Key result
Finite element analysis demonstrated that an annuloplasty ring with moderate annular reduction (10-25%) alone may be sufficient to achieve proper coaptation in a patient with Barlow's disease.
Why the study?
Standard annuloplasty causes marked annular reduction often requiring leaflet resection, prompting evaluation of whether moderate annular reduction can achieve sufficient coaptation in Barlow disease.
Does simulated annuloplasty with moderate annular reduction (10-25%) improve coaptation area in a patient-specific finite element model of Barlow's disease?
Does simulated annuloplasty with moderate annular reduction (10-25%) improve coaptation area in a patient-specific finite element model of Barlow's disease?
In silico finite element modeling suggests that moderate annuloplasty ring reduction (10-25%) may be sufficient to achieve proper leaflet coaptation in Barlow's disease, potentially avoiding the need for the standard 55% reduction.
May support less aggressive annuloplasty in Barlow's disease; hypothesis-generating and should not yet change practice.
Barlow's Disease affects the entire mitral valve apparatus causing mitral regurgitation. Standard annuloplasty procedures lead to an average of 55% annular area reduction of the end diastolic pre-operative annular area in Barlow's diseased valves. Following annular reduction, mitral valvuloplasty may be needed, usually with special focus on the posterior leaflet. An in silico pipeline to perform annuloplasty by utilizing the pre- and -postoperative 3D echocardiographic recordings was developed. Our objective was to test the hypothesis that annuloplasty ring sizes based on a percentage (10%-25%) decrease of the pre-operative annular area at end diastole can result in sufficient coaptation area for the selected Barlow's diseased patient. The patient specific mitral valve geometry and finite element model were created from echocardiography recordings. The post-operative echocardiography was used to obtain the artificial ring geometry and displacements, and the motion of the papillary muscles after surgery. These were used as boundary conditions in our annuloplasty finite element analyses. Then, the segmented annuloplasty ring was scaled up to represent a 10%, 20% and 25% reduction of the pre-operative end diastolic annular area and implanted to the end diastolic pre-operative finite element model. The pre-operative contact area decrease was shown to be dependent on the annular dilation at late systole. Constraining the mitral valve from dilating excessively can be sufficient to achieve proper coaptation throughout systole. The finite element analyses show that the selected Barlow's diseased patient may benefit from an annuloplasty ring with moderate annular reduction alone.
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Aguilera et al. (2022) studied Barlow's disease (n=1). Annuloplasty ring sizes based on 10%-25% reduction of pre-operative end diastolic annular area vs. Standard annuloplasty (55% reduction) or pre-operative state was evaluated on Coaptation area throughout systole. Finite element analysis demonstrated that an annuloplasty ring with moderate annular reduction (10-25%) alone may be sufficient to achieve proper coaptation in a patient with Barlow's disease.
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