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

Choi, Ahnryul; Rim, Yonghoon; Mun, Jeffrey S.; Kim, Hyunggun

doi:10.3233/bme-130816

Cited by 32 publications

(28 citation statements)

References 16 publications

(19 reference statements)

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“…The proposed computational model addressed some of the challenges in the state-of-the-art MV modeling field (Choi et al 2014; Mansi et al 2012; Stevanella et al 2011; Votta et al 2013; Wang and Sun 2013) with our substantial improvements, such as the capability of reconstructing all the main components of the MV apparatus, a more detailed and precise description of the MV leaflet thicknesses, a better idealization of the chordae tendineae structures with realistic key points and cross section areas identified and the detailed mapping of actual fiber microstructure. One of the main contributions in the present work was the acquisition of extensive in vitro experimental data for thorough and rigorous validations of the accuracy of our models, and, in the meantime, the sample integrity was carefully maintained throughout the entire model development process, including micro-CT imaging, measurements of fiber microstructural architecture, and mechanical testing for the same ovine mitral valve specimen.…”

Section: Discussionmentioning

confidence: 99%

“…Prot et al (Prot and Skallerud 2009; Prot et al 2007) proposed constitutive models of the MV apparatus for both transversely isotropic membrane and layer-specific nonlinear solid elements. More recently, FE simulations have been extensively utilized for in vivo and patient-specific modeling as well as surgical remodeling and planning (Choi et al 2014; Mansi et al 2012; Stevanella et al 2011; Votta et al 2013; Wang and Sun 2013), by incorporating image-based patient-specific geometry, in vivo dynamic boundaries, and/or physiopathological and surgically intervened conditions into the modeling platform. Computer simulations have also been applied to estimating in vivo stresses of the MVAL tissue for understanding how valvular stress variations affect MV function under healthy and diseased conditions (Krishnamurthy et al 2008;Lee et al 2014).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

On the effects of leaflet microstructure and constitutive model on the closing behavior of the mitral valve

Lee

Rabbah

Yoganathan

et al. 2015

Biomech Model Mechanobiol

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Recent long-term studies showed an unsatisfactory recurrence rate of severe mitral regurgitation 3–5 years after surgical repair, suggesting that excessive tissue stresses and the resulting strain-induced tissue failure are potential etiological factors controlling the success of surgical repair for treating mitral valve (MV) diseases. We hypothesized that restoring normal MV tissue stresses in MV repair techniques would ultimately lead to improved repair durability through the restoration of MV normal homeostatic state. Therefore, we developed a micro- and macro- anatomically accurate MV finite element model by incorporating actual fiber microstructural architecture and a realistic structure-based constitutive model. We investigated MV closing behaviors, with extensive in vitro data used for validating the proposed model. Comparative and parametric studies were conducted to identify essential model fidelity and information for achieving desirable accuracy. More importantly, for the first time, the interrelationship between the local fiber ensemble behavior and the organ-level MV closing behavior was investigated using a computational simulation. These novel results indicated not only the appropriate parameter ranges, but also the importance of the microstructural tuning (i.e., straightening and re-orientation) of the collagen/elastin fiber networks at the macroscopic tissue level for facilitating the proper coaptation and natural functioning of the MV apparatus under physiological loading at the organ level. The proposed computational model would serve as a logical first step toward our long-term modeling goal—facilitating simulation-guided design of optimal surgical repair strategies for treating diseased MVs with significantly enhanced durability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

On the effects of leaflet microstructure and constitutive model on the closing behavior of the mitral valve

Lee

Rabbah

Yoganathan

et al. 2015

Biomech Model Mechanobiol

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“…We have recently developed a novel virtual 3-D annuloplasty ring modeling platform providing a variety of types and sizes of annuloplasty rings that are currently available. 10 It is important to appropriately position the selected ring configuration over the prerepair mitral annulus to generate the most realistic virtual ring annuloplasty simulation and subsequent MV function simulation. First, discrete 3-D profiles of the virtual ring configuration and the prerepair mitral annulus were positioned with the intercommissural lines of the ring and mitral annulus superimposed ( Figure 3).…”

