We sought to understand how leaflet forces change in response to annular dilation and leaflet tethering in single ventricle physiology. Explanted fetal bovine tricuspid valves were sutured onto image-derived annuli and ventricular mounts. Control valves (CV) were secured to a size-matched HLHS-type annulus and compared to: 1) normal tricuspid valves (NTV) secured to a size-matched saddle-shaped annulus, 2) HLHS-type annulus with leaflet tethering (LT), 3) HLHS-type annulus with annular dilation (DIL), or 5) a combined disease model with both dilation and tethering (DIS). The specimens were tested in a systemic heart simulator at various SVPs. Leaflet forces were measured using optical strain sensors sutured to each leaflet edge. Average force in the anterior leaflet was 43.2% lower in CV compared to NTV (p<0.001). LT resulted in a 6.6% increase in average forces on the anterior leaflet (p=0.04), 10.7% increase on the posterior leaflet (p=0.03), and 14.1% increase on the septal leaflet (p<0.001). In DIL, average septal leaflet forces increased relative to the control valves by 42.2% (p=0.01). In DIS, average leaflet forces increased by 54.8% in the anterior leaflet (p<0.001), 37.6% in the posterior leaflet (p=0.03), and 79.9% in the septal leaflet (p<0.001). The anterior leaflet experiences the highest forces in the normal tricuspid annulus under SVP conditions. Annular dilation resulted in an increase in forces on the septal leaflet and leaflet tethering resulted in an increase in forces across all 3 leaflets. Annular dilation and leaflet tethering combined resulted in the largest increase in leaflet forces across all 3 leaflets.

我们试图了解在单心室生理学中，小叶力如何响应环状扩张和小叶束缚而变化。外植的胎牛三尖瓣被缝合到图像衍生的瓣膜环和心室支架上。控制阀 (CV) 固定在尺寸匹配的 HLHS 型瓣环上，并与：1) 固定在尺寸匹配的马鞍形瓣环上的正常三尖瓣 (NTV)，2) 带小叶束缚的 HLHS 型瓣环 (LT) ), 3) 具有环状扩张 (DIL) 的 HLHS 型环，或 5) 具有扩张和束缚 (DIS) 的组合疾病模型。这些标本在各种 SVP 的系统心脏模拟器中进行了测试。使用缝合到每个小叶边缘的光学应变传感器测量小叶力。与 NTV 相比，CV 中前叶的平均力低 43.2% (p<0.001)。LT 结果是 6。前叶平均力增加 6% (p=0.04)，后叶增加 10.7% (p=0.03)，隔叶增加 14.1% (p<0.001)。在 DIL 中，平均间隔小叶力相对于控制瓣膜增加了 42.2% (p=0.01)。在 DIS 中，前叶平均叶力增加 54.8% (p<0.001)，后叶增加 37.6% (p=0.03)，隔叶增加 79.9% (p<0.001)。在 SVP 条件下，前叶在正常三尖瓣环中承受的力最大。瓣环扩张导致隔膜传单上的力增加，传单束缚导致所有 3 个传单上的力增加。瓣环扩张和小叶束缚相结合导致所有 3 个小叶的小叶力增加最大。