Finite Element Modeling of Mitral Valve Repair

The mitral valve is a complex structure regulating forward flow of blood between the left atrium and left ventricle (LV). Multiple disease processes can affect its proper function, and when these diseases cause severe mitral regurgitation (MR), optimal treatment is repair of the native valve. The mitral valve (MV) is a dynamic structure with multiple components that have complex interactions. Computational modeling through finite element (FE) analysis is a valuable tool to delineate the biomechanical properties of the mitral valve and understand its diseases and their repairs. In this review, we present an overview of relevant mitral valve diseases, and describe the evolution of FE models of surgical valve repair techniques.

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Mitral valve disease

10.1093/med/9780199599639.003.0015 ◽

2011 ◽

Cited By ~ 1

Author(s):

Patrizio Lancellotti ◽

Julien Magne ◽

Kim O’Connor ◽

Luc A. Pierard

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Mitral Valve Disease ◽

Aortic Valve Disease ◽

Valve Disease ◽

Two Dimensional ◽

Valve Repair ◽

Associated Lesions ◽

Echocardiographic Evaluation ◽

Valve Diseases

Native mitral valve disease is the second valvular heart disease after aortic valve disease. For the last few decades, two-dimensional Doppler echocardiography was the cornerstone technique for evaluating patients with mitral valve disease. Besides aetiological information, echocardiography allows the description of valve anatomy, the assessment of disease severity, and the description of the associated lesions.This chapter will address the echocardiographic evaluation of mitral regurgitation (MR) and mitral stenosis (MS).In MR, the following findings should be assessed: 1. Aetiology. 2. Type and extent of anatomical lesions and mechanisms of regurgitation. 3. The possibility of mitral valve repair. 4. Quantification of MR severity. 5. Quantification of MR repercussions.In MS, the following findings should be assessed: 1. Aetiology. 2. Type and extent of anatomical lesions. 3. Quantification of MS severity. 4. Quantification of MS repercussions. 5. Wilkins or Cormier scores for the possibility of percutaneous mitral commissuroplasty.Management of patients with mitral valve disease is currently based on symptoms and on echocardiographic evaluation at rest. Therefore, knowing how to assess the severity of valve diseases as well as the pitfalls and the limitations of each echocardiographic method is of primary importance.

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P951 Intraprocedural echocardiographic technique to locate the insertion points of artificial chordae during transventricular beating heart mitral valve repair: ultrasound ""starry sky""

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.584 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Vairo ◽

M Marro ◽

G Speziali ◽

M Rinaldi ◽

S Salizzoni

Keyword(s):

