Mitral Valve Repair vs. Replacement: Hemodynamics in Valve Surgery

Fig. 1.. Diagram of the mitral valve anatomy. (A) Dark area: The mitral valve leaflets and their divisions. The anterior leaflet A1 is close to the anterolateral commissure (L); A2: The middle part of the leaflet; A3: Close to the posteromedial commissure (R); The posterior leaflet corresponds to the divisions P1, P2, and P3 of the anterior leaflet. Light area: The valve annulus (B) An anatomical diagram of a normal mitral valve (chordae tendineae and papillary muscles) observed from the left ventricular anterior-lateral incision.

Fig. 2.. Comparison of main hemodynamic parameters after mitral valve repair and replacement surgery.

Fig. 3.. Comparative analysis of left ventricular hemodynamic under different physiological and pathological conditions. The study simulated six different valve states and presented the morphologies of the valve contraction and relaxation phases in each state. The flow direction is indicated by white arrows, and the size of the vortices is represented by colors. The center of the vortex is indicated by a red star. The lines in the figure represent distances, and the scale is marked as “1 centimeter” with annotations. Healthy,bioprosthetic valve; Mecha-para (parallel to the natural valve), mechanical valve; Mecha-vertical, mechanical valve (perpendicular to the natural valve); TEER, transcatheter edge-to-edge mitral valve repair; MRF, mitral valve fraction; LVOT, left ventricular outflow tract. Image from “Impact of mitral valve interventions on left ventricular hemodynamics: Insights into energy loss and flow dynamics” Reproduced with permission from Feng et al. [30].

Fig. 4.. Comparison of the distribution of left ventricular diastolic blood flow during healthy conditions and mitral valve regurgitation. These images were obtained through 4D flow MRI using particle tracking. In the healthy left ventricle (LV) (a), the main part of the blood flow follows a smooth path from the left atrium to the aorta, while below the mitral valve there is a reverse-rotating vortex. In contrast, in the case of mitral valve regurgitation (b), a larger proportion of the circulating blood flows outward from the left ventricular outflow tract and several vortices are scattered around the left ventricle. The black arrows indicate the path and direction of the main flow part and the flow direction of the vortex part. LA, left atrium; LV, left ventricle; Ao, Aorta. (Reproduced with permission from Al-Wakeel N, Fernandes JF, Amiri A, Siniawski H, Goubergrits L, Berger F, et al; published by Journal of Magnetic Resonance Imaging : JMRI. 2015; 42: 1705–1712. Image from “Hemodynamic and energetic aspects of the left ventricle in patients with mitral regurgitation before and after mitral valve surgery” [80]).