Influence of Configuration on Stress Distribution of Pulmonary Monocusp Leaflet.

Purpose: For the relief of right ventricular outflow tract obstruction in operative treatment of tetralogy of Fallot and other complex congenital heart diseases, transannular monocusp patch operations are often necessary to prevent right ventricular pressure overload and reduce pulmonary regurgitation. However, long-term durability of a monocusp leaflet is unsatisfactory, its failure is believed to be related to mechanical stress, whose distribution is primarily affected by geometric configurations. Therefore, the influence of several geometrical parameters on stress distribution of leaflet is investigated.
Methods: Five parameters affecting leaflet configuration were established: angle between free edge of the leaflet and vessel wall, angle formed by the two end points of free edge, length of the free edge of the leaflet, height of the leaflet, and shape of elliptic conical surface constituting the leaflet surface. The first four parameters were fixed, and two factors were defined to describe the last parameter. Seven models with different values of these factors were analyzed using finite element method at the pressure of the pulmonary artery loaded on the leaflet.
Results: The peak stresses of all models occurred at end points of the free edge of the leaflet (tear high-risk regions). The middle of leaflet had the greatest stress gradient and produced tissue wrinkling; this area could be the risk region of calcification. Both factors were noted to influence the stress distribution, and one of the factors could also relieve the wrinkling.
Conclusions: The leaflet of model (1.2_min) had the most even stress distribution and lowest peak principal stress, which was the optimal choice among all the models.