Liang Ge1, William G Morrel2, Alison Ward3, Rakesh Mishra4, Zhihong Zhang5, Julius M Guccione6, Eugene A Grossi3, Mark B Ratcliffe7. 1. Department of Surgery, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California. 2. School of Medicine, University of California, San Francisco, California. 3. Department of Cardiothoracic Surgery, New York School of Medicine, New York, New York. 4. Department of Medicine, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California. 5. Veterans Affairs Medical Center, San Francisco, California. 6. Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California. 7. Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California. Electronic address: mark.ratcliffe@va.gov.
Abstract
BACKGROUND: Recurrent mitral regurgitation after mitral valve (MV) repair for degenerative disease occurs at a rate of 2.6% per year and reoperation rate progressively reaches 20% at 19.5 years. We believe that MV repair durability is related to initial postoperative leaflet and annular geometry with subsequent leaflet remodeling due to stress. We tested the hypothesis that MV leaflet and annular stress is increased after MV repair. METHODS: Magnetic resonance imaging was performed before and intraoperative three-dimensional (3D) transesophageal echocardiography was performed before and after repair of posterior leaflet prolapse in a single patient. The repair consisted of triangular resection and annuloplasty band placement. Images of the heart were manually co-registered. The left ventricle and MV were contoured, surfaced, and a 3D finite element (FE) model was created. Elements of the posterior leaflet region were removed to model leaflet resection and virtual sutures were used to repair the leaflet defect and attach the annuloplasty ring. RESULTS: The principal findings of the current study are the following: (1) FE simulation of MV repair is able to accurately predict changes in MV geometry including changes in annular dimensions and leaflet coaptation; (2) average posterior leaflet stress is increased; and (3) average anterior leaflet and annular stress are reduced after triangular resection and mitral annuloplasty. CONCLUSIONS: We successfully conducted virtual mitral valve prolapse repair using FE modeling methods. Future studies will examine the effects of leaflet resection type as well as annuloplasty ring size and shape.
BACKGROUND: Recurrent mitral regurgitation after mitral valve (MV) repair for degenerative disease occurs at a rate of 2.6% per year and reoperation rate progressively reaches 20% at 19.5 years. We believe that MV repair durability is related to initial postoperative leaflet and annular geometry with subsequent leaflet remodeling due to stress. We tested the hypothesis that MV leaflet and annular stress is increased after MV repair. METHODS: Magnetic resonance imaging was performed before and intraoperative three-dimensional (3D) transesophageal echocardiography was performed before and after repair of posterior leaflet prolapse in a single patient. The repair consisted of triangular resection and annuloplasty band placement. Images of the heart were manually co-registered. The left ventricle and MV were contoured, surfaced, and a 3D finite element (FE) model was created. Elements of the posterior leaflet region were removed to model leaflet resection and virtual sutures were used to repair the leaflet defect and attach the annuloplasty ring. RESULTS: The principal findings of the current study are the following: (1) FE simulation of MV repair is able to accurately predict changes in MV geometry including changes in annular dimensions and leaflet coaptation; (2) average posterior leaflet stress is increased; and (3) average anterior leaflet and annular stress are reduced after triangular resection and mitral annuloplasty. CONCLUSIONS: We successfully conducted virtual mitral valve prolapse repair using FE modeling methods. Future studies will examine the effects of leaflet resection type as well as annuloplasty ring size and shape.
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