Lazar Velicki, Stamenko Šušak,

**Part 4 Aortic Sclerosis/Aortic Stenosis 119** 

Jesper Hjortnaes and Elena Aikawa

Chapter 7 **Calcific Aortic Valve Disease 133** 

**Using Spiral Fourier Velocity Encoded MRI 3**

**Numerical Simulation of Aortic BMHVs 29** 

**Part 2 General Consideration of Aortic Valve Disease 51** 

Chapter 3 **Aortic Valve Disease from Etiology to Bedside 53**  Shahab Shahrzad and Samira Taban

Nada Čemerlić-Ađić and Aleksandar Redžek

Chapter 5 **Native and Prosthetic Aortic Valve Endocarditis 93** 

Chapter 6 **The Progression of Aortic Sclerosis to Aortic Stenosis 121**  Uzma Jalal Serageldin Raslan and Farouk Mookadam

Ioan Tilea, Brindusa Tilea, Cristina Maria Tatar and Mihaela Ispas

Sebastiaan Annerel, Tom Claessens, Peter Van Ransbeeck, Patrick Segers, Pascal Verdonck and Jan Vierendeels

Joao L. A. Carvalho and Krishna S. Nayak

**Part 1 Basic Science 1** 

## Contents

#### **Preface XIII**

**Part 1 Basic Science 1** 


#### **Part 2 General Consideration of Aortic Valve Disease 51**

Chapter 3 **Aortic Valve Disease from Etiology to Bedside 53**  Shahab Shahrzad and Samira Taban

#### **Part 3 Infective Endocarditis 71**

	- **Part 4 Aortic Sclerosis/Aortic Stenosis 119**

## **Part 5 Bioprosthetic Valve 163**

Chapter 8 **Clinical and Hemodynamic Performance of the Sorin Mitroflow Pericardial Bioprosthesis 165**  W. R. E. Jamieson, C. A. Yankah, R. Lorusso, O. Benhameid, R. I. Hayden, R. Forgie and H. Ling

Contents VII

Chapter 18 **Surgical Treatment of Bicuspid Aortic Valve Disease 331**

Ying-Fu Chen and Shuo-Tsan Lee

Chapter 9 **Influence of Prosthesis-Patient Mismatch on Survival with Aortic Valve Replacement 175**  W.R. Eric Jamieson, Charlie Zhang, Jennifer Higgins, Michael H. Yamashita and Jian Ye

#### **Part 6 Transcatheter Aortic Valve Implantation 193**


#### **Part 7 Congenital Anomalies of the Aortic Valve 267**


#### Chapter 18 **Surgical Treatment of Bicuspid Aortic Valve Disease 331** Ying-Fu Chen and Shuo-Tsan Lee

VI Contents

**Part 5 Bioprosthetic Valve 163** 

Chapter 10 **Current Indications for** 

Chapter 11 **Transcatheter Aortic Valve** 

Chapter 8 **Clinical and Hemodynamic Performance** 

Chapter 9 **Influence of Prosthesis-Patient Mismatch**

W.R. Eric Jamieson, Charlie Zhang,

**Part 6 Transcatheter Aortic Valve Implantation 193**

**Implantation: State of the Art 211** 

Chapter 12 **Transcatheter Aortic Valve Implantation 221**

Chapter 13 **Image-Guided Transcatheter Aortic** 

Chapter 14 **Unicuspid Aortic Valve 269**

Chapter 15 **Bicuspid Aortic Valve 275**

**of the Sorin Mitroflow Pericardial Bioprosthesis 165** 

**on Survival with Aortic Valve Replacement 175**

Jennifer Higgins, Michael H. Yamashita and Jian Ye

**Transcatheter Aortic Valve Implantation 195** Ibrahim Akin, Stephan Kische, Henrik Schneider, Tim C. Rehders, Christoph A. Nienaber and Hüseyin Ince

Alice Le Huu, Rony Atoui and Dominique Shum-Tim

**Valve Implantation Assistance System 251**  Mohamed Esmail Karar, David Holzhey, Matthias John, Ardawan Rastan, Friedrich-Wilhelm Mohr and Oliver Burgert

