Modeling Patient-Specific Deformable Mitral Valves

Ginty, Olivia K.; Moore, John; Peters, Terry M.; Bainbridge, Daniel

doi:10.1053/j.jvca.2017.09.005

Cited by 15 publications

(12 citation statements)

References 15 publications

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“…This will require a comprehensive re-assessment of the currently used soft materials with regard to their suitability for mimicking realistic valve functions. However, it is worth mentioning that Ginty et al [6] used the same soft material in their dynamic valve simulator. In-vitro cardiac tissue models are becoming increasingly important [12], but are still out of reach to be employed for surgical training.…”

Section: Discussionmentioning

confidence: 99%

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Flexible and comprehensive patient-specific mitral valve silicone models with chordae tendineae made from 3D-printable molds

et al. 2019

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Purpose Given the multitude of challenges surgeons face during mitral valve repair surgery, they should have a high confidence in handling of instruments and in the application of surgical techniques before they enter the operating room. Unfortunately, opportunities for surgical training of minimally-invasive repair are very limited, leading to a situation where most surgeons undergo a steep learning curve while operating the first patients.Methods In order to provide a realistic tool for surgical training, a commercial simulator was augmented by flexible patient-specific mitral valve replica. In an elaborated production pipeline, finalized after many optimization cycles, models were segmented from 3D ultrasound and then 3D-printable molds were computed automatically and printed in rigid material, the lower part being water-soluble. After silicone injection, the silicone model was dissolved from the mold and anchored in the simulator.Results To our knowledge, our models are the first to comprise the full mitral valve apparatus, i.e. the annulus, leaflets, chordae tendineae and papillary muscles. Nine different valve molds were automatically created according to the proposed workflow (seven prolapsed valves and two valves with functional mitral insufficiency). From these mold geometries, 16 replica were manufactured. A material test revealed that Ecoflex TM 00-30 is the most suitable material for leaflet-mimicking tissue out of seven mixtures. Production time was around 36h per valve.Twelve surgeons performed various surgical techniques,

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Section: Discussionmentioning

confidence: 99%

“…We use it as main material for printing of the lower shell, which is dissolved in water after silicone injection. We decided to use silicone early on, as other groups have made good experiences with it [6,14] and it is relatively easy to handle. Different silicone mixtures exist (e.g.…”

Section: D-printing and Silicone Injectionmentioning

confidence: 99%

Flexible and comprehensive patient-specific mitral valve silicone models with chordae tendineae made from 3D-printable molds

et al. 2019

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“…Recent developments in the assessment of MR with potential future value include (I) the 'average pixel intensity' (API) method (92), a novel digital quantification of the CW pixel intensity in grading MR severity; (II) 4D-flow CMR (93), which allows correction for MV motion; (III) real-time 3D TOE-based 4-dimensional MV models (94), which allow excellent morphological visualization and a comprehensive quantitative analysis of MV annulus and leaflets during the entire cardiac cycle; and (IV) 3D printing of MV (95,96), where the anatomy of a patient-specific MV can be accurately modeled to improve pre-operative planning of complex surgical interventions.…”

Section: Future Directionsmentioning

confidence: 99%

Multimodality imaging for the quantitative assessment of mitral regurgitation

Chew

Bounford

Plein

et al. 2018

Quant. Imaging Med. Surg.

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The natural history of mitral regurgitation (MR) results in significant morbidity and mortality. Innovations in non-invasive imaging have provided new insights into the pathophysiology and quantification of MR, in addition to early detection of left ventricular (LV) dysfunction and prognostic assessment in asymptomatic patients. Transthoracic (TTE) and transesophageal (TOE) echocardiography are the mainstay for diagnosis, assessment and serial surveillance. However, the advance from 2D to 3D imaging leads to improved assessment and characterization of mitral valve (MV) disease. Cardiovascular magnetic resonance (CMR) is increasingly used for MR quantitation and can provide an alternative imaging method if echocardiography is suboptimal or inconclusive. Other techniques such as exercise echocardiography, tissue Doppler imaging and speckle-tracking echocardiography can further offer complementary information on prognosis. This review summarises the current evidence for state-of-the-art cardiovascular imaging for the investigation of MR. Whilst advanced echocardiographic techniques are superior in the evaluation of complex MV anatomy, CMR appears the most accurate technique for the quantification of MR severity. Integration of multimodality imaging for the assessment of MR utilises the advantages of each imaging technique and offers the most comprehensive assessment of MR.

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“…We aim to develop a segmentation method that can be applied to both normal and highly diseased valves, to extract patient-specific leaflet geometry. Our focus is on delineating the leaflet surfaces for the purpose of creating molds for our related patient-specific MV modelling project, where silicone is applied to the molds to create valves for use in surgical training and planning [5]. To accomplish this, we propose a semi-automatic segmentation method based on active contours that iterates using a user-in-the-loop strategy.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, there is a need for patient-specific models that can permit the training and procedure-planning of patient-specific repairs to minimize its learning curve and preventable errors [4,6]. Previous work has demonstrated the potential for patient-specific valve modelling for both surgical training as well as preoperatively predicting surgical outcomes [5]. The cause of mitral regurgitation varies across patients, as any failure of these structures can render the valve inefficient.…”

Section: Introductionmentioning

confidence: 99%

Interactive-Automatic Segmentation and Modelling of the Mitral Valve

Carnahan

Ginty

Moore

et al. 2019

Functional Imaging and Modeling of the Heart

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Mitral valve regurgitation is the most common valvular disease, affecting 10% of the population over 75 years old. Left untreated, patients with mitral valve regurgitation can suffer declining cardiac health until cardiac failure and death. Mitral valve repair is generally preferred over valve replacement. However, there is a direct correlation between the volume of cases performed and surgical outcomes, therefore there is a demand for the ability of surgeons to practice repairs on patient specific models in advance of surgery. This work demonstrates a semi-automated segmentation method to enable fast and accurate modelling of the mitral valve that captures patient-specific valve geometry. This modelling approach utilizes 3D active contours in a user-in-the-loop system which segments first the atrial blood pool, then the mitral leaflets. In a group of 15 mitral valve repair patients, valve segmentation and modelling attains an overall accuracy (mean absolute surface distance) of 1.40 ± 0.26 mm, and an accuracy of 1.01 ± 0.13 mm when only comparing the extracted leaflet surface proximal to the ultrasound probe. Thus this image-based segmentation tool has the potential to improve the workflow for extracting patient-specific mitral valve geometry for 3D modelling of the valve.

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Modeling Patient-Specific Deformable Mitral Valves

Cited by 15 publications

References 15 publications

Flexible and comprehensive patient-specific mitral valve silicone models with chordae tendineae made from 3D-printable molds

Flexible and comprehensive patient-specific mitral valve silicone models with chordae tendineae made from 3D-printable molds

Multimodality imaging for the quantitative assessment of mitral regurgitation

Interactive-Automatic Segmentation and Modelling of the Mitral Valve

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