Interactive editing of virtual chordae tendineae for the simulation of the mitral valve in a decision support system

Abstract

Purpose Decision support systems for mitral valve disease are an important step toward personalized surgery planning. A simulation of the mitral valve apparatus is required for decision support. Building a model of the chordae tendineae is an essential component of a mitral valve simulation. Due to image quality and artifacts, the chordae tendineae cannot be reliably detected in medical imaging. Methods Using the position-based dynamics framework, we are able to realistically simulate the opening and closing of the mitral valve. Here, we present a heuristic method for building an initial chordae model needed for a successful simulation. In addition to the heuristic, we present an interactive editor to refine the chordae model and to further improve pathology reproduction as well as geometric approximation of the closed valve. Results For evaluation, five mitral valves were reconstructed based on image sequences of patients scheduled for mitral valve surgery. We evaluated the approximation of the closed valves using either just the heuristic chordae model or a manually refined model. Using the manually refined models, prolapse was correctly reproduced in four of the five cases compared to two of the five cases when using the heuristic. In addition, using the editor improved the approximation in four cases. Conclusions Our approach is suitable to create realistically parameterized mitral valve apparatus reconstructions for the simulation of normally and abnormally closing valves in a decision support system.

Using Position‐Based Dynamics for Simulating Mitral Valve Closure and Repair Procedures

“…For the definition of the cords, the leaflet vertices were manually annotated, and the heuristic was used for determining the PM tips, setting up the edge distance constraints and initial lengths. Afterwards, the cord lengths were scaled (individually or in groups) using the interactive editor [WTN*20] to provide a good visual match to the image data.…”

“…In the satisfactory case B5 (shown in Figures 4 and 9 (bottom row, right image)), changes in the parameterization of the cords compared to the results in the article [WGT*19] led to a very good approximation of the closed valve as well as the regurgitation orifice position and size. This was achieved using the interactive editor [WTN*20]. The general shape of the simulated closed valve B5 matches the annotations and the form seen in the image data well.…”

“…The novel approach presented here is an extension of Walczak et al . [WGT*19, WTN*20] and represents a proof of concept study for a practical approach to MV simulation for DSS.…”

Effect of transcatheter edge-to-edge repair device position on diastolic hemodynamic parameters: An echocardiography-based simulation study

“…The virtual TEER process is simulated by means of our previously developed approach (34)(35)(36). The approach simulates mitral valve dynamics with position-based dynamics (PBD), which is an efficient simulation technique designed for real time computer graphics applications.…”

A toolbox for generating scalable mitral valve morphometric models

“…MV geometry has been exploited to improve the design of medical devices through the development of annuloplasty ring designs which 1) mimic the native annular saddle-shape (Doll et al, 2019) and 2) optimise load bearing by the annulus (Ncho et al, 2020), for example. The evaluation of pre-and post-operative scenarios which account for a subject's MV shape have the potential to improve surgical planning, specifically patient-specific repair procedures (Kohli et al, 2021, Walczak et al, 2021.…”