**Part 7 Congenital Anomalies of the Aortic Valve 267**

Dardan Kocinaj, Ejup Pllana and Masar Gashi

**Valve Disease and Coronary Heart Disease 291**

Evaldas Girdauskas, Michael A. Borger and Thomas Kuntze

Chapter 17 **Novel Phenotypes in Bicuspid Aortic Valve Disease 315** 

**Relationship Between Bicuspid Aortic**

Venkata Thota and Farouk Mookadam

Blerim Berisha, Xhevdet Krasniqi,

Chapter 16 **A Case-Control Investigation of the** 

Mehmet Necdet Akkus

Hunaid A. Vohra, Robert N. Whistance and Sunil K. Ohri

W. R. E. Jamieson, C. A. Yankah, R. Lorusso, O. Benhameid, R. I. Hayden, R. Forgie and H. Ling

Preface

The book〝**Aortic Valve**〞is comprised of 18 chapters and is further organized into seven sections. **Section I** (Basic Science) includes two chapters. In Chapter 1 titled〝Rapid quantitation of aortic valve flow using spiral Fourier velocity encoded MRI〞by Joao LA Carvalho and Krishna S Nayak, the authors introduced spiral Fourier velocity encoding, a new method for rapid and non-invasive measurement of cardiovascular blood flow using magnetic resonance imaging ( MRI ), which is capable of accurately capturing peak velocities in flow jets due to stenosis or regurgitation. In Chapter 2, titled〝State-of-the-art methods for the numerical simulation of aortic BMHVs〞by Annerel Sebastiaan et al., the authors say that modern bileaflet mechanical heart valves (BMHVs) are still far from perfect and still face major design challenges. Authors introduce that numerical simulation techniques can provide valuable information and are considered as crucial in order to gain insights into the blood flow, and assess the performance of future valve prototypes. **Section** Ⅱ (General Consideration of Aortic Valve Disease) includes chapter 3 with the title 〝Aortic valve disease from etiology to bedside〞by Shahab Shahrzad and Samira Taban. The authors provide basic information that is essential to understanding aortic root anatomy and the general knowledge of aortic valve diseases, including management. **Section** Ⅲ (Infective Endocarditis) includes two chapters covering infective endocarditis. Chapter 4, 〝Aortic valve endocarditis〞by Lazar Velicki and Chapter titled〝Native and prosthetic aortic valve endocarditis〞by Ioan Tilea et al. These chapters describe various aspects of native and prosthetic aortic valve endocarditis, including epidemiology, pathogenesis, clinical presentation, microbiology, diagnosis, complications and updated medical and surgical treatments, and it will be informative to readers. **Section** Ⅳ (Aortic Sclerosis / Aortic Stenosis) includes two chapters. In Chapter 6, 〝The progression of aortic sclerosis to aortic stenosis〞by Uzma Jalal et al., the authors propose some thoughts that early, aggressive medical intervention be undertaken before the irrevocable process of calcification occurs. Chapter 7, titled〝Calcific aortic valve disease〞by Jesper Hjortnaes and Elena Aikawa, attempts to characterize the studies that have identified the molecular biology of calcific aortic valve disease, to understand the cellular mechanisms of the disease, and potentially preventing this disease procession. **Section V** (Bioprosthetic Valve) includes two chapters on cardiac valvular prosthesis. Chapter 8 which is titled 〝Clinical and hemodynamic performance of the Sorin Mitroflow pericardial bioprothesis〞by Jamieson et al., and Chapter 9,〝Influence of prosthesis-

