Mitral Regurgitation Due to Caseous Calcification of the Mitral Annulus

Tran, Donovan; Zuchowski, Colin

doi:10.7759/cureus.11402

Cited by 2 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mitral annulus calcification (MAC) is the deposition of calcified material around the mitral annulus leading to a reduced orifice area and stiffening of the surrounding tissue, which can lead to concomitant valvular involvement ( 1 ). This chronic disease is found in 10% of patients over the age 60 and 33% of those over 90 years ( 2 ), thus patients are often at very high risk for surgery.…”

Section: Introductionmentioning

confidence: 99%

Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification

Hill

Young

Prendergast

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

IntroductionTranscatheter mitral valve replacement is a promising alternative to open-heart surgery in elderly patients. Patients with severe mitral annulus calcification (MAC) are a particularly high-risk population, where postprocedural complications can have catastrophic effects. Amongst these, obstruction of the left ventricular outflow tract can lead to ventricular hypertrophic remodeling and subsequent heart failure, while subclinical valve thrombosis can result in early bioprosthetic valve failure.MethodsTo elucidate the mechanisms of left ventricular outflow tract obstruction and valve thrombosis following valve-in-MAC procedures, we used image processing and Computational Fluid Dynamics (CFD) software to generate patient- and device-specific models based on preprocedural CT data. Personalized computer simulations were performed to predict the left ventricular haemodynamics after implantation in three patients with severe MAC.ResultsThe simulations have successfully captured the increased pressure gradient in the left ventricular outflow tract as a result of the partial obstruction due to the implanted valve. Regions of wall shear stress above the threshold value for platelet activation were also observed on the bioprosthetic frame as a result of the reduced outflow tract area, which led to increases in flow resistance and blood residence time inside the ventricle. Consistent with these findings, areas of slow recirculating flow and blood stasis formed near the valve frame, creating potential pro-thrombotic conditions.DiscussionThis study provides insight into the relationship between size and shape of the outflow tract post-implantation, pressure gradients and pro-thrombotic flow metrics such as wall shear stress and blood residence time. Results show the potential of CFD modeling to bring key functional metrics into preprocedural assessment for a comprehensive evaluation of post-procedural risks beyond anatomical factors. Following further validation and extension to the atrial chamber, this approach can provide an in-depth analysis of the likelihood of valvular thrombosis.

show abstract

Section: Introductionmentioning

confidence: 99%

Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification

Hill

Young

Prendergast

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…This study is focussed on the replacement of the mitral valve for patients with Mitral Annular Calcification (MAC) known as Valve-in-MAC (ViMAC). In cases of MAC the soft mitral annulus becomes covered in a solid layer of calcium salts, reducing its flexibility and potentially causing paravalvular leakage (PVL) [3]. This solid layer also reduces the size of the annulus and TMVR devices are therefore too large, in this situation transcatheter aortic valves may be considered for the mitral position.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Transcatheter heart valve Migration and Embolization Risk Following Valve-in-MAC

Hill¹,

Young²,

Rajani³

et al. 2022

Computing in Cardiology Conference (CinC)

View full text Add to dashboard Cite

Transcatheter Valve Embolization and Migration (TVEM) is a rare, but catastrophic event where the prosthesis moves due to heamodynamic forces acting on the frame. TVEM following Transcatheter Mitral Valve Replacement (TMVR) is largely undocumented. Haemodynamic forces cannot be estimated during preprocedural planning and conventional imaging does not allow to compute them after replacement. To shed light on this issue, this study focusses on modelling haemodynamics after TMVR in 3 patients with Mitral Annular Calcification (MAC) known as Valve-in-MAC (ViMAC). Three-dimensional flow simulations are performed using the computational fluid dynamics (CFD) package STARCCM+. Results of the simulation are processed to compute the fluid forces acting on the device and pressure gradients in the left ventricular outflow tract (LVOT). Anatomical measurements are performed on CT data sets to assess the mitral valve size and shape, the extent and location of the calcification and the size of the LVOT after implantation. Our results show that the force distribution on the device is largely influenced by LVOT anatomy and contraction patterns.

show abstract

Mitral Regurgitation Due to Caseous Calcification of the Mitral Annulus

Cited by 2 publications

References 8 publications

Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification

Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification

Assessment of Transcatheter heart valve Migration and Embolization Risk Following Valve-in-MAC

Contact Info

Product

Resources

About