Three-Dimensional Ultrasound-Derived Physical Mitral Valve Modeling

Witschey, Walter R.; Pouch, Alison M.; McGarvey, Jeremy R.; Ikeuchi, Kaori; Contijoch, Francisco; Levack, Melissa M.; Yushkevick, Paul A.; Sehgal, Chandra M.; Jackson, Benjamin M.; Gorman, Robert C.; Gorman, Joseph H.

doi:10.1016/j.athoracsur.2014.04.094

Cited by 65 publications

(43 citation statements)

References 10 publications

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“…For the former, we note that it has been extensively validated and known to produce accurate results when compared to the manual segmentation (Jassar et al, 2014; Pouch et al, 2015b; Pouch et al, 2013; Witschey et al, 2014). For the later, we have extensively validated the method against gold-standard in-vitro data with accuracies to ±0.2 mm (Aggarwal et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

In-vivo heterogeneous functional and residual strains in human aortic valve leaflets

Aggarwal

Pouch

Lai

et al. 2016

Journal of Biomechanics

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Residual and physiological functional strains in soft tissues are known to play an important role in modulating organ stress distributions. Yet, no known comprehensive information on residual strains exist, or non-invasive techniques to quantify in-vivo deformations for the aortic valve (AV) leaflets. Herein we present a completely non-invasive approach for determining heterogeneous strains – both functional and residual – in semilunar valves and apply it to normal human AV leaflets. Transesophageal 3D echocardiographic (3DE) images of the AV were acquired from open-heart transplant patients, with each AV leaflet excised after heart explant and then imaged in a flattened configuration ex-vivo. Using an established spline parameterization of both 3DE segmentations and digitized ex-vivo images (Aggarwal et al., 2014), surface strains were calculated for deformation between the ex-vivo and three in-vivo configurations: fully open, just-coapted, and fully-loaded. Results indicated that leaflet area increased by an average of 20% from the ex-vivo to in-vivo open states, with a highly heterogeneous strain field. The increase in area from open to just-coapted state was the highest at an average of 25%, while that from just-coapted to fully-loaded remained almost unaltered. Going from the ex-vivo to in-vivo mid-systole configurations, the leaflet area near the basal attachment shrank slightly, whereas the free edge expanded by ~10%. This was accompanied by a 10° −20° shear along the circumferential-radial direction. Moreover, the principal stretches aligned approximately with the circumferential and radial directions for all cases, with the highest stretch being along the radial direction. Collectively, these results indicated that even though the AV did not support any measurable pressure gradient in the just-coapted state, the leaflets were significantly pre-strained with respect to the excised state. Furthermore, the collagen fibers of the leaflet were almost fully recruited in the just-coapted state, making the leaflet very stiff with marginal deformation under full pressure. Lastly, the deformation was always higher in the radial direction and lower along the circumferential one, the latter direction made stiffer by the preferential alignment of collagen fibers. These results provide significant insight into the distribution of residual strains and the in-vivo strains encountered during valve opening and closing in AV leaflets, and will form an important component of the tool that can evaluate valve's functional properties in a non-invasive manner.

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Section: Discussionmentioning

confidence: 99%

In-vivo heterogeneous functional and residual strains in human aortic valve leaflets

Aggarwal

Pouch

Lai

et al. 2016

Journal of Biomechanics

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“…Historically, x-ray fluoroscopy has been used as the primary imaging modality during catheter-based in- Another imaging-driven technology that will likely have a substantial impact for simulations in catheterization laboratories is the field of 3D bioprinting (10)(11)(12). In 3D bioprinting, layer-by-layer precise positioning of biological materials, with spatial control of the placement of functional components, can be used to fabricate 3D structures.…”

Section: Choice Of Imaging For Procedural Guidancementioning

confidence: 99%

The Symphony, the Ensemble, and the Interventional Imager…

Sengupta

Chandrashekhar

Narula

2015

JACC: Cardiovascular Imaging

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“…Early 3D printing efforts of the mitral valve apparatus have primarily used TEE [26, 60, 61]. The mitral valve apparatus is exquisitely complex including the left atrial and ventricular wall, the annulus, the leaflets, the chordae tendineae and the papillary muscles.…”

Section: Cardiovascular Applicationsmentioning

confidence: 99%

“…Mahmood et al reported specialized commercial TEE software to segment the mitral annulus [26] and subsequently the leaflets [62]. Witschey et al [61], similarly printed models of mitral valves of normal and ischemic mitral regurgitation and myxomatous degeneration from 3D TEE images using a semi-automated segmentation method (Figure 10). The mitral annulus could be printed in 30 min and the entire valve within 90 min, with the bulk likely expended on the printing time.…”

Section: Cardiovascular Applicationsmentioning

confidence: 99%

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Cardiothoracic Applications of 3-dimensional Printing

Giannopoulos

Steigner

George

et al. 2016

Journal of Thoracic Imaging

142

108

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Summary Medical 3D printing is emerging as a clinically relevant imaging tool in directing preoperative and intraoperative planning in many surgical specialties and will therefore likely lead to interdisciplinary collaboration between engineers, radiologists, and surgeons. Data from standard imaging modalities such as CT, MRI, echocardiography and rotational angiography can be used to fabricate life-sized models of human anatomy and pathology, as well as patient-specific implants and surgical guides. Cardiovascular 3D printed models can improve diagnosis and allow for advanced pre-operative planning. The majority of applications reported involve congenital heart diseases, valvular and great vessels pathologies. Printed models are suitable for planning both surgical and minimally invasive procedures. Added value has been reported toward improving outcomes, minimizing peri-operative risk, and developing new procedures such as transcatheter mitral valve replacements. Similarly, thoracic surgeons are using 3D printing to assess invasion of vital structures by tumors and to assist in diagnosis and treatment of upper and lower airway diseases. Anatomic models enable surgeons to assimilate information more quickly than image review, choose the optimal surgical approach, and achieve surgery in a shorter time. Patient-specific 3D-printed implants are beginning to appear and may have significant impact on cosmetic and life-saving procedures in the future. In summary, cardiothoracic 3D printing is rapidly evolving and may be a potential game-changer for surgeons. The imager who is equipped with the tools to apply this new imaging science to cardiothoracic care is thus ideally positioned to innovate in this new emerging imaging modality.

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Three-Dimensional Ultrasound-Derived Physical Mitral Valve Modeling

Cited by 65 publications

References 10 publications

In-vivo heterogeneous functional and residual strains in human aortic valve leaflets

In-vivo heterogeneous functional and residual strains in human aortic valve leaflets

The Symphony, the Ensemble, and the Interventional Imager…

Cardiothoracic Applications of 3-dimensional Printing

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