Abstract 18319: Virtual Mitral Valve Repair for Improved Pre-surgical Planning: Quantitative Evaluation of Neochordoplasty versus Leaflet Resection
Background: Neochordoplasty and/or leaflet resection are reliable and reproducible mitral valve (MV) repair techniques for the treatment of chordal rupture with severe mitral regurgitation (MR). We developed a novel computational evaluation strategy to determine the biomechanical and physiologic characteristics of MV dynamics prior to and following potential MV repair techniques to optimize surgical planning for neochordoplasty or leaflet resection.
Methods: Virtual MV models from patients with P2 chordal rupture and severe MR were created using 3D echocardiographic data (N=5). Virtual neochordoplasty was designed by adding six neochordae between the papillary muscles and the P2 scallop. Virtual resection was performed by removing a pre-defined quadrangular shaped leaflet portion in the P2 scallop and merging the excised leaflet edges. Computational simulations of MV function (pre- and post-repair) were performed using dynamic finite element methods. Coaptation lengths and leaflet stress distributions were evaluated.
Results: The MVs with P2 chordal rupture demonstrated severe P2 prolapse, leaflet malcoaptation, and large stress concentrations. Both repair techniques markedly reduced posterior leaflet prolapse and restored sufficient leaflet coaptation. Virtual neochordoplasty showed larger coaptation lengths (A2-P2) compared to virtual resection. Excessive stress concentrations in the P2 scallop disappeared and peak stress values decreased by up to 85% following both repair techniques.
Conclusion: We have quantitatively evaluated patient-specific MV function before and after potential MV repair using a novel virtual MV repair protocol. Both virtual neochordoplasty and leaflet resection techniques decreased posterior leaflet prolapse, lessened stress concentration, and restored leaflet coaptation. This virtual simulation strategy has the potential for improved pre-surgical planning to optimize post-repair MV function.
Author Disclosures: A. Choi: None. T.C. Nguyen: None. D.D. McPherson: None. H. Kim: None.
- © 2015 by American Heart Association, Inc.