• Journal of Mechanical Science and Technology
• /
• 제15권7호
• /
• pp.1061-1071
• /
• 2001

The present study investigated design parameters of shunt valves and anti-siphon device used to treat patients with hydrocephalus. The shunt valve controls drainage of cerebrospinal fluid (CSF) through passive deflection of a thin and small diaphragm. The anti-siphon device(ASD) is optionally connected to the valve to prevent overdrainage when the patients are in the standing position. The major design parameters influencing pressure-flow characteristics of the shunt valve were analyzed using ANSYS structural program. Experiments were performed on the commercially available valves and showed good agreements with the computer simulation. The results of the study indicated that predeflection of the shunt valve diaphragm is an important design parameter to determine the opening pressure of the valve. The predeflection was found to depend on the diaphragm tip height and could be adjusted by the diaphragm thickness and its elastic modulus. The major design parameters of the ASD were found to be the clearance (gap height) between the thin diaphragm and the flow orifice. Besides the gap height, the opening pressure of the ASD could be adjusted by the diaphragm thickness, its elastic modulus, area ratio of the diaphragm to the flow orifice. Based on the numerical simulation which considered the increased subcutaneous pressure introduced by the tissue capsule pressure on the implanted shunt valve system, optimum design parameters were proposed for the ASD.

• 대한기계학회:학술대회논문집
• /
• 대한기계학회 2002년도 학술대회지
• /
• pp.699-702
• /
• 2002

Shunt valves implanted in the subcutaneous tissue of brain to treat patient with hydrocephalus were numerically simulated to investigate influence of pressure pulsation on their flow control characteristics. Shunt valves are subjected to pressure variation since ventricles enclosing the brain are under pressure pulsation rather than uniform pressure due to blood pressure variation. We modeled flow orifice through shunt valve and imposed pulsating pressure and valve diaphragm movement to compute flow through the valve. The results of our study indicated that flow rate increased by $40{\%}$ by introducing pressure pulsation and diaphragm movement on the shunt valve. Our results demonstrate the pressure-flow control characteristics of shunt valves unplanted above human brain may be quite different from the characteristics obtained by syringe pump test with uniform pressure and no diaphragm movement.

• KIEE International Transactions on Electrophysics and Applications
• /
• 제4C권1호
• /
• pp.31-34
• /
• 2004

This paper presents the fabrication and testing of a two-way pressure regulation micro shunt valve with an anti-siphon effect that can be implanted in hydrocephalus patients. This micro shunt valve consists of a silicone rubber membrane and a valve seat for the opening pressure control as well as the anti-siphon behavior. The two-way pressure regulation and the anti-siphon effect of the micro shunt valve are verified experimentally for various sizes of membranes and valve seats.

• 한국정밀공학회:학술대회논문집
• /
• 한국정밀공학회 2000년도 춘계학술대회 논문집
• /
• pp.1051-1054
• /
• 2000

We developed the micro CSF (celebrospinal fluid) shunt valve with surface and bulk micromachining technology in polymer MEMS. This micro CSF shunt valve was formed with four micro check valves to have a membrane connected to the anchor with the four bridges. The up-down movement of the membrane made the CSF on & off and the valve characteristic such as open pressure was controlled by the thickness and shape of the bridge and the membrane. The membrane, anchor and bridge layer were made of the $O_2$ RIE (reactive ion etching) patterned Parylene thin film to be about 5~10 microns in thickness on the silicon wafer. The dimension of the rectangular nozzle is 0.2＊0.2 $\textrm{mm}^2$ and the membrane 0.45 mm in diameter. The bridge width is designed variously from 0.04 mm to 0.12 mm to control the valve characteristics. To protect the membrane and bridge in the CSF flow, we developed the packaging system for the CSF micro shunt valve with the deep RIE of the silicon wafer. Using this package, we can control the gap size between the membrane and the nozzle, and protect the bridge not to be broken in the flow. The total dimension of the assembled system is 2.5＊2.5 $\textrm{mm}^2$ in square, 0.8 mm in height. We could precisely control the burst pressure and low rate of the valve varing the design parameters, and develop the whole CSF shunt system using this polymer MEMS fabricated CSF shunt valve.

• 대한의용생체공학회:의공학회지
• /
• 제23권5호
• /
• pp.391-395
• /
• 2002

수두증 환자를 치료하기 위해 머리에 시술 되는 션트밸브가 받는 뇌압 펄스가 밸브의 유량조절 특성에 미치는 영향을 수치적으로 해석하였다. 션트밸브를 통한 유량을 계산하기 위하여 밸브 다이아프램이 형성하는 유량 오리피스를 모델링 하여 맥동압력과 변동하는 압력에 의한 다이아프램의 움직임을 고려하였다. 연구 결과, 압력 펄스와 이에 따른 다이아프램의 움직임에 의하여 유량이 40% 이상 증가함을 보였다. 이 결과는, 뇌실에 시술 되는 션트밸브의 압력-유량 조절특성이 제조 직후 맥동이 없는 유량을 공급하는 시린지 펌프를 사용하여 구한 실험 결과와 상당히 다르다는 사실을 보여주었다.

