Simulation Based Design and Evaluation of a Transcatheter Mitral Heart Valve Frame

In certain populations, open heart surgery to replace a diseased mitral valve is not an option, leaving percutaneous delivery a viable alternative. However, a surgical transcatheter based delivery of a metallic support frame incorporating a tissue derived valve puts considerable constraints on device specifications. Expansion to a large diameter from the catheter diameter without mechanical fracture involves advanced device design and appropriate material processing and selection. In this study, a new frame concept is presented with a desirable feature that incorporates wings that protrude during expansion to establish adequate fixation. Expansion characteristics of the design in relation to annulus fixation were quantified through finite element analysis predictions of the frame wing span and angles. Computational modeling and simulation was used to identify many favorable design features for the transcatheter mitral valve frame and obtain desired expansion diameters (35–45 mm), acceptable radial stiffness (2.7 N/mm), and ensure limited risk of failure based on predicted plastic deformations.

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Mitral valve disease and open heart surgery in osteogenesis imperfecta tarda.

Heart ◽

10.1136/hrt.35.1.103 ◽

1973 ◽

Vol 35 (1) ◽

pp. 103-106 ◽

Cited By ~ 44

Author(s):

S J Wood ◽

J Thomas ◽

M V Braimbridge

Keyword(s):

Mitral Valve ◽

Osteogenesis Imperfecta ◽

Mitral Valve Disease ◽

Heart Surgery ◽

Open Heart Surgery ◽

Valve Disease ◽

Open Heart

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Early results of a real-world series with two transapical transcatheter mitral valve replacement devices

Clinical Research in Cardiology ◽

10.1007/s00392-020-01757-z ◽

2020 ◽

Author(s):

S. Ludwig ◽

D. Kalbacher ◽

N. Schofer ◽

A. Schäfer ◽

B. Koell ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Surgery ◽

Open Heart Surgery ◽

Functional Improvement ◽

Study Cohort ◽

Early Results ◽

Transcatheter Mitral Valve Replacement

Abstract Aims Transcatheter mitral valve replacement (TMVR) with dedicated devices promises to fill the treatment gap between open-heart surgery and edge-to-edge repair for patients with severe mitral regurgitation (MR). We herein present a single-centre experience of a TMVR series with two transapical devices. Methods and results A total of 11 patients were treated with the Tendyne™ (N = 7) or the Tiara™ TMVR systems (N = 4) from 2016 to 2020 either as compassionate-use procedures or as commercial implants. Clinical and echocardiographic data were collected at baseline, discharge and follow-up and are presented in accordance with the Mitral Valve Academic Research Consortium (MVARC) definitions. The study cohort [age 77 years (73, 84); 27.3% male] presented with primary (N = 4), secondary (N = 5) or mixed (N = 2) MR etiology. Patients were symptomatic (all NYHA III/IV) and at high surgical risk [logEuroSCORE II 8.1% (4.0, 17.4)]. Rates of impaired RV function (72.7%), severe pulmonary hypertension (27.3%), moderate or severe tricuspid regurgitation (63.6%) and prior aortic valve replacement (63.6%) were high. Severe mitral annulus calcification was present in two patients. Technical success was achieved in all patients. In 90.9% (N = 10) MR was completely eliminated (i.e. no or trace MR). Procedural and 30-day mortality were 0.0%. At follow-up NYHA class was I/II in the majority of patients. Overall mortality after 3 and 6 months was 10.0% and 22.2%. Conclusions TMVR was performed successfully in these selected patients with complete elimination of MR in the majority of patients. Short-term mortality was low and most patients experienced persisting functional improvement. Graphic abstract

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Case report of simultaneous transcatheter mitral valve-in-valve implantation and percutaneous closure of two paravalvular leaks

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz123 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Masahiko Asami ◽

Thomas Pilgrim ◽

Stephan Windecker ◽

Fabien Praz

Keyword(s):

