Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Modeling of normal heart valve development in children

Authors: L.A. Bockeria 1, O.A. Makhachev 1, V.V. Golubkov 2,   M.S. Panova 1, T.Yu. Filippkina 1, B.E. Narsiya 1

Company:
1 A.N. Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences, Rublevskoe shosse, 135, Moscow, 121552, Russia; 

  2 Institute of Systemic Analysis of the Russian Academy of Sciences, pr. 60-letiya Oktyabrya, 9, Moscow, 117312, Russia

Link: Clinical Physiology of Blood Circulaiton. 2013; (): -

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Abstract

Objective of the research is to study the process of heart valves development in growing children's bodies using mathematical modeling. Material and methods. The data obtained from morphometric study of 1447 unfixed preparations of normal hearts of the children in the age group between birth and 15 years was used as research material. Circumferences were taken as measurable indicators of the development of heart valves, and body growth and development were assessed using height (body length measurements) and age. Based on developmental systems theory mathematical models showing the correlation between the circumferences of heart valves, age and height, as well as between height and age of children of both genders were constructed. The constructed models were used to perform analysis of heart valve development. Results. It was shown that the established age-related models of the correlation between the dynamics of development of cardiac valve circumferences and body growth for both genders were very effective in describing the statistical data (in them the adequacy criterion R2 value is higher than 0.98). It was determined that at the age of ~20 months (bifurcation point), regardless of the type of the heart valve and child's gender, qualitative changes in the pattern of correlation between the circumferences of heart valves and body growth and age occur: in the age range from 0 to the age of bifurcation the rate of the average valve growth in size was 3.5 times, and of the height – 4.5 times more intensive than in older children. Three age-related time periods in heart valve development and growth were established. In the first period, from 0 to tmax the valve growth outpaces somatic growth with indexed circumference reaching its maximum value at tmax age. In the second period, from tmax to tpr values (tmax < tpr), on the contrary, somatic growth outpaces valve growth. In the third period (t > tpr) valve development and somatic growth are proportional. The duration of the first period doesn't depend on gender and it is longer for aortic valve compared to three other heart valves (an average value for boys and girls is 7.12 months compared to 4.87; 5.16 and 4.94 months). The duration of the second period for left side of the heart is longer than for the right side of the heart (111.70; 122.53 versus 83.20; 80.73 in boys and 93.24; 117.31 versus 65.77; 71.86 in girls). The second period in the right-sided valves ends around 6 years of age on the average, and in aortic and mitral valves – by 8–10 years of age respectively. Conclusion. Universal age-related models that are able to describe the dynamics of body growth and development of the circumferences of heart valves with a high degree of adequacy were created. Three time periods in the concurrent processes of the development of heart valves and body growth are outlined – when development of valves outpaces the body growth, somatic growth outpaces valve growth and the period when valves and body growth is proportional. The growth of aortic valve was more continuous in the first period. The second period was characterized by more continuous development of valves of the left side of the heart in comparison with the valves of the right side of the heart, it has physiological significance related to the function of the left side of the heart and of the left ventricle in particular.

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