Dynamic, patient-specific mitral valve modelling for planning transcatheter repairs
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Transcatheter, beating heart repair techniques for mitral valve regurgitation is a very active area of development. However, it is difficult to both simulate and predict the clinical outcomes of mitral repairs, owing to the complexity of mitral valve geometry and the influence of hemodynamics. We aim to produce a workflow for manufacturing dynamic patient-specific models to simulate the mitral valve for transcatheter repair applications.
In this paper, we present technology and associated workflow, for using transesophageal echocardiography to generate dynamic physical replicas of patient valves. We validate our workflow using six patient datasets representing patients with unique or particularly challenging pathologies as selected by a cardiologist. The dynamic component of the models and their resultant potential as procedure planning tools is due to a dynamic pulse duplicator that permits the evaluation of the valve models experiencing realistic hemodynamics.
Early results indicate the workflow has excellent anatomical accuracy and the ability to replicate regurgitation pathologies, as shown by colour Doppler ultrasound and anatomical measurements comparing patients and models. Analysis of all measurements successfully resulted in t critical two-tail > t stat and p values > 0.05, thus demonstrating no statistical difference between the patients and models, owing to high fidelity morphological replication.
Due to the combination of a dynamic environment and patient-specific modelling, this workflow demonstrates a promising technology for simulating the complete morphology of mitral valves undergoing transcatheter repairs.
KeywordsModelling Mitral valve Mitral valve models Surgical simulation Transcatheter devices 3D printing
The authors would like to thank Paul Picot and Kevin Barker for help in the design and construction of the MVS pulse duplicator, Nora Boone for help in its validation and Dave Ly for help in computer-aided design (CAD) software work. Funding: This study was funded by the Academic Medical Organization of Southwestern Ontario, as well as by the Canadian Foundation for Innovation (20994), the Ontario Research Fund (IDCD), and the Canadian Institutes for Health Research (FDN 201409).
Compliance with ethical standards
Conflict of interest
John Moore and Terry Peters are co-owners of Archetype Medical, developers of the MVS pulse duplicator. The other authors declare no conflicts of interest.
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