A workflow for patient-specific fluid–structure interaction analysis of the mitral valve: A proof of concept on a mitral regurgitation case

Abstract

The mechanics of the mitral valve (MV) are the result of the interaction of different anatomical structures complexly arranged within the left heart (LH), with the blood flow. MV structure abnormalities might cause valve regurgitation which in turn can lead to heart failure. Patient-specific computational models of the MV could provide a personalised understanding of MV mechanics, dysfunctions and possible interventions. In this study, we propose a semi-automatic pipeline for MV modelling based on the integration of state-of-the-art medical imaging, i.e. cardiac magnetic resonance (CMR) and 3D transoesophagealechocardiogram (TOE) with fluid-structure interaction (FSI) simulations. An FSI model of a patient with MV regurgitation was implemented using the finite element (FE) method and smoothed particle hydrodynamics (SPH). Our study showed the feasibility of combining image information and computer simulations to reproduce patient-specific MV mechanics as seen on medical images, and the potential for efficient in-silico studies of MV disease, personalised treatments and device design.

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

“…with a moving boundary in an attempt to quantify blood flow (local hemodynamics) inside the LV, but none of these studies considered LV tissue thickness or other tissue characteristics 40,59,62,64,66,[132][133][134][135][136] . In addition, several researchers have recently used FSI as a promising tool for computational cardiology because it allows for the complete coupling of the heart wall and blood flow mechanics, thus demonstrating its worth as the most comprehensive tool for numerical modeling of the LV 60,[137][138][139][140][141][142][143][144][145][146][147][148][149][150][151][152][153][154] . However, since: (1) patient-specific boundary conditions were not used; (2) normal valves and ventricles were modeled instead of those with C3VD; and (3) patient-specific geometries were not used, the models developed in these studies didn't satisfy the three requirements outlined in the Introduction 60,[137][138][139][140][141][142][143][144][145][146][147][148]…”

“…However, since: (1) patient-specific boundary conditions were not used; (2) normal valves and ventricles were modeled instead of those with C3VD; and (3) patient-specific geometries were not used, the models developed in these studies didn't satisfy the three requirements outlined in the Introduction 60,[137][138][139][140][141][142][143][144][145][146][147][148][149][150][151][152][153][154] . While some models were partially validated using DE 145,152 or MRI 60 , many were not validated. Five of the studies 60,74,137,143,147 did impose boundary conditions on the calculations by coupling fluid-structure modeling calculations with lumped-parameter modeling, but the lumped-parameter models were either not patient-specific and/or they required information from MRI.…”

A toolbox for generating scalable mitral valve morphometric models

“…Besides, current in vivo imaging modalities are unable to properly capture the chordae and the PM (Gao et al, 2017b), and therefore our mathematical representation and distribution of the same is based on such assumptions. This, however, does not differ from computational studies employing average mitral leaflet geometries (Choi et al, 2016, Alleau et al, 2019 and even patient-specific (Gao et al, 2017a, Biffi et al, 2019 ones, since patient-specific chordal distributions are very difficult to obtain.…”

“…Computational studies have focused on diseased MV shapes (Caballero et al, 2019, Biffi et al, 2019, Aguilera et al, 2021 and surgical procedures (Choi et al, 2020, Kong et al, 2018, either using structure-only finite element (FE) analysis (which allows to study leaflet stress patterns), or fluid-structure interaction (FSI) simulations (which accounts for the interaction between blood flow and the structure of the valve). The accuracy of these models is sensitive to valve geometry; however, even though several MV models from the literature are based on patient-specific geometries obtained from medical imaging, the associated generation process can be time consuming and computationally expensive, especially when employing numerical mesh-based approaches (Zhang et al, 2019).…”

Fluid–Structure Interaction Analyses of Biological Systems Using Smoothed-Particle Hydrodynamics

“…The SPH method was demonstrated and validated in several articles on mitral valve closure [30,[40][41][42]. Subsequently, it was used to assess several diseased mitral valve states [43][44][45][46] and applications of medical devices designed to correct them [47][48][49][50]. Besides the mitral valve, other valves have been studied using the same methods [42,[51][52][53][54][55].…”