## Preface

The book〝**Aortic Valve**〞is comprised of 18 chapters and is further organized into seven sections. **Section I** (Basic Science) includes two chapters. In Chapter 1 titled〝Rapid quantitation of aortic valve flow using spiral Fourier velocity encoded MRI〞by Joao LA Carvalho and Krishna S Nayak, the authors introduced spiral Fourier velocity encoding, a new method for rapid and non-invasive measurement of cardiovascular blood flow using magnetic resonance imaging ( MRI ), which is capable of accurately capturing peak velocities in flow jets due to stenosis or regurgitation. In Chapter 2, titled〝State-of-the-art methods for the numerical simulation of aortic BMHVs〞by Annerel Sebastiaan et al., the authors say that modern bileaflet mechanical heart valves (BMHVs) are still far from perfect and still face major design challenges. Authors introduce that numerical simulation techniques can provide valuable information and are considered as crucial in order to gain insights into the blood flow, and assess the performance of future valve prototypes. **Section** Ⅱ (General Consideration of Aortic Valve Disease) includes chapter 3 with the title 〝Aortic valve disease from etiology to bedside〞by Shahab Shahrzad and Samira Taban. The authors provide basic information that is essential to understanding aortic root anatomy and the general knowledge of aortic valve diseases, including management. **Section** Ⅲ (Infective Endocarditis) includes two chapters covering infective endocarditis. Chapter 4, 〝Aortic valve endocarditis〞by Lazar Velicki and Chapter titled〝Native and prosthetic aortic valve endocarditis〞by Ioan Tilea et al. These chapters describe various aspects of native and prosthetic aortic valve endocarditis, including epidemiology, pathogenesis, clinical presentation, microbiology, diagnosis, complications and updated medical and surgical treatments, and it will be informative to readers. **Section** Ⅳ (Aortic Sclerosis / Aortic Stenosis) includes two chapters. In Chapter 6, 〝The progression of aortic sclerosis to aortic stenosis〞by Uzma Jalal et al., the authors propose some thoughts that early, aggressive medical intervention be undertaken before the irrevocable process of calcification occurs. Chapter 7, titled〝Calcific aortic valve disease〞by Jesper Hjortnaes and Elena Aikawa, attempts to characterize the studies that have identified the molecular biology of calcific aortic valve disease, to understand the cellular mechanisms of the disease, and potentially preventing this disease procession. **Section V** (Bioprosthetic Valve) includes two chapters on cardiac valvular prosthesis. Chapter 8 which is titled 〝Clinical and hemodynamic performance of the Sorin Mitroflow pericardial bioprothesis〞by Jamieson et al., and Chapter 9,〝Influence of prosthesispatient mismatch on survival with aortic valve replacement〞 by Jamieson et al. These chapters describe the various issues of cardiac prostheses including the newly developed bioprosthesis with excellent hemodynamic performance and a comprehensive review of prosthesis-patient mismatch after aortic valve replacement. **Section VI** (Transcatheter Aortic Valve Implantation) is comprised of four chapters. Chapter 10, "Current indications for transcatheter aortic valve implantation" by Ibrahim Akin et al. Chapter 11, "Transcatheter aortic valve implantation: State of the art" by Alice Le Huu et al., Chapter 12, "Transcatheter aortic valve implantation" by Hunaid A Vohra et al. These chapters provide the most recent evidence of transcatheter aortic valve implantation that has recently emerged as an effective therapeutic alternative to conventional aortic valve replacement for high-risk patients with severe aortic valvular stenosis. In Chapter 13, titled "Image-guided transcatheter aortic valve implantation assistance system" by Mohamed Esmail Karar et al. the authors have developed a novel system to overcome the current technical difficulties with the TAVI under 2D fluoroscopy guidance. It would be a promising design for helping the physician more accurately to put the aortic valve prosthesis in the exact position. **The Last Section** (Congenital Anomalies of the Aortic Valve) includes 5 chapters. Chapters 14, "Unicuspid aortic valve" by Venkata Thota and Farouk Mookadam, and 15, "Bicuspid aortic valve" by Blerim Berisha et al. clearly describe the anomalies of the congenital aortic valve diseases from the perspective of embryology, epidemiology, clinical presentation, diagnosis, and treatment. In Chapter 16, which is titled "A case-control investigation of the relation between bicuspid aortic valve disease and coronary heart disease", by Mehmet Necded Akkus, the author conducts a prospective case-control study to search for a relationship between bicuspid aortic valve disease and coronary artery disease. Chapter 17, "Novel phenotypes in bicuspid aortic valve disease" by Evaldas Girdauskas et al. addresses the recent updated phenotype studies of bicuspid aortic valve disease. It is a novel concept and comprehensive to the readers. The final chapter is titled "Surgical treatment of bicuspid aortic valve disease", written by Ying-Fu Chen and Shou-Tsan Lee. The authors describe the updated information regarding surgical treatment for patients with bicuspid aortic valve disease, including balloon valvuloplasty, valve replacement, Ross procedure, repair of regurgitant valve, valve-sparing aortic root replacement, and ascending aortic replacement.

Preface XI

sincerely appreciate the efforts of the team at InTech Open Access Publisher, especially publishing process managers, including Alenka Urbacic, and Zeljko Spalj, who patiently, with the editorial process, led to the production process, and editorial consultant, Viktorija Zgela, who invited us to carry out this very important book. We are indebted to our English editor, Bill Franke, at National Cheng Kung University in Tainan. His help has been incredibly important, and his experience is invaluable. We are also very grateful to Man-Lin Chen and Shan-Tsu Kuo, the administrative assistants in the Division of Cardiovascular Surgery and Graduate Institute of Medicine at Kaohsiung Medical University, who were extremely helpful and have

Finally, we wish to acknowledge the support of our families and the many sacrifices they have made to make this book possible. Our wives, Jane-Jane Wang and Ruey-Ling Huang, were our greatest support and encouragement, whose love and support

**Ying-Fu Chen, MD, PhD** 

Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital

> Graduate Institute of Medicine, Kaohsiung Medical University

**Chwan-Yau Luo, MD, MSc** 

Division of Cardiovascular Surgery, National Cheng Kung University Hospital

National Cheng Kung University

Associate Professor

School of Medicine,

Tainan, Taiwan

Professor

Kaohsiung, Taiwan

made important contributions to this book.

make it all worthwhile.

