Among the four valves of the heart, the aortic valve (AV) is frequently affected by disease. When progressive dilatation of the valve produces a leak when the valve should close (regurgitation), repair may be possible. AV repair is a desirable option because, contrary to AV replace-ment using a prosthesis, it does not require life-long anticoagulation treatment, and retains the original tissues that naturally combat structural degradation. All the AV repair procedures developed by cardiac surgeons require a good stabilization of the ventriculo-aortic junction (VAJ) diameter, through annuloplasty or reimplantation, for long-term success. In the present work, a preliminary design for a new type of annuloplasty ring is proposed that surgeons could tailor to the each valve’s shape and suture inside the VAJ. The design consists in wrapping a commonly available surgical biomaterial into a ring of controlled radial flexibility. For sizing and material selection, several models of increasing complexity were created to account for the anisotropic, hyperelastic nature of all the materials involved. First, an analytical model was programmed in MATLAB to assess the radial flexibility of annuloplasty rings formed with different biomaterials and select those that could match the physiological VAJ radial flexibility between systolic and diastolic pressures. The same program was also used to reproduce the experimental radial and longitudinal stretches of the human VAJ from 0 to 140 mmHg pressures. The analytical models were used to calibrate the parameters of independent finite element (FE) models of the VAJ and ring. Finally, the FE approach was extended to simulate the ring after suturing inside the VAJ, to determine the radial flexibility of the assembly under pulsatile pressure. Supple Peri-Guard® bo-vine pericardium patches used in transverse orientation emerged as the best currently available material option for the proposed ring, although a material providing more physiological radial flexibility would be desirable.

No description available.

Superviseur : Dr. Piet Van Vliet Collaborateurs: Dr. Alexandre Dubrac, Dr. Martin Smith / Résumé INTRODUCTION : Les maladies valvulaires du cœur surviennent dans 2% de la population, impliquant souvent un reflux sanguin dû au rétrécissement de la valve. Nous avons récemment identifié deux familles non apparentées étant atteintes par une sténose aortique. Le séquençage exomique des familles a révélé une mutation entrainant une perte de fonction homozygote pour le gène ADAMTS19. La relation entre la perturbation du gène ADAMTS19 et la sténose a été reproduite et donc confirmée grâce à une souris ADAMTS19-LACZ KO/KO. Cette souris montre également que ADAMTS19 est spécifiquement exprimé dans les cellules valvulaires interstitielles (VICs) dans les valves. Le rôle d’ADAMTS19 durant le développement des valves reste inconnu. Pour analyser le patron d’expression d’ADAMTS19 pendant le développement du cœur, nous avons obtenu un modèle de souris transgénique contenant une CRE-tamoxifen inductible (Cre-ERT2) qui est exprimé sous l’influence du promoteur humain ADAMTS19. HYPOTHESE/OBJECTIF : Nous émettons l’hypothèse que le promoteur humain d’ADAMTS19 inséré dans la souris ADAMTS19-Cre-ERT2 contient toutes les séquences régulatrices permettant d’exprimer le gène ADAMTS19 et que ADAMTS19 est principalement exprimé au niveau des cellules valvulaires interstitielles dans les valves. L’objectif est de caractériser le patron d’expression d’ADAMTS19 en analysant sa distribution durant le développement grâce à une souris reportrice tdTomato. Comme ADAMTS19 est spécifiquement exprimé dans les VICs, cet outil transgénique permettrait d’étudier ces cellules durant le développement. METHODE/RESULTAT : Suite à une étude in silico le promoteur ADAMTS19 est apparu comme extrêmement conservé. Par conséquent, pour analyser l’expression d’ADAMTS19 nous avons obtenu une souris BAC ADAMTS19-Cre-ERT2 contenant la séquence conservée que nous avons croisé avec une souris reportrice tdTomato. Le Tamoxifen est administré aux femelles gestantes par gavage aux jours embryonnaires E9,5, E11,5 ainsi que E13,5, et les cœurs sont extrait a E16,5. Des coupes de cœurs embryonnaires vont permettre d’identifier la localisation et la morphologie des cellules marquées. L’expression d’ADMATS19 dans les cellules valvulaires interstitielles est consistant avec le fait qu’ADAMTS19 est connu pour affecter les valves durant le développent et dans le cas de maladie valvulaire. Cependant, le patron des valves n’est pas reproductible au travers des générations. De plus, nous observons qu’ADAMTS19 est marqué dans des cellules des oreillettes et ventricule dans une lignée et dans une sous population de cellules de l’artère pulmonaire dans une autre. CONCLUSION : L’analyse des séquences de chaque lignée par séquençage permettre d’investiguer la raison de ses différents patrons et de mettre en évidence des régulateurs spécifiques. / BACKGROUND: Valvular heart disease (VHD) occurs in ~2% of the general population, often resulting in reduced or disturbed blood flow. We recently identified two unrelated families with recessive inheritance patterns of progressive polyvalvular heart disease in absence of any clear syndromic phenotype. Exome sequencing revealed homozygous, rare, loss of function (LOF) alleles in both families for the gene ADAMTS19. The relation between ADAMTS19 mutation and aortic stenosis were confirm via an ADAMTS19-LacZ KO/KO mouse model. This model also shows that ADAMTS19 is specific of VICs during valve development. The ADAMTS protein family includes 19 proteases that are involved in matrix remodeling, and tissue homeostasis in development and disease. However, the role of ADAMTS19 specifically during valve development remains unknown. We aim to characterize ADAMTS19 expression using a BAC transgenic ADMTS19-CRERT2 mouse. HYPOTHESE/OBJECTIVE We hypothesize that the BAC used to make the ADMTS19-CRERT2 mouse contains all the regulatory elements to express it and also that its expression will be specific to the VICs. The objective is to establish the ADAMTS19- CREERT2 and therefore to create a new tool to study VICs in vivo. METHODS/RESULTS: In silico analysis of the human and mouse ADAMTS19 genomic regions showed a high level of conservation. Thus, to analyze ADAMTS19 expression patterns during mouse development, we obtained a BAC transgenic mouse model containing a tamoxifen inducible Cre (CreERT2) that is expressed under the influence of the human ADAMTS19 promoter and surrounding genomic region. We crossed males from several lines created in parallel with Rosa-tdTomato reporter females to generate offspring in which expression of the fluorescent tdTomato reporter is activated in ADAMTS19-expressing cells upon tamoxifen administration. Surprisingly, whole mount imaging of embryos induced at E13.5 and isolated at E16.5 revealed strong, but distinct labelling patterns in offspring from different ADAMTS19CreERT2 sublines. Whereas one line exclusively labelled VICs, consistent with ADAMTS19 in situ RNA expression data from the Eurexpress database, another line specifically labelled cells in atrial and ventricular, but not VICs. A third line seems to label only a subset of cells in the pulmonary artery. Labeling of ADAMTS19-positive VICs is consistent with ADAMTS19 affecting valve development and VHD. In addition, we observed exclusive ADAMTS19-dependent labelling in atrial and ventricular cells or in a subset of pulmonary artery cells in two different sublines. CONCLUSION: The distinct expression patterns in offspring from different ADAMTS19-Cre-ERT2 lines indicates that although regulation of ADAMTS19 is conserved between human and mouse, expression in VICs versus other cells may be dependent on mutually exclusive regulatory mechanisms.

