Abstract 15648: Quantitative Evaluation of Mitral Valve Dynamics for Improved Planning of Mitral Valve Repairs
Introduction: Mitral valve (MV) repair with ring annuloplasty is the standard surgical technique for the treatment of mitral regurgitation (MR). Long-term studies report MR recurrence in up to 2-4% of repairs. We have developed a novel computational evaluation strategy to determine the biomechanical and physiologic characteristics of MV dynamics prior to and following virtual MV repair to help with optimal surgical planning.
Methods: Virtual MV models from patients with large annular dilation and severe MR in the anterolateral region were created using 3D echocardiographic data sets. Two different types of annuloplasty rings were modeled in the simulation: Physio (flat) and Physio II (saddle-shaped). Proper ring size was determined using standard clinical guidelines. Computational simulations of MV function (pre- and post-repair) were performed using dynamic finite element methods. Coaptation ratio (CR) and structural stress distribution across the MVs were determined and compared.
Results: Pathologic MVs demonstrated substantial anterolateral malcoaptation (CR=0.34, Fig. 1A). Following virtual ring annuloplasty, there was marked improvement in coaptation (CR=0.65 for Physio, CR=0.62 for Physio II). Pre-repair simulation revealed large stress concentrations over the posterior leaflet (Fig. 1B). Stress concentration decreased by 54% after virtual MV repair. The saddle-shaped Physio II ring demonstrated more evenly distributed stress reduction while the flat ring (Physio) more effectively increased leaflet coaptation.
Conclusion: We have quantitatively evaluated patient-specific MV function before and after MV repair using a novel computational simulation protocol. Virtual ring annuloplasty simulation demonstrated sufficient restoration of leaflet coaptation and reduced stress concentration following repair. This simulation strategy has the potential for improved pre-surgical planning and intraoperative evaluation of MV repair.
Author Disclosures: A. Choi: None. Y. Rim: None. S.T. Laing: None. D.D. McPherson: None. H. Kim: None.
- © 2014 by American Heart Association, Inc.