Transcatheter aortic valve implantation: the procedure

Transcatheter aortic valve implantation (TAVI) for the treatment of symptomatic severe aortic stenosis has emerged as an effective treatment for high risk patients. In 2002 TAVI was performed for the first time in a human by Alain Cribier, using an antegrade access approach via the femoral vein, crossing the intra-atrial septum after puncture and passing the native aortic valve in the direction of blood flow. This technically demanding approach was subsequently replaced by retrograde transfemoral arterial access. For patients with severe peripheral vascular disease or inadequately sized femoral arteries, the transapical route provides an alternative route with antegrade access to the aortic valve via puncture of the anterolateral wall of the left ventricle. The transsubclavian access approach using most frequently the left subclavian artery and direct transaortic access have been introduced more recently and attest to the versatility of TAVI in terms of access site. This article will focus on the different access site options available to operators, provide a step-by-step guide through the procedure, and a detailed description of the technological evolution of transcatheter heart valve systems.

Simulation of the flow through automatic valves of hermetic compressors by the immersed boundary method approach

The main goal of the present work is to verify the applicability of the Immersed Boundary Method together with the Virtual Physical Model to solve the flow through automatic valves of hermetic compressors. The valve was simplified to a two-dimensional radial diffuser, with diameter ratio of D/d = 1.5, and simulated for a one cycle of opening and closing process with a imposed velocity of 3.0 cm/s for the reed, dimensionless gap between disks in the range of 0.07 < s/d < 0.10, and inlet Reynolds number equal to 1500. The good results obtained showed that the methodology has great potential as project tool for this type of valve systems. © The Authors, 2011.

Synthese und Charakterisierung von Modellen für Photoschalter und elektronische Ventile

Gegenstand der vorliegenden Arbeit war die Synthese von organischen Photoschalter-Modellen auf der Basis von mesoionischen Pyrimidinium-olaten und Bis(thienylperfluorocyclopentenen), sowie die Darstellung substituierter Biphenyl-Biradikale als Modelle für Ventil-Systeme im Sinne eines neuen Schalter-Ventil-Konzeptes.Aufbauend auf meiner Arbeit über mesoionische Pyrimidinium-olate wurde ein henkelverbrücktes Ansa-Mesoion mit einem 16-gliedrigen Makrocyclus, sowie drei mehrcyclische mesoionische Systeme synthetisiert und auf ihr Schaltverhalten hin untersucht. Das Ansa-Mesoion stellt ein erstes einfaches Modell für Schalter-Ventil-Konjugate dar. Zur Darstellung der photochromen Bis(thienylethene) wurden die aus der Literatur bekannten Syntheserouten nach Irie als auch nach Feringa auf neue Strukturen angewandt und die Schalteigenschaften der Bis(thienylethene) optisch nachgewiesen. Die Anordnung der reaktiven Endgruppen in den synthetisierten Verbindungen schafft ideale Voraussetzungen für eine große konformelle Änderung, welche im Schalter-Ventil-Konjugat erwünscht ist. Durch vielfaches Durchlaufen des Schaltprozesses (> 100 Cyclen) konnte die hohe Reversibilität des Schaltvorganges belegt werden.Als Ventilmodelle wurden mit stabilen Nitroxidradikalen substituierte Biphenyle verwendet, deren primärer konformativer Freiheitsgrad durch die Drehung um die Phenyl-Phenyl-Einfachbindung gegeben ist. Experimentelle ESR-Daten und deren Vergleich mit Spektrensimulationen bestätigten die Abhängigkeit der Austauschwechselwirkung J zwischen den Radikalen vom Biphenyldiederwinkel.

Experimental evaluation of position control methods for hydraulic systems

Presents a unified and systematic assessment of ten position control strategies for a hydraulic servo system with single-ended cylinder driven by a proportional directional control valve. We aim at identifying those methods that achieve better tracking, have a low sensitivity to system uncertainties, and offer a good balance between development effort and end results. A formal approach for solving this problem relies on several practical metrics, which is introduced herein. Their choice is important, as the comparison results between controllers can vary significantly, depending on the selected criterion. Apart from the quantitative assessment, we also raise aspects which are difficult to quantify, but which must stay in attention when considering the position control problem for this class of hydraulic servo systems.

