Key result
In a computational human cardiac function simulator, a novel annuloplasty ring with a sub-valvular element corrected simulated ischemic mitral regurgitation and increased peak average chordae force to 116% of healthy levels.
Why the study?
Does a novel annuloplasty ring with a sub-valvular element correct ischemic mitral regurgitation in a computational human heart model?
Does a novel annuloplasty ring with a sub-valvular element correct ischemic mitral regurgitation in a computational human heart model?
A novel annuloplasty ring with a sub-valvular element successfully corrected ischemic mitral regurgitation in a highly detailed computational human heart model, supporting its potential for clinical translation.
No immediate clinical implications; leaves open translation of simulated benefits to patients.
Ischemic mitral regurgitation is associated with substantial risk of death. We sought to: (1) detail significant recent improvements to the Dassault Systèmes human cardiac function simulator (HCFS); (2) use the HCFS to simulate normal cardiac function as well as pathologic function in the setting of posterior left ventricular (LV) papillary muscle infarction; and (3) debut our novel device for correction of ischemic mitral regurgitation. We synthesized two recent studies of human myocardial mechanics. The first study presented the robust and integrative finite element HCFS. Its primary limitation was its poor diastolic performance with an LV ejection fraction below 20% caused by overly stiff ex vivo porcine tissue parameters. The second study derived improved diastolic myocardial material parameters using in vivo MRI data from five normal human subjects. We combined these models to simulate ischemic mitral regurgitation by computationally infarcting an LV region including the posterior papillary muscle. Contact between our novel device and the mitral valve apparatus was simulated using Dassault Systèmes SIMULIA software. Incorporating improved cardiac geometry and diastolic myocardial material properties in the HCFS resulted in a realistic LV ejection fraction of 55%. Simulating infarction of posterior papillary muscle caused regurgitant mitral valve mechanics. Implementation of our novel device corrected valve dysfunction. Improvements in the current study to the HCFS permit increasingly accurate study of myocardial mechanics. The first application of this simulator to abnormal human cardiac function suggests that our novel annuloplasty ring with a sub-valvular element will correct ischemic mitral regurgitation.
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Baillargeon et al. (2015) studied Ischemic mitral regurgitation. Novel annuloplasty ring with a sub-valvular element vs. Simulated infarcted left ventricle (untreated) was evaluated on Mitral valve coaptation and chordae force. In a computational human cardiac function simulator, a novel annuloplasty ring with a sub-valvular element corrected simulated ischemic mitral regurgitation and increased peak average chordae force to 116% of healthy levels.
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