Virtual ring annuloplasty and papillary muscle relocation improved leaflet coaptation and decreased posterior mitral leaflet stress in a patient-specific functional mitral regurgitation model.
Does ring annuloplasty combined with papillary muscle relocation improve mitral valve biomechanics in a patient-specific computational model of functional mitral regurgitation?
Patient-specific computational modeling demonstrates that adding papillary muscle relocation to ring annuloplasty improves leaflet coaptation and reduces leaflet stress in functional mitral regurgitation.
OBJECTIVES: Functional mitral regurgitation (FMR) is a significant complication of left ventricle (LV) dysfunction associated with poor prognosis and commonly treated by undersized ring annuloplasty. This study aimed to quantitatively simulate the treatment outcomes and mitral valve (MV) biomechanics following ring annulopalsty and papillary muscle relocation (PMR) procedures for a FMR patient. METHODS: We utilized a validated finite element model of the left heart for a patient with severe FMR and LV dilation from our previous study and simulated virtual ring annuloplasty procedures with various sizes of Edwards Classic and GeoForm annuloplasty rings. The model included detailed geometries of the left ventricle, mitral valve, and chordae tendineae, and incorporated age- and gender- matched nonlinear, anisotropic hyperelastic tissue material properties, and simulated chordal tethering at diastole due to LV dilation. RESULTS: Ring annuloplasty with either the Classic or GeoForm ring improved leaflet coaptation and increased the total leaflet closing force while increased posterior mitral leaflet (PML) stresses and strains. Classic rings resulted in larger coaptation forces and areas compared to GeoForm rings. The PMR procedure further improved the leaflet coaptation, decreased the PML stress and strain for both ring shapes and all sizes in this patient model. CONCLUSIONS: This study demonstrated that a rigorously developed patient-specific computational model can provide useful insights into annuloplasty repair techniques for the treatment of FMR patients and could potentially serve as a tool to assist in pre-operative planning for MV repair surgical or interventional procedures.
Kong et al. (Thu,) conducted a other in Functional mitral regurgitation (n=1). Virtual ring annuloplasty and papillary muscle relocation was evaluated on Leaflet coaptation, total leaflet closing force, and posterior mitral leaflet stresses and strains. Virtual ring annuloplasty and papillary muscle relocation improved leaflet coaptation and decreased posterior mitral leaflet stress in a patient-specific functional mitral regurgitation model.