Section: Virtual Ring Annuloplastymentioning

confidence: 99%

“…The computational evaluation of MV function using finite element (FE) methods is a valuable tool to assess the biomechanical aspects of the MV apparatus after surgical intervention. [10][11][12][13] Several recent studies reported ring annuloplasty simulations using FE techniques under various physiologic conditions. 14,15 Although these studies provide valuable information as to the effect of annuloplasty rings from a biomechanical perspective, it is still difficult to directly translate this information to the clinical setting to predict patient-specific ring annuloplasty outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…In the present study, we investigated the effect of annuloplasty ring shape on patient-specific MVs using our established 3-dimensional (3-D) echocardiographybased computational MV evaluation protocols. [10][11][12][13] Two distinct prototype annuloplasty rings (physiologic shape vs nonphysiologic shape) were virtually implanted in patient MV models having considerable MR. The first annuloplasty ring was the Physio II (Edwards Lifesciences Inc, Irvine, Calif), which restores a flattened mitral annulus to a saddle (ie, physiologic) shape.…”

Section: Introductionmentioning

confidence: 99%

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Computational virtual evaluation of the effect of annuloplasty ring shape

Choi

McPherson

Kim

2016

Numer Methods Biomed Eng

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Mitral regurgitation (MR) is a result of mitral valve (MV) pathology. Its etiology can be categorized as degenerative or functional MR. Ring annuloplasty aims to reconfigure a dilated mitral annulus to its normal size and shape. We investigated the effect of annuloplasty ring shape on MR outcome using our established 3D echocardiography-based computational MV evaluation protocols. Virtual patient MV models were created from 3D transesophageal echocardiographic data in patients with MR due to mitral annular dilation. Two distinct annuloplasty rings (Physio II and GeoForm) were designed and virtually implanted to the patient MVs. Dynamic FE simulations of MV function were performed for each MV following virtual ring annuloplasty of either ring, and physiologic and biomechanical characteristics of MV function were compared. Excessive stress values appeared primarily in the mid-anterior and mid-posterior regions, and lack of leaflet coaptation was found in pre-annuloplasty patient MVs. Both rings demonstrated marked reduction of stresses and efficient leaflet coaptation. The Physio II ring demonstrated more evenly distributed stress reduction across the leaflets and annulus compared to the GeoForm ring. Conversely, the highly non-planar curvature of the GeoForm ring more effectively increased leaflet coaptation compared to the Physio II ring. This indicates that the shape of annuloplasty ring affects post-annuloplasty physiologic and biomechanical conditions, which can lead to tissue alteration over a longer period of time following ring annuloplasty. This virtual ring annuloplasty simulation strategy provides detailed physiologic and biomechanical information and may help better plan the optimal ring selection and improved patient-specific MV repairs.

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A comprehensive pipeline for multi‐resolution modeling of the mitral valve: Validation, computational efficiency, and predictive capability

Drach

Khalighi

Sacks

2017

Numer Methods Biomed Eng

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Multiple studies have demonstrated that the pathological geometries unique to each patient can affect the durability of mitral valve (MV) repairs. While computational modeling of the MV is a promising approach to improve the surgical outcomes, the complex MV geometry precludes use of simplified models. Moreover, the lack of complete in-vivo geometric information presents significant challenges in the development of patient-specific computational models. There is thus a need to determine the level of detail necessary for predictive MV models. To address this issue, we have developed a novel pipeline for building attribute-rich computational models of MV with varying fidelity directly from the in-vitro imaging data. The approach combines high-resolution geometric information from loaded and unloaded states to achieve a high level of anatomic detail, followed by mapping and parametric embedding of tissue attributes to build a high resolution, attribute-rich computational models. Subsequent lower resolution models were then developed, and evaluated by comparing the displacements and surface strains to those extracted from the imaging data. We then identified the critical levels of fidelity for building predictive MV models in the dilated and repaired states. We demonstrated that a model with a feature size of ~5 mm and mesh size of ~1 mm was sufficient to predict the overall MV shape, stress, and strain distributions with high accuracy. However, we also noted that more detailed models were found to be needed to simulate microstructural events. We conclude that the developed pipeline enables sufficiently complex models for biomechanical simulations of MV in normal, dilated, repaired states.

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

Cited by 32 publications

References 16 publications

On the effects of leaflet microstructure and constitutive model on the closing behavior of the mitral valve

On the effects of leaflet microstructure and constitutive model on the closing behavior of the mitral valve

Computational virtual evaluation of the effect of annuloplasty ring shape

A comprehensive pipeline for multi‐resolution modeling of the mitral valve: Validation, computational efficiency, and predictive capability

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