Abstract 17521: Improved Evaluation of Mitral Valve Pathophysiology for Better Prediction of Repair Success
Background: Computational simulation in combination with 3D echocardiography can provide detailed biomechanical information of mitral valve (MV) function with better pathophysiologic evaluation. Often MV deterioration occurs with chronic abnormally large stress forces over the leaflets and annulus. We have developed a novel computational evaluation strategy to determine MV pathophysiology and predict abnormal stress areas.
Methods: Patients with normal (n=5) and pathologic (n=5) MVs were recruited, and volumetric MV geometry was obtained from 3D echocardiography. Virtual 3D MV models including annulus, leaflets, papillary muscles and chordae tendineae were created. Computational simulations of the MVs were performed using dynamic finite element methods, and structural stress distributions across the MV including leaflet coaptation stress were compared.
Results: A large range of stress distributions was observed in the pathologic MVs. In particular, A2 (0.35±0.06 MPa vs. 0.25±0.03 MPa, p<0.05), P1 (0.20±0.07 MPa vs. 0.14±0.02 MPa, p<0.05) and P2 (0.29±0.01 MPa vs. 0.21±0.09 MPa, p<0.05) regions demonstrated different stress distributions between the pathologic and normal MVs. Leaflet coaptation in the pathologic MVs (0.22±0.08%) was smaller than the normal MVs (0.33±0.04%, p=0.013). Clinical observation of regurgitant jets close to the anterolateral commissure corresponded to the regions with abnormal leaflet coaptation and excessively large stress occurrence.
Conclusion: Computational simulation of patient-specific virtual MV function demonstrated excessive stress concentration and abnormal coaptation near regions of regurgitant jet. This novel computational MV evaluation strategy has the potential for predicting pathophysiologic alteration of MV structure and improving pre-surgical planning for MV repair.
- © 2012 by American Heart Association, Inc.