Leaflet replacement in aortic valve repair (AVr) is associated with increased long-term repair failure. Hemodynamic performance and mechanical stress levels were investigated after porcine AVr with 5 types of clinically relevant replacement materials to ascertain which material(s) would be best suited for repair. Porcine aortic roots with intact aortic valves were placed in a left-heart simulator mounted with a high-speed camera for baseline valve assessment. Then, the non-coronary leaflet was excised and replaced with autologous porcine pericardium (APP), glutaraldehyde-fixed bovine pericardial patch (BPP; Synovis™), extracellular matrix scaffold (CorMatrix™), or collagen-impregnated Dacron (HEMASHIELD™). Hemodynamic parameters were measured over a range of cardiac outputs (2.5–6.5L/min) post-repair. Material properties of the above materials along with St. Jude Medical™ Pericardial Patch with EnCapTM Technology (SJM) were determined using pressurization experiments. Finite element models of the aortic valve and root complex were then constructed to verify the hemodynamic characteristics and determine leaflet stress levels. This study demonstrates that APP and SJM have the closest profiles to normal aortic valves; therefore, use of either replacement material may be best suited. Increased stresses found in BPP, HEMASHIELD™, and CorMatrix™ groups may be associated with late repair failure.

Leaflet replacement in aortic valve repair (AVr) is associated with increased long-term repair failure. Hemodynamic performance and mechanical stress levels were investigated after porcine AVr with 5 types of clinically relevant replacement materials to ascertain which material(s) would be best suited for repair. Porcine aortic roots with intact aortic valves were placed in a left-heart simulator mounted with a high-speed camera for baseline valve assessment. Then, the non-coronary leaflet was excised and replaced with autologous porcine pericardium (APP), glutaraldehyde-fixed bovine pericardial patch (BPP; Synovis™), extracellular matrix scaffold (CorMatrix™), or collagen-impregnated Dacron (HEMASHIELD™). Hemodynamic parameters were measured over a range of cardiac outputs (2.5–6.5L/min) post-repair. Material properties of the above materials along with St. Jude Medical™ Pericardial Patch with EnCapTM Technology (SJM) were determined using pressurization experiments. Finite element models of the aortic valve and root complex were then constructed to verify the hemodynamic characteristics and determine leaflet stress levels. This study demonstrates that APP and SJM have the closest profiles to normal aortic valves; therefore, use of either replacement material may be best suited. Increased stresses found in BPP, HEMASHIELD™, and CorMatrix™ groups may be associated with late repair failure.

No description available.