Fluid–structure interactions of the mitral valve and left heart: Comprehensive strategies, past, present and future

Abstract

SUMMARYThe remodeling that occurs after a posterolateral myocardial infarction can alter mitral valve function by creating conformational abnormalities in the mitral annulus and in the posteromedial papillary muscle, leading to mitral regurgitation (MR). It is generally assumed that this remodeling is caused by a volume load and is mediated by an increase in diastolic wall stress. Thus, mitral regurgitation can be both the cause and effect of an abnormal cardiac stress environment. Computational modeling of ischemic MR and its surgical correction is attractive because it enables an examination of whether a given intervention addresses the correction of regurgitation (fluid-flow) at the cost of abnormal tissue stress. This is significant because the negative effects of an increased wall stress due to the intervention will only be evident over time. However, a meaningful fluid-structure interaction model of the left heart is not trivial; it requires a careful characterization of the in-vivo cardiac geometry, tissue parameterization though inverse analysis, a robust coupled solver that handles collapsing Lagrangian interfaces, automatic grid-generation algorithms that are capable of accurately discretizing the cardiac geometry, innovations in image analysis, competent and efficient constitutive models and an understanding of the spatial organization of tissue microstructure. In this manuscript, we profile our work toward a comprehensive fluid-structure interaction model of the left heart by reviewing our early work, presenting our current work and laying out our future work in four broad categories: data collection, geometry, fluid-structure interaction and validation.Keywords biofluid-structure interactions; ischemic mitral regurgitation; imaging based finite element models

Image-based large-eddy simulation in a realistic left heart

“…The most natural one is to extract the heart geometry at one chosen moment in the heart cycle and to solve an electrical-fluid-structure interaction (EFSI) problem [27,28,29,30,31,32].…”

Effect of bending rigidity in a dynamic model of a polyurethane prosthetic mitral valve

“…They found this approach to accelerate the process of mitral valve modelling for patient-specific analysis. There are also several recent review papers on mitral valve research, each with a different focus (Sacks et al 2009;Einstein et al 2010;Weinberg et al 2010).…”

“…It is known, for instance, that the remodelling that occurs after a posterolateral myocardial infarction can alter mitral valve function by creating conformational abnormalities in the mitral annulus and in the posteromedial papillary muscle, leading to mitral regurgitation and ultimately requiring valve repair or replacement (Einstein et al 2010). Each year, approximately 250,000 valve replacement procedures are carried out worldwide (Yoganathan et al 2004).…”

Towards Patient-Specific Finite-Element Simulation of MitralClip Procedure

“…Several constitutive laws have been proposed, from simple isotropic linear elasticity to more complex anisotropic non-linear hyper-elasticity [9,11,13]. Fluid-structure interaction models have also been investigated [2]. Yet, most of these models have been developed on synthetic or ex-vivo anatomies [4].…”