The objective of this study is to establish a mathematical characterization of the mitral valve annulus that allows a precise qualitative and quantitative assessment of annular dynamics in the beating heart. We define annular geometry through 16 miniature markers sewn onto the annuli of 55 sheep. Using biplane videofluoroscopy, we record marker coordinates in vivo. By approximating these 16 marker coordinates through piecewise cubic splines, we generate a smooth mathematical representation of the 55 mitral annuli. We time-align these 55 annulus representations with respect to characteristic hemodynamic time points to generate an averaged baseline annulus representation. To characterize annular physiology, we extract classical clinical metrics of annular form and function throughout the cardiac cycle. To characterize annular dynamics, we calculate displacements, strains, and curvature from the discrete mathematical representations. To illustrate potential future applications of this approach, we create rapid prototypes of the averaged mitral annulus at characteristic hemodynamic time points. In summary, this study introduces a novel mathematical model that allows us to identify temporal, regional, and inter-subject variations of clinical and mechanical metrics that characterize mitral annular form and function. Ultimately, this model can serve as a valuable tool to optimize both surgical and interventional approaches that aim at restoring mitral valve competence.
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We thank Paul Chang, Eleazar P. Briones, Lauren R. Davis, and Kathy N. Vo for technical assistance, Maggie Brophy and Sigurd Hartnett for careful marker image digitization, and George T. Daughters III for computation of 4D data from biplane 2D marker coordinates. This work was supported in part by the US National Science Foundation grant CAREER award CMMI-0952021 to Ellen Kuhl, by US National Institutes of Health grants R01 HL29589 and R01 HL67025 to D. Craig Miller, by the Deutsche Herzstiftung, Frankfurt, Germany, Research Grant S/06/07 to Wolfgang Bothe, by the U.S.- Norway Fulbright Foundation, the Swedish Heart-Lung Foundation, and the Swedish Society for Medical Research to John-Peder Escobar Kvitting, and by the Western States Affiliate American Heart Association Fellowship to Julia C. Swanson.
Associate Editor Jane Grande-Allen oversaw the review of this article.
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Rausch, M.K., Bothe, W., Kvitting, JP.E. et al. Characterization of Mitral Valve Annular Dynamics in the Beating Heart. Ann Biomed Eng 39, 1690–1702 (2011). https://doi.org/10.1007/s10439-011-0272-y
- Mitral regurgitation
- Mitral valve