• 한국전산유체공학회:학술대회논문집
• /
• 한국전산유체공학회 2000년도 춘계 학술대회논문집
• /
• pp.21-26
• /
• 2000

Pressure-flow control characteristics of a commercially available cerebrospinal flow(CSF) control shunt valve was tested using fluid-solid interaction analysis. Pre-stress of the valve diaphragm(membrane) was computed for proper valve opening. The results were ir good agreements with the valve specification listed in the commercially available CSF control valve. The results of the study can be effectively used to design variety of CSF control shunt valves.

• Journal of Chest Surgery
• /
• 제33권6호
• /
• pp.476-486
• /
• 2000

Background: Pulmonary atresia with intact ventricular septum(PA/IVS) is an anatomically heterogenous anomaly with a variety of surgical strategies possible. The purpose of the study is to evaluate the influence of right ventricular size on the early and midterm results of surgical repair of PA/IVS. Material and method: Medical records of 20 consecutive patients with PA/IVS operated on between January 1993 and August 1999 were retrospectively reviewed. There were 12 boys and 8 girls whose ages ranged from 2 days to 14.5 months (median 6 days). Their body weight ranged from 2.52kg to 9.35 kg(median 3.18kg). The preoperative Z-value of the diameter of the tricuspid valve(T-valve) was less than or -4 in 5 patients, between -4 and -2 in 1, between -2 and 0 in 7, between 0 and 2 in 6, and greater than or 2 in 1. All patients who had z-value of tricuspid valve greater than -2.05 were attempted biventricular repair(n=15) and all patients who had it smaller than -4.4 underwent systemic-pulmonary shunt operation only(n=3) or bidirectinal cavopulmonary shunt with right ventricular reconstruction(n=2). Result: Two early deaths(2/20, 10%) occurred. Both were infants who underwent transannular patch with shunt. One of these two had huge right ventricle(Z-value of tricuspid valve = 5). There were 2 late non-cardiac deaths 3 and 7 months after operations respectively. Follow-up was completed in all children at a mean of 35.3 months(range, 5 to 54 months). 10 of 11 survivors who underwent transannular patch or valvotomy with or without shunt procedure were in NYHA functional class I even though some of them had small interatrial communication or patent shunt. All three patients who had shunt procedure only at initial palliation completed Fontan procedures with no death. Two patients who underwent right ventricular outflow reconstruction with bidirectional cavopulmonary shunt were also in good condition. Conclusion: The transanular RVOT patch or valvotomy with or without systemic-pumonary shunt as an initial palliative procedure to achieve biventricular repair for the patients who had neither too small nor too large right ventricle(-2.05$\leq$Z-value of T-value of T-valve$\leq$2) could be performed at low operative risk(1/14 7.1%). Systemic-pulmonary shunt procedure and bidirectional cavopulmonary shunt procedure for the patients who had small right ventricle(Z-value of T-valve$\leq$4.4) could be also performed with low risk. But a patient with huge right atrium and ventricle(Z-value of t-valve=5) had poor operative result.

• Journal of Korean Neurosurgical Society
• /
• 제48권3호
• /
• pp.251-258
• /
• 2010

Objective : Despite rapid evolution of shunt devices, the complication rates remain high. The most common causes are turning from obstruction, infection, and overdrainage into mainly underdrainage. We investigated the incidence of complications in a consecutive series of hydrocephalic patients. Methods : From January 2002 to December 2009, 111 patients underwent ventriculoperitoneal (VP) shunting at our hospital. We documented shunt failures and complications according to valve type, primary disease, and number of revisions. Results : Overall shunt survival time was 268 weeks. Mean survival time of gravity-assisted valve (GAV) was 222 weeks versus 286 weeks for other shunts. Survival time of programmable valves (264 weeks) was longer than that of pressure-controlled valves (186 weeks). The most common cause for shunt revision was underdrainage (13 valves). The revision rate due to underdrainage in patients with GAV (7 of 10 patients) was higher than that for other valve types. Of 7 patients requiring revision for GAV underdrainage, 6 patients were bedridden. The overall infection rate was 3.6%, which was lower than reported series. Seven patients demonstrating overdrainage had cranial defects when operations were performed (41%), and overdrainage was improved in 5 patients after cranioplasty. Conclusion : Although none of the differences was statistically significant, some of the observations were especially notable. If a candidate for VP shunting is bedridden, GAV may not be indicated because it could lead to underdrainage. Careful procedure and perioperative management can reduce infection rate. Cranioplasty performed prior to VP shunting may be beneficial.

