Abstract 15648: Quantitative Evaluation of Mitral Valve Dynamics for Improved Planning of Mitral Valve Repairs

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ahnryul Choi ◽  
Yonghoon Rim ◽  
Susan T Laing ◽  
David D McPherson ◽  
Hyunggun Kim
Keyword(s):  
Stress Concentration ◽  
Mitral Valve ◽  
Stress Reduction ◽  
Surgical Planning ◽  
Computational Simulation ◽  
Patient Specific ◽  
Stress Concentrations ◽  
Computational Evaluation ◽  
Ring Annuloplasty ◽  
Leaflet Coaptation

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.

Abstract 17214: Prediction of Mitral Valve Repair: Pre-Repair versus Virtual Repair versus Post-Repair

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
MyungGu Yeo ◽  
Tom T Nguyen ◽  
David D McPherson ◽  
Hyunggun Kim
Keyword(s):  
Mitral Valve ◽  
Surgical Planning ◽  
Patient Specific ◽  
Valve Repair ◽  
Repair Strategy ◽  
Dynamic Finite Element ◽  
Ring Annuloplasty ◽  
Before And After ◽  
Leaflet Coaptation ◽  
Leaflet Prolapse

Introduction: Partial leaflet resection followed by ring annuloplasty is a reliable and reproducible mitral valve (MV) repair technique for the treatment of severe mitral regurgitation (MR) due to posterior chordal rupture. Hypothesis: We have developed a novel computational virtual MV repair strategy to predict the biomechanical and physiologic characteristics of post-repair MV dynamics to help with optimal surgical planning. Methods: Computational MV models were created using pre- and post-repair 3D echocardiographic data of a patient having posterior chordal rupture and severe MR. Virtual resection was designed by removing a pre-defined triangle-shaped leaflet portion in the P2 scallop and merging the excised leaflet edges. Virtual ring annuloplasty with the same ring size as the post-repair MV was performed following the triangular leaflet resection. Computational simulations of MV function (pre-repair, virtual repair, and post-repair) were performed using dynamic finite element methods. Leaflet coaptation across the MVs were quantitatively determined and compared. Results: The pre-repair MV with P2 chordal rupture showed severe P2 prolapse and leaflet malcoaptation. The post-repair MV demonstrated markedly reduced prolapse and sufficiently restored leaflet coaptation. The virtually repaired MV revealed a similar coaptation ratio as the post-repair MV indicating effective restoration of normal MV function. Both virtual repair and post-repair MVs showed improved coaptation not only in the P2 region but also in the A1-P1 and A3-P3 regions. Conclusions: We have quantitatively evaluated patient-specific MV function before and after potential MV repair using a novel virtual MV repair protocol. Both virtual repair and post-repair MVs decreased posterior leaflet prolapse and restored normal coaptation. This virtual MV repair strategy has the potential for improved pre-surgical planning to predict and optimize post-repair MV function.

scholarly journals Fast image-based model of mitral valve closure for surgical planning

2008 ◽  
Author(s):  
Peter Hammer ◽  
Nikolay Vasilyev ◽  
Douglas Perrin ◽  
Pedro del Nido ◽  
Robert Howe
Keyword(s):  
Mitral Valve ◽  
Surgical Planning ◽  
Equations Of Motion ◽  
Planning System ◽  
Patient Specific ◽  
Valve Closure ◽  
Spring Model ◽  
Closed State ◽  
Mass Spring Model ◽  
Mass Spring

Surgical repair of the mitral valve results in better outcomes than valve replacement, yet diseased valves are often replaced due to the technical difficulty of the repair process. A surgical planning system based on patient-specific medical images that allows surgeons to simulate and compare potential repair strategies could greatly improve surgical outcomes. The system must simulate valve closure quickly and handle the complex boundary conditions imposed by the chords that tether the valve leaflets. We have developed a process for generating a triangulated mesh of the valve surface from volumetric image data of the opened valve. The closed position of the mesh is then computed using a mass-spring model of dynamics. In the mass-spring model, triangle sides are treated as linear springs supporting only tension. Chords are also treated as linear springs, and self-collisions are detected and handled inelastically. The equations of motion are solved using implicit numerical integration. The simulated closed state is compared with an image of the same valve taken in the closed state to assess accuracy of the model. The model exhibits rapid valve closure and is able to predict the closed state of the valve with reasonable accuracy.

scholarly journals A novel finite element-based patient-specific mitral valve repair: virtual ring annuloplasty

2014 ◽  
Vol 24 (1) ◽  
pp. 341-347 ◽  
Author(s):  
Ahnryul Choi ◽  
Yonghoon Rim ◽  
Jeffrey S. Mun ◽  
Hyunggun Kim
Keyword(s):  
Finite Element ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Patient Specific ◽  
Valve Repair ◽  
Ring Annuloplasty

