Semi-automated mitral valve morphometry and computational stress analysis using 3D ultrasound

Pouch, Alison M.; Chun, Xu; Yushkevich, Paul A.; Jassar, Arminder S.; Vergnat, Mathieu; Gorman, Joseph H.; Gorman, Robert C.; Sehgal, Chandra M.; Jackson, Benjamin M.

doi:10.1016/j.jbiomech.2011.11.033

Cited by 42 publications

(36 citation statements)

References 25 publications

(31 reference statements)

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“…It raises the possibility that the MMR annuli are congenitally enlarged and flat, and these annular distortions maybe the primary cause of the MMR. Annular flattening and enlargement has been shown to decrease leaflet curvature resulting in increased leaflet stress [2, 3, 16] and strain [17, 18], which in MMR annuli over time, may cause myxomatous tissue degeneration, chordal rupture and MR. A recent study by Lee et.al. supports this theory [19].…”

Section: Commentmentioning

confidence: 99%

Regional Annular Geometry in Patients With Mitral Regurgitation: Implications for Annuloplasty Ring Selection

Jassar

Vergnat

Jackson

et al. 2014

The Annals of Thoracic Surgery

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Background The saddle shape of the normal mitral annulus has been quantitatively described by several groups. There is strong evidence that this shape is important to valve function. A more complete understanding of regional annular geometry in diseased valves may provide a more educated approach to annuloplasty ring selection and design. We hypothesized that mitral annular shape is markedly distorted in patients with diseased valves. Methods Real-time 3-dimensional echocardiography was performed in patients with normal mitral valves (n=20), ischemic mitral regurgitation (IMR, n=10) and myxomatous mitral regurgitation (MMR, n=20). Thirty-six annular points were defined to generate a 3D model of the annulus. Regional annular parameters were measured from these renderings. Left ventricular inner diameter (LVIDd) was obtained from 2D echocardiographic images. Results Annular geometry was significantly different between the three groups. The annuli were larger in the MMR and the IMR groups. The annular enlargement was greater and more pervasive in the MMR. Both diseases were associated with annular flattening though the regional distribution of that flattening was different between groups. LVIDd was increased in both groups. However, relative to the LVIDd, the annulus was disproportionately dilated in the MMR group. Conclusion Patients with MMR and IMR have enlarged and flattened annuli. In the case of MMR, annular distortions may be the driving factor leading to valve incompetence. These data suggest that the goal of annuloplasty should be the restoration of normal annular saddle shape and that the use of flexible, partial and flat rings may be ill advised.

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Section: Commentmentioning

confidence: 99%

Regional Annular Geometry in Patients With Mitral Regurgitation: Implications for Annuloplasty Ring Selection

Jassar

Vergnat

Jackson

et al. 2014

The Annals of Thoracic Surgery

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“…They can simulate the behavior and physiological activity of the body, and thus enable valuable insights for diagnosis and therapy. For instance, soft tissue deformations and a body's stress behavior, caused by forces and momentums acting on the body in the context of surgical manipulation, can be estimated by means of an elasticity simulation [2] .…”

Section: Description Of Purposementioning

confidence: 99%

Integration of a biomechanical simulation for mitral valve reconstruction into a knowledge-based surgery assistance system

et al. 2015

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A mitral valve reconstruction (MVR) is a complex operation in which the functionality of incompetent mitral valves is re-established by applying surgical techniques. This work deals with predictive biomechanical simulations of operation scenarios for an MVR, and the simulation's integration into a knowledge-based surgery assistance system.We present a framework for the definition of the corresponding surgical workflow, which combines semantically enriched surgical expert knowledge with a biomechanical simulation. Using an ontology, 'surgical rules' which describe decision and assessment criteria for surgical decision-making are represented in a knowledge base. Through reasoning these 'rules' can then be applied on patient-specific data in order to be converted into boundary conditions for the biomechanical soft tissue simulation, which is based on the Finite Elements Method (FEM). The simulation, which is implemented in the open-source C++ FEM software HiFlow 3 , is controlled via the Medical Simulation Markup Language (MSML), and makes use of High Performance Computing (HPC) methods to cope with real-time requirements in surgery.The simulation results are presented to surgeons to assess the quality of the virtual reconstruction and the consequential remedial effects on the mitral valve and its functionality. The whole setup has the potential to support the intraoperative decision-making process during MVR where the surgeon usually has to make fundamental decision under time pressure.

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“…21,69,79 Our group and others have developed algorithms to extract MV geometry from 3D transesophageal echocardiographic (TEE) data, create a patient-specific computational MV model, and perform FE simulations of MV function. 65,76,78,89,92 …”

Section: D Echocardiography For Patient-specific Mv Imagingmentioning

confidence: 99%

“…44 This group also performed in-vivo MV modeling and stress analysis using their semi-automated 3D image processing and modeling system incorporated. 69,100 Mansi et al presented an integrated framework for volumetric FE modeling of the MV apparatus, performed a sensitivity analysis, and evaluated MV function in 25 patients. 65 Our group developed a novel algorithm for MV modeling including segmentation of the MV apparatus geometry and patient-specific annular motion over the cardiac cycle.…”

Section: Patient-specific 3d MV Modeling and Analysismentioning

confidence: 99%

Computational Mitral Valve Evaluation and Potential Clinical Applications

Chandran

Kim

2014

Ann Biomed Eng

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The mitral valve (MV) apparatus consists of the two asymmetric leaflets, the saddle-shaped annulus, the chordae tendineae, and the papillary muscles. MV function over the cardiac cycle involves complex interaction between the MV apparatus components for efficient blood circulation. Common diseases of the MV include valvular stenosis, regurgitation, and prolapse. MV repair is the most popular and most reliable surgical treatment for early MV pathology. One of the unsolved problems in MV repair is to predict the optimal repair strategy for each patient. Although experimental studies have provided valuable information to improve repair techniques, computational simulations are increasingly playing an important role in understanding the complex MV dynamics, particularly with the availability of patient-specific real-time imaging modalities. This work presents a review of computational simulation studies of MV function employing finite element (FE) structural analysis and fluid-structure interaction (FSI) approach reported in the literature to date. More recent studies towards potential applications of computational simulation approaches in the assessment of valvular repair techniques and potential pre-surgical planning of repair strategies are also discussed. It is anticipated that further advancements in computational techniques combined with the next generations of clinical imaging modalities will enable physiologically more realistic simulations. Such advancement in imaging and computation will allow for patient-specific, disease-specific, and case-specific MV evaluation and virtual prediction of MV repair.

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Semi-automated mitral valve morphometry and computational stress analysis using 3D ultrasound

Cited by 42 publications

References 25 publications

Regional Annular Geometry in Patients With Mitral Regurgitation: Implications for Annuloplasty Ring Selection

Regional Annular Geometry in Patients With Mitral Regurgitation: Implications for Annuloplasty Ring Selection

Integration of a biomechanical simulation for mitral valve reconstruction into a knowledge-based surgery assistance system

Computational Mitral Valve Evaluation and Potential Clinical Applications

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