Mitral Valve ◽

Heart Surgery ◽

Open Heart Surgery ◽

Transoesophageal Echocardiography ◽

Paravalvular Leak ◽

Open Heart ◽

Surgical Risk ◽

Significant Difference ◽

Valve In Valve ◽

Valve Implantation

Abstract Background Concomitant structural degeneration of surgical mitral bioprostheses and paravalvular leak (PVL) is rare but potentially fatal. Data pertaining to simultaneous transcatheter mitral valve implantation (TMVI) and percutaneous PVL closure are limited, and the optimal treatment strategy remains undetermined. We report a case of simultaneous TMVI and double percutaneous PVL closure in a patient with a degenerated bioprosthetic mitral valve and associated medial and lateral PVLs. Case summary A 75-year-old woman who underwent combined aortic (Edwards Perimount Magna 19 mm) and mitral (Edwards Perimount Magna 25 mm) surgical valve replacement 6 years ago was referred for treatment of new-onset orthopnoea and severely reduced exercise capacity. Transoesophageal echocardiography revealed severe mitral stenosis and concomitant moderate to severe mitral regurgitation, originating from two PVLs located medial and lateral from the surgical bioprosthesis. Due to high surgical risk, we performed successful transseptal mitral valve-in-valve (ViV) implantation combined with the closure of two PVLs during the same procedure. Discussion Although surgery should be considered as a first-line treatment in this setting, most patients have extremely high or prohibitive surgical risk inherent to repeat open heart surgery. Mitral ViV implantation appears a reasonable treatment option for patients with failed mitral bioprostheses. Furthermore, a recent study of percutaneous PVL closure showed no significant difference in long-term all-cause mortality compared with redo open-heart surgery. Simultaneous TMVI and percutaneous PVL closure appears feasible in selected high-risk patients.

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Open heart surgery with mitral valve replacement - ordeal of an undiagnosed haemophilia patient.

Clinical & Laboratory Haematology ◽

10.1046/j.1365-2257.2003.00498.x ◽

2003 ◽

Vol 25 (2) ◽

pp. 131-133 ◽

Cited By ~ 6

Author(s):

K. Ghosh ◽

M. Madkaikar ◽

F. Jijina ◽

S. Gandhi ◽

S. Shetty ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart

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Robotic mitral valve surgery: how soon will we be moving away from open heart surgery?

Future Cardiology ◽

10.2217/fca.12.61 ◽

2012 ◽

Vol 8 (6) ◽

pp. 797-799

Author(s):

Saina Attaran ◽

Jon Anderson ◽

Prakash Punjabi

Keyword(s):

Mitral Valve ◽

Heart Surgery ◽

Open Heart Surgery ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Open Heart

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Primary Cardiac Sarcoma Remission after Surgery: 5-Years Follow-up: Case Report

The Heart Surgery Forum ◽

10.1532/hsf.1936 ◽

2018 ◽

Vol 21 (5) ◽

pp. E401-E403 ◽

Cited By ~ 2

Author(s):

Melike Elif Teker ◽

Önder Teskin

Keyword(s):

Case Report ◽

Mitral Valve ◽

Heart Surgery ◽

Open Heart Surgery ◽

Radical Resection ◽

Patient Specific ◽

Anterior Leaflet ◽

Full Remission ◽

Primary Cardiac Sarcoma

Background: Primary cardiac sarcoma is a rare and atypical clinical entity. We present a patient with long-term remission after primary cardiac sarcoma resection. Case Report: A 42-year-old previously healthy female presented to the emergency department after an effort-induced 30-minute episode of chest pain and extreme shortness of breath. Physical examination upon admission was remarkable for a pulse of 99/minute; blood pressure was 101/73 mmHg. Transthoracic echocardiography showed a mass measuring 5.5 × 5.6 cm extending from the left septum to the mitral valve anterior leaflet. A multilobulated broad-based 5.5 × 5.6 × 4 cm3 mass invading a large portion of the left septum to the mitral valve anterior leaflet was completely excised in the open heart surgery. Chemotherapy regimen (paclitaxel 175 mg/m2/day on day 1, every 21 days) was started after operation. Full remission was provided. Metastasis and recurrence have not been observed for 5 years of follow-up by PET. We observed during 5 years and used a PET. And the finally we did not see metastasis at the 5 years of follow-up. Conclusions: We strongly recommend that a patient-specific multidisciplinary approach involving radical resection, chemotherapy, and radiation therapy in these cases results in patient survival and a significant improvement in quality of life. We also think that it is necessary to perform MRI to exclude other illnesses that are considered to be a myxoma.