Mitral Valve ◽

Real Time ◽

Mitral Valve Repair ◽

Three Dimensional ◽

Free Edge ◽

Beating Heart ◽

Valve Repair ◽

Native Valve ◽

Intense Signal ◽

Echocardiographic Technique

Abstract BACKGROUND Mitral valve repair is the preferred surgical treatment for severe mitral regurgitation due to degenerative leaflet prolapse. Within the growing era of transcatheter treatments for valvular heart disease, an innovative micro-invasive trans-ventricular beating-heart procedure was developed. Three-dimensional transoesophageal echocardiographic guidance is crucial to assist the operator in instrument navigation and chords positioning. Indeed, it is important an equidistant chords placement on the leaflet to ensure a uniform force distribution on the prolapsing segment and to avoid damaging of the previously inserted chords. PURPOSE To propose an intraoperative three-dimensional echocardiographic technique that allows operators to see the exact location of the polytetrafluoroethylene (ePTFE) chords used for the mitral repair. METHODS The procedure is performed using a device that is introduced through a posterolateral ventriculotomy and it is advanced towards the mitral valve under real-time 3D transoesophageal guidance. The prolapsing segments are grasped with the jaw of the instrument and the chords are implanted to achieve the proper distribution of forces and then tensioned and secured outside the ventricle. The proposed technique exploits the greater echogenicity of the artificial chord loop compared to native chords and leaflets. By lowering of the gains, remaining in the three-dimensional mitral valve surgical view, the signals of the native structures are attenuated, the underlying ventricular cavity appears black and the insertion points are visible as an intense signal on the virtual free edge of the leaflet treated. Figure 1 shows the intraoperative sequence of images of a case performed at our centre. The images were acquired using real time single beat three-dimensional reconstruction. Figure 1A shows the surgical view of the native valve with prolapse of the P2-P3 scallops. Image 1B reveals the prolapsing leaflet grasping and device location. After gain lowering, it’s possible to see the intense signal of the positioned artificial chord (Figure 1C). It can also be noted how this position matches with the position of the device at the time of grasping. Image 1D shows the partial disappearance of the prolapse during the tensioning test after the positioning of a second chord in a more medial position. Figure 1E shows the correct position of the ePTFE chords. We can notice the second chord placed in a medial position from the first one. This view, with dark ventricular chamber and intense signals of chordae loops, looks like a "STARRY SKY". RESULTS This technique allows to locate the correct insertion points of the artificial chords during the procedure. CONCLUSIONS This is a simple technique to guide operators during trans-ventricular beating heart mitral valve repair with ePTFE chords. Abstract P951 Figure 1

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Transvalvular pressure gradients for different methods of mitral valve repair: only neochordoplasty achieves native valve gradients

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivx323 ◽

2017 ◽

Vol 26 (2) ◽

pp. 248-255 ◽

Cited By ~ 3

Author(s):

Silje Ekroll Jahren ◽

Samuel Hurni ◽

Paul Philipp Heinisch ◽

Bernhard Winkler ◽

Dominik Obrist ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Pressure Gradients ◽

Valve Repair ◽

Native Valve

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Uniformity in bioprosthetic mitral valve sizing -- when will we get there?

10.22541/au.163256756.65416017/v1 ◽

2021 ◽

Author(s):

Cian Tan ◽

Mohamad Bashir ◽

Mohammed Idhrees

Keyword(s):

Mitral Valve ◽

Experimental Technique ◽

Porcine Model ◽

Biomechanical Properties ◽

Bioprosthetic Valve ◽

Valve Repair ◽

Mitral Valves ◽

Uniform Approach ◽

Bioprosthetic Valves ◽

Bioprosthetic Mitral Valve

Much has changed since the introduction of surgical valve repair in the 1950s, from the introduction bioprosthetic valves to percutaneous approaches to valve repair. Yet, despite substantial advancements in bioprosthetic valve technology, there has been a lack of direct, independent comparison between bioprosthetic mitral valve devices, accompanied by a marked heterogeneity in approaches to the sizing and selection thereof. Wang et al. have hence endeavoured to evaluate, head-to-head, the technical successes and biomechanical outcomes associated with three different bioprosthetic mitral valves (Epic, Abbott, IL; Mosaic, Medtronic, MN; Mitris Resilia, Edwards Lifesciences, CA) in a porcine model, under standardised haemodynamic and anatomical conditions. With a robust experimental technique, they have made clear the heterogeneity in both sizing and biomechanical properties between bioprosthetic mitral valves, and have further emphasised the need for a uniform approach to the manufacturing and sizing of bioprosthetic valves.

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Neochord placement versus triangular resection in mitral valve repair: A finite element model

Journal of Surgical Research ◽

10.1016/j.jss.2016.07.011 ◽

2016 ◽

Vol 206 (1) ◽

pp. 98-105 ◽

Cited By ~ 7

Author(s):

Ashley E. Morgan ◽

Joe L. Pantoja ◽

Eugene A. Grossi ◽

Liang Ge ◽

Jonathan W. Weinsaft ◽

...

