Virtual downsizing for decision support in mitral valve repair
- 74 Downloads
Various options are available for the treatment of mitral valve insufficiency, including reconstructive approaches such as annulus correction through ring implants. The correct choice of general therapy and implant is relevant for an optimal outcome. Additional to guidelines, decision support systems (DSS) can provide decision aid by means of virtual intervention planning and predictive simulations. Our approach on virtual downsizing is one of the virtual intervention tools that are part of the DSS workflow. It allows for emulating a ring implantation based on patient-specific lumen geometry and vendor-specific implants.
Our approach is fully automatic and relies on a lumen mask and an annulus contour as inputs. Both are acquired from previous DSS workflow steps. A virtual surface- and contour-based model of a vendor-specific ring design (26–40 mm) is generated. For each case, the ring geometry is positioned with respect to the original, patient-specific annulus and additional anatomical landmarks. The lumen mesh is parameterized to allow for a vertex-based deformation with respect to the user-defined annulus. Derived from post-interventional observations, specific deformation schemes are applied to atrium and ventricle and the lumen mesh is altered with respect to the ring location.
For quantitative evaluation, the surface distance between the deformed lumen mesh and segmented post-operative echo lumen close to the annulus was computed for 11 datasets. The results indicate a good agreement. An arbitrary subset of six datasets was used for a qualitative evaluation of the complete lumen. Two domain experts compared the deformed lumen mesh with post-interventional echo images. All deformations were deemed plausible.
Our approach on virtual downsizing allows for an automatic creation of plausible lumen deformations. As it takes only a few seconds to generate results, it can be added to a virtual intervention toolset without unnecessarily increasing the pipeline complexity.
KeywordsMitral valve insufficiency Annuloplasty Computer-aided treatment Virtual downsizing Geometric processing DSSMitral
This work is part of the BMBF VIP+ project DSSMitral (partially funded by the German Federal Ministry of Education and Research under Grant 03VP00852).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
- 1.Funkat A, Beckmann A, Lewandowski J, Frie M, Ernst M, Schiller W, Gummert JF, Cremer J (2014) Cardiac surgery in Germany during 2013: a report on behalf of the german society for thoracic and cardiovascular surgery. Thorac Cardiovasc Surg 62:380–392. https://doi.org/10.1055/s-0034-1383430 CrossRefGoogle Scholar
- 3.Mick SL, Keshavamurthy S, Gillinov AM (2015) Mitral valve repair versus replacement. Ann Cardiothorac Surg 4:230–237. https://doi.org/10.3978/j.issn.2225-319X.2015.03.01 Google Scholar
- 4.Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD (2014) AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol 63:57–185. https://doi.org/10.1016/j.jacc.2014.02.536 CrossRefGoogle Scholar
- 5.Sündermann SH, Czesla M, Kempfert J, Walther T, Nataf P, Raanani E, Jacobs S, Alfieri O, Maisano F, Falk V (2017) Results of mitral valve repair with an adjustable annuloplasty ring 2 years after implantation. Heart Vessels 32:843–849. https://doi.org/10.1007/s00380-016-0934-7 CrossRefGoogle Scholar
- 6.Glower DD (2012) Surgical approaches to mitral regurgitation. J Am Coll Cardiol 60:1315–1322, ISSN 0735-1097. https://doi.org/10.1016/j.jacc.2011.11.081
- 7.Mesana TG, Lam BK, Chan V, Chen K, Ruel M, Chan K (2013) Clinical evaluation of functional mitral stenosis after mitral valve repair for degenerative disease: potential effect on surgical strategy. J Thorac Cardiovasc Surg 146:1418–1425. https://doi.org/10.1016/j.jtcvs.2013.08.011 CrossRefGoogle Scholar
- 11.Mansi T, Voigt I, Georgescu B, Zheng C, Mengue EA, Hackl M, Ionasec RI, Noack T, Seeburger J, Comaniciu D (2012) An integrated framework for finite-element modeling of mitral valve biomechanics from medical images: application to MitralClip intervention planning. Med Image Anal 16:1330–1346. https://doi.org/10.1016/j.media.2012.05.009 CrossRefGoogle Scholar
- 14.Wong VM, Wenk JF, Zhang Z, Cheng G, Acevedo-Bolton G, Burger M, Saloner DA, Wallace AW, Guccione JM, Ratcliffe MB, Ge L (2012) The effect of mitral annuloplasty shape in ischemic mitral regurgitation: a finite element simulation. Ann Thorac Surg 93:776–782. https://doi.org/10.1016/j.athoracsur.2011.08.080 CrossRefGoogle Scholar
- 15.Ender J, Končar-Zeh J, Mukherjee C, Jacobs S, Borger MA, Viola C, Gessat M, Fassl J, Mohr FW, Falk V (2008) Value of augmented reality-enhanced transesophageal echocardiography (TEE) for determining optimal annuloplasty ring size during mitral valve repair. Ann Thorac Surg 86:1473–1478. https://doi.org/10.1016/j.athoracsur.2008.07.073 CrossRefGoogle Scholar
- 18.Stevanella M, Maffessanti F, Conti CA, Votta E, Arnoldi A, Lombardi M, Parodi O, Caiani EG, Redaelli A (2011) Mitral valve patient-specific finite element modeling from cardiac MRI: application to an annuloplasty procedure. Cardiovasc Eng Technol 2:66–76. https://doi.org/10.1007/s13239-010-0032-4 CrossRefGoogle Scholar
- 20.Augustin CM, Crozier A, Neic A, Prassl AJ, Karabelas E, Ferreira da Silva T, Fernandes JF, Campos F, Kuehne T, Plank G (2016) Patient-specific modeling of left ventricular electromechanics as a driver for haemodynamic analysis. EP Europace 18:121–129. https://doi.org/10.1093/europace/euw369 CrossRefGoogle Scholar
- 22.Mansi T, Durrleman S, Bernhardt B, Sermesant M, Delingette H, Voigt I, Lurz P, Taylor AM, Blanc J, Boudjemline Y, Pennec X, Ayache N (2009) A statistical model of right ventricle in tetralogy of Fallot for prediction of remodelling and therapy planning. Med Image Comput Comput Assist Interv 12(Pt 1):214–221Google Scholar
- 23.Mansi T, André B, Lynch M, Sermesant M, Delingette H, Boudjemline Y, Ayache N (2009) Virtual pulmonary valve replacement interventions with a personalised cardiac electromechanical model. In: Magnenat-Thalmann N, Zhang JJ, Feng DD (eds) Recent advances in the 3D physiological human. Springer, Heidelberg, pp 75–90. https://doi.org/10.1007/978-1-84882-565-9_5 CrossRefGoogle Scholar
- 27.Timek TA, Lai DT, Liang D, Tibayan F, Langer F, Rodriguez F, Daughters GT, Ingels NB, Miller DC (2004) Effects of paracommissural septal–lateral annular cinching on acute ischemic mitral regurgitation. Circulation 110:79–84. https://doi.org/10.1161/01.CIR.0000138975.05902.a5 CrossRefGoogle Scholar
- 29.Schroeder W, Martin K, Lorensen B (2004) The visualization toolkit: an object-oriented approach to 3d graphics. Academic Press, Cambridge. ISBN 978-0123-8758-22Google Scholar