Precedent-free fault isolation in a diesel engine EGR valve system

In this paper, a framework for isolating unprecedented faults for an EGR valve system is presented. Using normal behavior data generated by a high fidelity engine simulation, the recently introduced Growing Structure Multiple Model System (GSMMS) is used to construct models of normal behavior for an EGR valve system and its various subsystems. Using the GSMMS models as a foundation, anomalous behavior of the entire system is then detected as statistically significant departures of the most recent modeling residuals from the modeling residuals during normal behavior. By reconnecting anomaly detectors to the constituent subsystems, the anomaly can be isolated without the need for prior training using faulty data. Furthermore, faults that were previously encountered (and modeled) are recognized using the same approach as the anomaly detectors.

Compensator for constant relative stability in process control systems

Process control systems are designed for a closed-loop peak magnitude of 2dB, which corresponds to a damping coefficient () of 0.5 approximately. With this specified constraint, the designer should choose and/or design the loop components to maintain a constant relative stability. However, the manipulative variable in almost all chemical processes will be the flow rate of a process stream. Since the gains and the time constants of the process will be functions of the manipulative variable, a constant relative stability cannot be maintained. Up to now, this problem has been overcome either by selecting proper control valve flow characteristics or by gain scheduling of controller parameters. Nevertheless, if a wrong control valve selection is made then one has to account for huge loss in controllability or eventually it may lead to an unstable control system. To overcome these problems, a compensator device that can bring back the relative stability of the control system was proposed. This compensator is similar to a dynamic nonlinear controller that has both online and offline information on several factors related to the control system. The design and analysis of the proposed compensator is discussed in this article. Finally, the performance of the compensator is validated by applying it to a two-tank blending process. It has been observed that by using a compensator in the process control system, the relative stability could be brought back to a great extent despite the effects of changes in manipulative flow rate.

Parameter estimation in water-distribution systems by least squares

The weighted-least-squares method using sensitivity-analysis technique is proposed for the estimation of parameters in water-distribution systems. The parameters considered are the Hazen-Williams coefficients for the pipes. The objective function used is the sum of the weighted squares of the differences between the computed and the observed values of the variables. The weighted-least-squares method can elegantly handle multiple loading conditions with mixed types of measurements such as heads and consumptions, different sets and number of measurements for each loading condition, and modifications in the network configuration due to inclusion or exclusion of some pipes affected by valve operations in each loading condition. Uncertainty in parameter estimates can also be obtained. The method is applied for the estimation of parameters in a metropolitan urban water-distribution system in India.

Engineered spin-valve type magnetoresistance in Fe3O4-CoFe2O4 core-shell nanoparticles

Naturally occurring spin-valve-type magnetoresistance (SVMR), recently observed in Sr2FeMoO6 samples, suggests the possibility of decoupling the maximal resistance from the coercivity of the sample. Here we present the evidence that SVMR can be engineered in specifically designed and fabricated core-shell nanoparticle systems, realized here in terms of soft magnetic Fe3O4 as the core and hard magnetic insulator CoFe2O4 as the shell materials. We show that this provides a magnetically switchable tunnel barrier that controls the magnetoresistance of the system, instead of the magnetic properties of the magnetic grain material, Fe3O4, and thus establishing the feasibility of engineered SVMR structures. (C) 2013 AIP Publishing LLC.

Modelling and characterisation of an ortho-planar micro-valve

The main difficulties encountered in the development of microscale fluidic pumping systems stem from the fact that these systems tend to comprise highly three-dimensional parts, which are incompatible with traditional microproduction technologies. Regardless of the type of pumping principle, most of the hydraulic systems contain valves and in particular a one-way valve. This paper presents the design and modelling of an ortho-planar one-way microvalve. The main advantages of such a valve are that it is very compact and can be made from a single flat piece of material. An analytical model of the spring deflection has been developed and compared to FEM. A prototype with a bore of 1.5 mm has been build using a micro EDM (electro discharge machining) machine and also tested. © 2006 International Federation for Information Processing.

Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis

Aims Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify predictors of in-hospital mortality. Methods Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals. Results Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p = 0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score > 3. Conclusions The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.

Transcatheter aortic valve implantation (TAVI): state of the art techniques and future perspectives.

Transcatheter aortic valve therapies are the newest established techniques for the treatment of high risk patients affected by severe symptomatic aortic valve stenosis. The transapical approach requires a left anterolateral mini-thoracotomy, whereas the transfemoral method requires an adequate peripheral vascular access and can be performed fully percutaneously. Alternatively, the trans-subclavian access has been recently proposed as a third promising approach. Depending on the technique, the fine stent-valve positioning can be performed with or without contrast injections. The transapical echo-guided stent-valve implantation without angiography (the Lausanne technique) relies entirely on transoesophageal echocardiogramme imaging for the fine stent-valve positioning and it has been proved that this technique prevents the onset of postoperative contrast-related acute kidney failure. Recent published reports have shown good hospital outcomes and short-term results after transcatheter aortic valve implantation, but there are no proven advantages in using the transfemoral or the transapical technique. In particular, the transapical series have a higher mean logistic Euroscore of 27-35%, a procedural success rate above 95% and a mean 30-day mortality between 7.5 and 17.5%, whereas the transfemoral results show a lower logistic Euroscore of 23-25.5%, a procedural success rate above 90% and a 30-day mortality of 7-10.8%. Nevertheless, further clinical trials and long-term results are mandatory to confirm this positive trend. Future perspectives in transcatheter aortic valve therapies would be the development of intravascular devices for the ablation of the diseased valve leaflets and the launch of new stent-valves with improved haemodynamic, different sizes and smaller delivery systems.

Apical access and closure devices for transapical transcatheter heart valve procedures.

The majority of transcatheter aortic valve implantations, structural heart procedures and the newly developed transcatheter mitral valve repair and replacement are traditionally performed either through a transfemoral or a transapical access site, depending on the presence of severe peripheral vascular disease or anatomic limitations. The transapical approach, which carries specific advantages related to its antegrade nature and the short distance between the introduction site and the cardiac target, is traditionally performed through a left anterolateral mini-thoracotomy and requires rib retractors, soft tissue retractors and reinforced apical sutures to secure, at first, the left ventricular apex for the introduction of the stent-valve delivery systems and then to seal the access site at the end of the procedure. However, despite the advent of low-profile apical sheaths and newly designed delivery systems, the apical approach represents a challenge for the surgeon, as it has the risk of apical tear, life-threatening apical bleeding, myocardial damage, coronary damage and infections. Last but not least, the use of large-calibre stent-valve delivery systems and devices through standard mini-thoracotomies compromises any attempt to perform transapical transcatheter structural heart procedures entirely percutaneously, as happens with the transfemoral access site, or via a thoracoscopic or a miniaturised video-assisted percutaneous technique. During the past few years, prototypes of apical access and closure devices for transapical heart valve procedures have been developed and tested to make this standardised successful procedure easier. Some of them represent an important step towards the development of truly percutaneous transcatheter transapical heart valve procedures in the clinical setting.

Granular Attrition due to Rotary Valve in a Pneumatic Conveying System

The rotary valve is a widely used mechanical device in many solids-handling industrial processes. However, it may also be responsible for most of the attrition effects occurring in a typical process. In this study, the attrition effects occurring in a rotary valve operating as a stand-alone device and as part of a pneumatic conveying system were investigated. In the former case granular attrition was carried out at three different rotary valve speeds and the experimental results obtained were found to be in good agreement with the Gwyn correlation. In the latter case three typical air flow rates were used in the pneumatic conveying system. The size distribution of the attrition product obtained at the lowest air flow rate used was not adequately described by the Gwyn correlation. The attrition process and mechanisms involved were analysed and the minimum size of the attrition product obtained from both modes of operations was found to be similar.