In assuming the editorship of this book, we felt it was important to publish it as soon as possible to maximize the effect of the most up-to-date knowledge in the field of aortic valve for the reader. While we hope this book will be particularly useful to cardiologists and cardiovascular surgeons and trainees, we also believe that this book will be a valuable resource for radiologists, cardiovascular anesthesiologist, and other healthcare professionals who have a special interest in treating or caring for patients with aortic valve disease.

We wish to express our gratitude to many people whose efforts made completion of this book possible. We are especially indebted to our esteemed contributing authors, who generously shared their extraordinary expertise and timely contribution. We sincerely appreciate the efforts of the team at InTech Open Access Publisher, especially publishing process managers, including Alenka Urbacic, and Zeljko Spalj, who patiently, with the editorial process, led to the production process, and editorial consultant, Viktorija Zgela, who invited us to carry out this very important book. We are indebted to our English editor, Bill Franke, at National Cheng Kung University in Tainan. His help has been incredibly important, and his experience is invaluable. We are also very grateful to Man-Lin Chen and Shan-Tsu Kuo, the administrative assistants in the Division of Cardiovascular Surgery and Graduate Institute of Medicine at Kaohsiung Medical University, who were extremely helpful and have made important contributions to this book.

X Preface

patient mismatch on survival with aortic valve replacement〞 by Jamieson et al. These chapters describe the various issues of cardiac prostheses including the newly developed bioprosthesis with excellent hemodynamic performance and a comprehensive review of prosthesis-patient mismatch after aortic valve replacement. **Section VI** (Transcatheter Aortic Valve Implantation) is comprised of four chapters. Chapter 10, "Current indications for transcatheter aortic valve implantation" by Ibrahim Akin et al. Chapter 11, "Transcatheter aortic valve implantation: State of the art" by Alice Le Huu et al., Chapter 12, "Transcatheter aortic valve implantation" by Hunaid A Vohra et al. These chapters provide the most recent evidence of transcatheter aortic valve implantation that has recently emerged as an effective therapeutic alternative to conventional aortic valve replacement for high-risk patients with severe aortic valvular stenosis. In Chapter 13, titled "Image-guided transcatheter aortic valve implantation assistance system" by Mohamed Esmail Karar et al. the authors have developed a novel system to overcome the current technical difficulties with the TAVI under 2D fluoroscopy guidance. It would be a promising design for helping the physician more accurately to put the aortic valve prosthesis in the exact position. **The Last Section** (Congenital Anomalies of the Aortic Valve) includes 5 chapters. Chapters 14, "Unicuspid aortic valve" by Venkata Thota and Farouk Mookadam, and 15, "Bicuspid aortic valve" by Blerim Berisha et al. clearly describe the anomalies of the congenital aortic valve diseases from the perspective of embryology, epidemiology, clinical presentation, diagnosis, and treatment. In Chapter 16, which is titled "A case-control investigation of the relation between bicuspid aortic valve disease and coronary heart disease", by Mehmet Necded Akkus, the author conducts a prospective case-control study to search for a relationship between bicuspid aortic valve disease and coronary artery disease. Chapter 17, "Novel phenotypes in bicuspid aortic valve disease" by Evaldas Girdauskas et al. addresses the recent updated phenotype studies of bicuspid aortic valve disease. It is a novel concept and comprehensive to the readers. The final chapter is titled "Surgical treatment of bicuspid aortic valve disease", written by Ying-Fu Chen and Shou-Tsan Lee. The authors describe the updated information regarding surgical treatment for patients with bicuspid aortic valve disease, including balloon valvuloplasty, valve replacement, Ross procedure, repair of regurgitant valve, valve-sparing aortic root

In assuming the editorship of this book, we felt it was important to publish it as soon as possible to maximize the effect of the most up-to-date knowledge in the field of aortic valve for the reader. While we hope this book will be particularly useful to cardiologists and cardiovascular surgeons and trainees, we also believe that this book will be a valuable resource for radiologists, cardiovascular anesthesiologist, and other healthcare professionals who have a special interest in treating or caring for patients

We wish to express our gratitude to many people whose efforts made completion of this book possible. We are especially indebted to our esteemed contributing authors, who generously shared their extraordinary expertise and timely contribution. We

replacement, and ascending aortic replacement.

with aortic valve disease.

Finally, we wish to acknowledge the support of our families and the many sacrifices they have made to make this book possible. Our wives, Jane-Jane Wang and Ruey-Ling Huang, were our greatest support and encouragement, whose love and support make it all worthwhile.

#### **Ying-Fu Chen, MD, PhD**

Professor Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital Graduate Institute of Medicine, Kaohsiung Medical University Kaohsiung, Taiwan

#### **Chwan-Yau Luo, MD, MSc**

Associate Professor Division of Cardiovascular Surgery, National Cheng Kung University Hospital School of Medicine, National Cheng Kung University Tainan, Taiwan

**Part 1** 

**Basic Science** 