• Journal of Korean Neurosurgical Society
• /
• 제60권1호
• /
• pp.1-7
• /
• 2017

Objective : The diagnosis of shunt malfunction can be challenging since neuroimaging results are not always correlated with clinical outcomes. The purpose of this study was to evaluate the efficacy of a simple, minimally invasive cerebrospinal fluid (CSF) lumbar tapping test that predicts shunt under-drainage in hydrocephalus patients. Methods : We retrospectively reviewed the clinical and radiological features of 48 patients who underwent routine CSF lumbar tapping after ventriculoperitoneal shunt (VPS) operation using a programmable shunting device. We compared shunt valve opening pressure and CSF lumbar tapping pressure to check under-drainage. Results : The mean pressure difference between valve opening pressure and CSF lumbar tapping pressure of all patients were $2.21{\pm}24.57mmH_2O$. The frequency of CSF lumbar tapping was $2.06{\pm}1.26times$. Eighty five times lumbar tapping of 41 patients showed that their VPS function was normal which was consistent with clinical improvement and decreased ventricle size on computed tomography scan. The mean pressure difference in these patients was $-3.69{\pm}19.20mmH_2O$. The mean frequency of CSF lumbar tapping was $2.07{\pm}1.25times$. Fourteen cases of 10 patients revealed suspected VPS malfunction which were consistent with radiological results and clinical symptoms, defined as changes in ventricle size and no clinical improvement. The mean pressure difference was $38.07{\pm}23.58mmH_2O$. The mean frequency of CSF lumbar tapping was $1.44{\pm}1.01times$. Pressure difference greater than $35mmH_2O$ was shown in 2.35% of the normal VPS function group (2 of 85) whereas it was shown in 64.29% of the suspected VPS malfunction group (9 of 14). The difference was statistically significant (p=0.000001). Among 10 patients with under-drainage, 5 patients underwent shunt revision. The causes of the shunt malfunction included 3 cases of proximal occlusion and 2 cases of distal obstruction and valve malfunction. Conclusion : Under-drainage of CSF should be suspected if CSF lumbar tapping pressure is $35mmH_2O$ higher than the valve opening pressure and shunt malfunction evaluation or adjustment of the valve opening pressure should be made.

• 대한의용생체공학회:의공학회지
• /
• 제22권5호
• /
• pp.403-412
• /
• 2001

수두증 환자의 뇌압을 조절하기 위해 사용되는 션트밸브의 압력-유량제어 특성과 설계변수 변화에 따른 특성곡선의 변화를 수치적으로 해석 하였다. 해석에 사용된 션트밸브는 국내에서 설계 제작된 일정 압력형 다이아프램 타입이며 실험을 통하여 해석의 타당성을 검증하였다. 션트밸브 내부에 장착된 압력-유량 제어용 소형 다이아프램이 실리콘 일래스토머 계통의 유연한 재질이므로 유동구조 상호해석을 수행하였다 구조해석시의 재료 비선형성을 고려하여 고탄성 재료에 대한 므니 리블린(Mooney-Rivlin) 근사를 적용하였다. 수치해석결과 얻어진 압력-유량제어 특성곡선은 실험결과와 유사하였고 션트밸브를 통한 압력강하의 대부분은 소형 다이아프램에서 이루어짐을 확인할 수 있었다 본 연구에서 해석된 션트밸브의 압력-유량 특성곡선의 기울기는 7.37mm$H_2O$.hr/cc로서 상용 션트밸브의 기울기 평균값 0.40mm$H_2O$.hr/cc과 비슷하여 일정압력형 션트밸브의 특성을 잘 나타내었다. 오프닝압력의 크기는 밸브 다이아프램의 초기쳐짐량 크기에 의존하였고. 25mm$H_2O$와 80mm$H_2O$의 오프닝압력을 얻기 위해서는 10.2$\mu$m와 35.3$\mu$m의 초기쳐짐량이 필요하였다. 밸브가 열리면서 유동이 발생할 경우, 유동 오리피스 간극이 107m 이내이므로 션트밸브의 성공적인 동작을 위해서는 정밀설계와 제작기술이 요구된다. 본 연구를 통해 다이아프램의 초기쳐짐량과 유동 오리피스를 형성하는 다이아프램 끝단의 라운딩 크기가 압력-유량 특성곡선의 기울기에 영향을 미치는 주요 설계변수임을 확인하였다.