Is it possible to assess the best mitral valve repair in the individual patient? Preliminary results of a finite element study from magnetic resonance imaging data
| Autor: | Emiliano Votta, Alberto Redaelli, Francesco Sturla, Aldo Domenico Milano, Alessandro Mazzucco, Giuseppe Faggian, Giovanni Puppini, Marco Stevanella, Konstantinos Pechlivanidis, Francesco Onorati |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Mitral Valve Annuloplasty medicine.medical_treatment finite element analysis Cardiovascular Imaging Computer-Assisted Models Mitral valve Mitral valve annuloplasty 80 and over Mitral valve prolapse Polytetrafluoroethylene Aged 80 and over Heart Valve Prosthesis Implantation medicine.diagnostic_test Models Cardiovascular Biomechanics Anatomy Biomechanical Phenomena Treatment Outcome medicine.anatomical_structure Surgery Computer-Assisted Heart Valve Prosthesis patient-specific modeling Chordae Tendineae Mitral Valve Female Chordae tendineae Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine Stress Prosthesis Design artificial ePTFE neochordae mitral valve repair Imaging Three-Dimensional Magnetic resonance imaging Predictive Value of Tests Cardiac magnetic resonance imaging Image Interpretation Computer-Assisted medicine Humans Aged Finite Element Analysis Mitral Valve Prolapse Patient Selection Recovery of Function Stress Mechanical Computer Simulation Magnetic Resonance Imaging Surgery Image Interpretation Papillary muscle Mitral valve repair mitral valve prolapse business.industry Mechanical medicine.disease Three-Dimensional business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 148:1025-1034 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2014.05.071 |
| Popis: | Objectives Finite element modeling was adopted to quantitatively compare, for the first time and on a patient-specific basis, the biomechanical effects of a broad spectrum of different neochordal implantation techniques for the repair of isolated posterior mitral leaflet prolapse. Methods Cardiac magnetic resonance images were acquired from 4 patients undergoing surgery. A patient-specific 3-dimensional model of the mitral apparatus and the motion of the annulus and papillary muscles were reconstructed. The location and extent of the prolapsing region were confirmed by intraoperative findings, and the mechanical properties of the mitral leaflets, chordae tendineae and expanded polytetrafluoroethylene neochordae were included. Mitral systolic biomechanics was simulated under preoperative conditions and after 5 different neochordal procedures: single neochorda, double neochorda, standard neochordal loop with 3 neochordae of the same length and 2 premeasured loops with 1 common neochordal loop and 3 different branched neochordae arising from it, alternatively one third and two thirds of the entire length. Results The best repair in terms of biomechanics was achieved with a specific neochordal technique in the single patient, according to the location of the prolapsing region. However, all techniques achieved a slight reduction in papillary muscle forces and tension relief in intact native chordae proximal to the prolapsing region. Multiple neochordae implantation improved the repositioning of the prolapsing region below the annular plane and better redistributed mechanical stresses on the leaflet. Conclusions Although applied on a small cohort of patients, systematic biomechanical differences were noticed between neochordal techniques, potentially affecting their short- to long-term clinical outcomes. This study opens the way to patient-specific optimization of neochordal techniques. |
| Databáze: | OpenAIRE |
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