Mechanics of Healthy and Functionally Diseased Mitral Valves: A Critical Review

2013 ◽  
Vol 135 (2) ◽  
Author(s):  
Jean-Pierre M. Rabbah ◽  
Neelakantan Saikrishnan ◽  
Andrew W. Siefert ◽  
Arvind Santhanakrishnan ◽  
Ajit P. Yoganathan
Keyword(s):  
Mitral Valve ◽  
Left Atrium ◽  
Surgical Planning ◽  
Patient Specific ◽  
Mitral Valves ◽  
Medical Device Design ◽  
Unidirectional Flow ◽  
Patient Health

The mitral valve is a complex apparatus with multiple constituents that work cohesively to ensure unidirectional flow between the left atrium and ventricle. Disruption to any or all of the components—the annulus, leaflets, chordae, and papillary muscles—can lead to backflow of blood, or regurgitation, into the left atrium, which deleteriously effects patient health. Through the years, a myriad of surgical repairs have been proposed; however, a careful appreciation for the underlying structural mechanics can help optimize long-term repair durability and inform medical device design. In this review, we aim to present the experimental methods and significant results that have shaped the current understanding of mitral valve mechanics. Data will be presented for all components of the mitral valve apparatus in control, pathological, and repaired conditions from human, animal, and in vitro studies. Finally, current strategies of patient specific and noninvasive surgical planning will be critically outlined.

scholarly journals Minimally Invasive Mini-orbitozygomatic Approach for Clipping an Anterior Communicating Artery Aneurysm: Virtual Reality Surgical Planning

2020 ◽  
Author(s):  
Nicolás González Romo ◽  
Franco Ravera Zunino
Keyword(s):  
Virtual Reality ◽  
Minimally Invasive ◽  
Surgical Planning ◽  
Artery Aneurysm ◽  
Patient Specific ◽  
Anterior Communicating Artery ◽  
Imaging Data ◽  
Advantages And Disadvantages ◽  
Orbitozygomatic Approach ◽  
Skull Base Anatomy

AbstractVirtual reality (VR) has increasingly been implemented in neurosurgical practice. A patient with an unruptured anterior communicating artery (AcoA) aneurysm was referred to our institution. Imaging data from computed tomography angiography (CTA) was used to create a patient specific 3D model of vascular and skull base anatomy, and then processed to a VR compatible environment. Minimally invasive approaches (mini-pterional, supraorbital and mini-orbitozygomatic) were simulated and assessed for adequate vascular exposure in VR. Using an eyebrow approach, a mini-orbitozygomatic approach was performed, with clip exclusion of the aneurysm from the circulation. The step-by-step process of VR planning is outlined, and the advantages and disadvantages for the neurosurgeon of this technology are reviewed.

scholarly journals Patient-specific access planning in minimally invasive mitral valve surgery

2020 ◽  
Vol 136 ◽  
pp. 109475
Author(s):  
Dario Di Perna ◽  
Miguel Castro ◽  
Yannig Gasc ◽  
Pascal Haigron ◽  
Jean-Philippe Verhoye ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Patient Specific

4D Mitral Valve Motion Analysis Using Multi-Plane Cine Cardiac MRI Reconstructions for Functional Classification of Patients With Mitral Regurgitation

2014 ◽  
Author(s):  
Abhiram Rao ◽  
Prahlad G. Menon
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Motion Analysis ◽  
Ventricular Remodeling ◽  
Systolic Dysfunction ◽  
Survival Rates ◽  
Image Data ◽  
Anatomical Reconstruction ◽  
Patient Specific ◽  
Operative Planning

Mitral regurgitation (MR) is a common consequence of ventricular remodeling in heart failure (HF) patients with systolic dysfunction and is associated with diminished survival rates. Characterization of patient-specific anatomy and function of the regurgitant mitral valve (MV) can enhance surgical decision making in terms of medical device choice and deployment strategy for minimally invasive endovascular approaches for MV repair. As a first step toward pre-operative planning for MV repair, we examine the feasibility of using cardiac magnetic resonance (CMR) images acquired in multiple orientations to resolve leaflet function and timing. In this study, MV motion of a HF patient with ischemic heart disease exhibiting both adverse ventricular remodeling and MR was compared pre-operatively against a normal control from the Sunnybrook cardiac database, starting with manually segmented 2D MV contours from cine CMR images acquired in multiple orientations. We find that MV motion analysis from CMR imaging is feasible and anatomical reconstruction using oriented segmentations from a combination of imaging slices acquired in multiple orientations can help overcome inherent limitations of CMR image data in terms of resolving small anatomical features, owing to finite slice-thicknesses and partial volume effects.

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