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Analysis of a Lightweight Aluminum Vehicle Chassis in a Simulation-Based Design Approach

Global Journal of Researches in Engineering ◽

10.34257/gjrejvol20is1pg1 ◽

2020 ◽

pp. 1-10

Author(s):

Mohsen Alardhi ◽

Fahad Almaskari ◽

Melad Fahed ◽

Jasem Alrajhi

Keyword(s):

Safety Factor ◽

Side Impact ◽

Design Approach ◽

Element Analysis ◽

Trade Offs ◽

Simulation Based Design ◽

Simulation Based ◽

Impact Side ◽

Von Mises ◽

Vehicle Chassis

This study investigates different chassis designs through a simulation-based design approach. The inherent aluminum ductility and softness could make chassis a daunting modification if not analyzed properly. Structural finite element analysis is comprehensively performed on a vehicle chassis for static loading cases up to 1G in equivalent acceleration. The analysis of the vehicle chassis of both A36 steel and 6061 aluminum for the scenarios of bump, front impact, side impact and a rollover. The von Mises stresses and displacement results showed that the steel chassis possessed higher safety factor in all load cases. The safety factors for an aluminum clone of the steel chassis in some load cases are below 1.0, hence indicating that the failure criterion has been triggered and failure would occur under the 1G load. The original aluminum chassis deformation is far more severe than steel reaching as high as 9.88 mm for the bump loading. A modified aluminum chassis is proposed, by optimizing the wall thickness of the rectangular bars. The slight increase in weight resulted in overcoming the deficiency of aluminum in load carrying capacity. An evaluation matrix procedure is implemented to analyze the trade offs between cost, weight and safety factor for the three chassis materials.

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Giant Left Atrium in Triple Rheumatic Heart Disease

International Cardiovascular Forum Journal ◽

10.17987/icfj.v13i0.498 ◽

2018 ◽

Vol 13 ◽

Author(s):

Gëzim Berisha ◽

Edmond Haliti ◽

Gani Bajraktari

Keyword(s):

Pulmonary Hypertension ◽

Heart Disease ◽

Mitral Valve ◽

Left Atrium ◽

Rheumatic Heart Disease ◽

Heart Surgery ◽

Open Heart Surgery ◽

Heart Team ◽

Giant Left Atrium ◽

Rheumatic Heart

The giant left atrium (GLA) is a rare condition, commonly associated with rheumatic mitral valve disease, and very rarely with non rheumatic heart disease (nRHD). The triple valvular heart disease with involved mitral, aortic and tricuspid valves is quite uncommon. A 47 year female patient with a past medical history of rheumatic heart disease (RHD) and known severe mitral stenosis was with severe breathlessness (NYHA class IV). She had undergone mitral valve commissurotomy and tricuspid valve annuloplasty 12 years previously. Transthoracic echocardiography revealed a giant left atrium, moderate to severe mitral valve restenosis, severe mitral regurgitation, moderate aortic regurgitation and severe tricuspid regurgitation, associated with severe secondary pulmonary hypertension and a markedly dilated right heart chambers. The patient was considered inoperable by the heart team, because of advanced pulmonary hypertension predicting a very high risk for open heart surgery. The final treatment decision was a difficult and complex issue.

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Effect of Edge-to-Edge-Repair on Annulus Tension of Prolapsed Mitral Valve

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19571 ◽

2010 ◽

Author(s):

Shamik Bhattacharya ◽

Zhaoming He

Keyword(s):

Mitral Valve ◽

Heart Surgery ◽

Open Heart Surgery ◽

Force Component ◽

Posterior Leaflet ◽

Ring Annuloplasty ◽

Repair Procedure ◽

Prolapsed Mitral Valve ◽

Leaflet Prolapse

The edge-to-edge repair (ETER) technique is a mitral valve (MV) repair procedure. It approximates the leading edges of the mitral leaflets by use of sutures, exhibits promising predictable repair results and offers the advantage of being performed pericutaneously without the need for open heart surgery. The technique is becoming a popular surgical procedure to correct MV prolapse caused by abnormal chordal elongation. MV prolapse leads to mitral regurgitation (MR). Generally the ETER technique is performed as a secondary procedure to ring annuloplasty. Although some groups have performed ETER without the ring annuloplasty, recent studies have shown that ETER technique alone leads to substandard results [1]. It is necessary to define the MV annulus mechanics in ETER condition during valve closure or mid-systole as it directly affects the annulus tension (AT) in the annulus plane. AT in the annulus plane is an important force component which balances the myocardium force and contributes to maintaining the annulus shape and size. This AT change caused by the ETER can lead to annulus dilation, reoccurrence of MR and impact reintervention. The objective of the current study is to understand this AT change in the MV annulus tension during the mid-systole in the ETER condition in order to improve the long term efficacy of the ETER procedure on MV annulus tension, after the technique has been applied with both anterior leaflet prolapse and posterior leaflet prolapse.

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