Effects of different annuloplasty rings on anterior mitral leaflet dimensions

Bothe, Wolfgang; Kvitting, John‐Peder Escobar; Swanson, Julia C.; Hartnett, Sigurd; Ingels, Neil B.; Miller, D. Craig

doi:10.1016/j.jtcvs.2009.12.014

Cited by 38 publications

(36 citation statements)

References 20 publications

(20 reference statements)

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“…These results appear to be reasonable, taking the ring rigidity into account. Moreover, it has been reported that even a flexible band could not preserve any contraction in the AP and CC directions of the annulus postoperatively [8]. In our study, both saddle-shaped rings were also unable to preserve any annular dynamics.…”

Section: Commentcontrasting

confidence: 66%

“…According to those reports, maintaining or recovering the physiologic three-dimensional annular shape can reduce the leaflet strain and is important for the long-term valve function. However, it was reported that neither the anteroposterior nor the commissure-to-commissure dimensions change throughout the cardiac cycle after ring implantation with a saddle, flat, or even flexible ring in an acute animal model [8]. On the other hand, it was reported that only the annular folding dynamics were preserved by a flexible band [4].…”

mentioning

confidence: 99%

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Is Physiologic Annular Dynamics Preserved After Mitral Valve Repair With Rigid or Semirigid Ring?

Ryomoto

Mitsuno

Yamamura

et al. 2014

The Annals of Thoracic Surgery

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Section: Commentcontrasting

confidence: 66%

mentioning

confidence: 99%

Is Physiologic Annular Dynamics Preserved After Mitral Valve Repair With Rigid or Semirigid Ring?

Ryomoto

Mitsuno

Yamamura

et al. 2014

The Annals of Thoracic Surgery

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“…Displacements were imposed to the nodes on the annulus, whose original commissurecommissure diameter was of 45 mm, to adapt its shape to the profile of a 40 mm total rigid ring, representative of the most commonly implanted type of annular prostheses. 3 This ring had a D-shaped design, with the straight portion of the D corresponding to the anterior portion of the ring, an approximately 4:3 ratio between commissural and septo-lateral ring diameters, and a slightly non-planar profile. Nodal displacements were set assuming that the change in annular length was uniform in the intertrigonal tract of the annulus and in the posterior one.…”

Section: Boundary Conditionsmentioning

confidence: 99%

Mitral Valve Patient-Specific Finite Element Modeling from Cardiac MRI: Application to an Annuloplasty Procedure

Stevanella

Maffessanti

Conti

et al. 2011

Cardiovasc Eng Tech

102

121

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We aim at testing the possibility to build patientspecific structural finite element models (FEMs) of the mitral valve (MV) from cardiac magnetic resonance (CMR) imaging and to use them to predict the outcome of mitral annuloplasty procedures. MV FEMs were built for one healthy subject and for one patient with ischemic mitral regurgitation. On both subjects, CMR imaging of 18 longaxis planes was performed with a temporal resolution of 55 time-frames per cardiac cycle. Three-dimensional MV annulus geometry, leaflets surface and PM position were manually obtained using custom software. Hyperelastic anisotropic mechanical properties were assigned to MV tissues. A physiological pressure load was applied to the leaflets to simulate valve closure until peak systole. For the pathological model only, a further simulation was run, simulating undersized rigid annuloplasty before valve closure. Closure dynamics, leaflets stresses and tensions in the subvalvular apparatus in the healthy MV were consistent with previous computational and experimental data. The regurgitant valve model captured with good approximation the real size and position of regurgitant areas at peak systole, and highlighted abnormal tensions in the annular region and sub-valvular apparatus. The simulation of undersized rigid annuloplasty showed the restoration of MV continence and normal tensions in the subvalvular apparatus and at the annulus. Our method seems suitable for implementing detailed patient-specific MV FEMs to simulate different scenarios of clinical interest. Further work is mandatory to test the method more deeply, to reduce its computational time and to expand the range of modeled surgical procedures.

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“…1(d)). The D-shaped annulus and its dimensions were based on the nominal profile of a native MV [22,23,29,32]. For the Dshaped annulus, the flat portion was positioned such that it was proximal to the aorta, matching anatomical in vivo orientation.…”

Section: Mitral Annulus Geometriesmentioning

confidence: 99%

“…This nontraditional mitral PHV design is based on the assumption that mimicking the unaltered native MV annulus would be optimal for restoring normal cardiac function. In addition, majority of mitral annuloplasty rings employ D-shaped annulus geometry [27][28][29]. Most annuloplasty rings used in present day clinical procedures are designed considering structural factors, such as leaflet stress distribution during annulus interaction with the time-varying motion of the left heart complex, and eventual surgical selection is made based on matching with patient-specific anatomy and ease of positioning.…”

Section: Introductionmentioning

confidence: 99%

Role of Mitral Annulus Diastolic Geometry on Intraventricular Filling Dynamics

Okafor

Santhanakrishnan

Raghav

et al. 2015

Journal of Biomechanical Engineering

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The mitral valve (MV) is a bileaflet valve positioned between the left atrium and ventricle of the heart. The annulus of the MV has been observed to undergo geometric changes during the cardiac cycle, transforming from a saddle D-shape during systole to a flat (and less eccentric) D-shape during diastole. Prosthetic MV devices, including heart valves and annuloplasty rings, are designed based on these two configurations, with the circular design of some prosthetic heart valves (PHVs) being an approximation of the less eccentric, flat D-shape. Characterizing the effects of these geometrical variations on the filling efficiency of the left ventricle (LV) is required to understand why the flat D-shaped annulus is observed in the native MV during diastole in addition to optimizing the design of prosthetic devices. We hypothesize that the D-shaped annulus reduces energy loss during ventricular filling. An experimental left heart simulator (LHS) consisting of a flexible-walled LV physical model was used to characterize the filling efficiency of the two mitral annular geometries. The strength of the dominant vortical structure formed and the energy dissipation rate (EDR) of the measured fields, during the diastolic period of the cardiac cycle, were used as metrics to quantify the filling efficiency. Our results indicated that the O-shaped annulus generates a stronger (25% relative to the D-shaped annulus) vortical structure than that of the D-shaped annulus. It was also found that the O-shaped annulus resulted in higher EDR values throughout the diastolic period of the cardiac cycle. The results support the hypothesis that a D-shaped mitral annulus reduces dissipative energy losses in ventricular filling during diastole and in turn suggests that a symmetric stent design does not provide lower filling efficiency than an equivalent asymmetric design.

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Effects of different annuloplasty rings on anterior mitral leaflet dimensions

Cited by 38 publications

References 20 publications

Is Physiologic Annular Dynamics Preserved After Mitral Valve Repair With Rigid or Semirigid Ring?

Is Physiologic Annular Dynamics Preserved After Mitral Valve Repair With Rigid or Semirigid Ring?

Mitral Valve Patient-Specific Finite Element Modeling from Cardiac MRI: Application to an Annuloplasty Procedure

Role of Mitral Annulus Diastolic Geometry on Intraventricular Filling Dynamics

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