Finite element analysis of annuloplasty and papillary muscle relocation on a patient-specific mitral regurgitation model

Abstract

ObjectivesFunctional mitral regurgitation (FMR) is a significant complication of left ventricle (LV) dysfunction associated with poor prognosis and commonly treated by undersized ring annuloplasty. This study aimed to quantitatively simulate the treatment outcomes and mitral valve (MV) biomechanics following ring annulopalsty and papillary muscle relocation (PMR) procedures for a FMR patient.MethodsWe utilized a validated finite element model of the left heart for a patient with severe FMR and LV dilation from our previous study and simulated virtual ring annuloplasty procedures with various sizes of Edwards Classic and GeoForm annuloplasty rings. The model included detailed geometries of the left ventricle, mitral valve, and chordae tendineae, and incorporated age- and gender- matched nonlinear, anisotropic hyperelastic tissue material properties, and simulated chordal tethering at diastole due to LV dilation.ResultsRing annuloplasty with either the Classic or GeoForm ring improved leaflet coaptation and increased the total leaflet closing force while increased posterior mitral leaflet (PML) stresses and strains. Classic rings resulted in larger coaptation forces and areas compared to GeoForm rings. The PMR procedure further improved the leaflet coaptation, decreased the PML stress and strain for both ring shapes and all sizes in this patient model.ConclusionsThis study demonstrated that a rigorously developed patient-specific computational model can provide useful insights into annuloplasty repair techniques for the treatment of FMR patients and could potentially serve as a tool to assist in pre-operative planning for MV repair surgical or interventional procedures.

Long-term outcomes of etiology specific annuloplasty ring repair of ischemic mitral regurgitation

“…The unconventional geometry of the GeoForm ring is postulated to increase valvular stresses, as the annulus is made to conform to its three-dimensional shape. Mathematical modeling has confirmed these hypotheses (24). Although a high number of sutures were used to anchor the annuloplasty, we observed three mechanical device disruptions in our study, accounting for almost half of the cases with recurrent MR. Three cases of ring dehiscence were also reported by Guenzinger (12) in a series of seventy GeoForm patients, however only reported one device dehiscence in a patient with endocarditis in the study by De Bonis (11).…”

A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient

“…Following the selection guidelines (Borghetti et al, 2000), a 38 ring size was chosen based on the surface area of the device and the AML. However, rather than modeling the implantation of the actual ring with its full cross-sectional geometry, ring implantation was simplified by displacing the nodes of the MA to the 3D shape of the ring, as previously presented in Kong et al (2018). The 3D ring shape and dimensions were obtained from literature.…”

Numerical modeling of transapical mitral valve repair

“… edge-to-edge repair (Avanzini et al 2011;Zhong et al 2014;Sturla et al 2015a);  annuloplasty procedure (Choi et al 2014;Baillargeon et al 2015;Kong et al 2018);  MV repair with neochordae implantation (Rim et al 2014;Morgan et al 2016;Choi et al 2017 (Fig. 1.11)).…”

“…Tokie modeliai, turintys realistišką morfologiją ir personalizuotas kraštines sąlygas, naudojami tirti MV mechaniką ir jos pokyčius esant patologijai bei prognozuoti vožtuvo elgseną atlikus patologijos chirurginę korekciją. Literatūroje pateikiami skirtingi vožtuvo korekcijos būdai, tyrinėti naudojant struktūrinius modelius: vožtuvo burės rezekcija (Choi et al 2017), centrinės koaptacijos metodas (Sturla et al 2015a), anuloplastija (Kong et al 2018) ir neochordų implantavimas į papiliarinį raumenį (Morgan et al 2016).…”