Keyword(s):

Finite Element ◽

Mitral Valve ◽

Finite Element Model ◽

Mitral Valve Repair ◽

Element Model ◽

Valve Repair

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Biomechanical Properties of Human Coronary Sinus for Minimally Invasive Mitral Valve Repair

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19638 ◽

2010 ◽

Author(s):

Thuy Pham ◽

Wei Sun

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Operative Mortality ◽

Treatment Options ◽

Mitral Valve Regurgitation ◽

Biomechanical Properties ◽

Current Treatment ◽

Valve Repair ◽

Surgical Treatments

Mitral valve regurgitation, the leakage of blood back to the left atrium during systole, is a significant cause of morbidity and mortality. The current treatment options for symptomatic mitral regurgitation are mitral valve repair and replacement. However, the operative mortality for both of these treatments remains substantial (1). Furthermore, these treatments are often not referred for elderly patients with comorbidities. Thus, there is a pressing need for less invasive, non-surgical treatments of mitral regurgitation.

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Strategy for Active Infective Native Valve Endocarditis and Tips on Mitral Valve Repair

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.37.155 ◽

2008 ◽

Vol 37 (3) ◽

pp. 155-158

Author(s):

Masaru Sawazaki ◽

Shiro Tomari ◽

Kohji Yamana

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Native Valve ◽

Native Valve Endocarditis

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Surgical Outcomes in Native Valve Infectious Endocarditis: The Experience of the Cardiovascular Surgery Clinic – Cluj-Napoca Heart Institute

Medicine and Pharmacy Reports ◽

10.15386/cjmed-482 ◽

2015 ◽

Vol 88 (3) ◽

pp. 338-342 ◽

Cited By ~ 2

Author(s):

Adrian Molnar ◽

Ioan Muresan ◽

Catalin Trifan ◽

Dana Pop ◽

Diana Sacui

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Mechanical Valve ◽

Infectious Endocarditis ◽

Valve Repair ◽

Native Valve

Background and aims. The introduction of Duke’s criteria and the improvement of imaging methods has lead to an earlier and a more accurate diagnosis of infectious endocarditis (IE). The options for the best therapeutic approach and the timing of surgery are still a matter of debate and require a close colaboration between the cardiologist, the infectionist and the cardiac surgeon.Methods. We undertook a retrospective, descriptive study, spanning over a period of five years (from January 1st, 2007 to December 31st, 2012), on 100 patients who underwent surgery for native valve infectious endocarditis in our unit.Results. The patients’ age varied between 13 and 77 years (with a mean of 54 years), of which 85 were males (85%). The main microorganisms responsible for IE were: Streptococcus Spp. (21 cases – 21%), Staphylococcus Spp. (15 cases – 15%), and Enterococcus Spp. (9 cases – 9%). The potential source of infection was identified in 26 patients (26%), with most cases being in the dental area (16 cases – 16%). The lesions caused by IE were situated in the left heart in 96 patients (96%), mostly on the aortic valve (50 cases – 50%). In most cases (82%) we found preexisting endocardial lesions which predisposed to the development of IE, most of them being degenerative valvular lesions (38 cases – 38%). We performed the following surgical procedures: surgery on a single valve - aortic valve replacement (40 cases), mitral valve replacement (19 cases), mitral valve repair (1 case), surgery on more than one valve – mitral and aortic valve replacement (20 cases), aortic and tricuspid valve replacement (1 case), aortic valve replacement with a mechanical valve associated with mitral valve repair (5 cases), aortic valve replacement with a biological valve associated with mitral valve repair (2 cases), and mitral valve replacement with a mechanical valve combined with De Vega procedure on the tricuspid valve (1 case). In 5 patients (5%) the bacteriological examination of valve pieces excised during surgery was positive. In 3 cases it matched the germ identified in the hemocultures, and in 2 cases it evidenced another bacterium.Conclusion. The overall mortality of 5% is well between the limits presented in literature, being higher (30%) in patients who required emergency surgery. For the patients who return into our clinic with prosthetic valve endocarditis, the mortality after surgery was even higher (50%).

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