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Towards Patient-Specific Mitral Valve Surgical Simulations

  • Amir H. Khalighi
  • Bruno V. Rego
  • Andrew Drach
  • Robert C. Gorman
  • Joseph H. Gorman
  • Michael S. SacksEmail author
Chapter

Abstract

Ischemic mitral regurgitation (IMR) occurs when a mitral valve (MV) is rendered incompetent by left ventricular (LV) remodeling induced by a myocardial infarction (MI). Hemodynamically significant, IMR affects at least 300,000 Americans. This important clinical problem is expected to grow substantially during the next 20 years as the population ages. MV repair with undersized ring annuloplasty has been the preferred treatment for IMR. However, 1/3 of all patients treated this way develop significant recurrent IMR within 6 months. Using real-time 3D echocardiography (rt-3DE) image analysis software, it has been demonstrated that IMR in humans is etiologically heterogeneous. In one subset of patients the predominant cause of IMR is annular dilatation and flattening; in the remaining patients, leaflet tethering is the dominant pathology. It has been demonstrated that recurrent IMR after ring annuloplasty occurs most commonly when leaflet tethering is the primary cause of IMR. There is now agreement that adjunctive procedures are required to treat IMR caused by leaflet tethering. However, there is no consensus regarding the best procedure. Multicenter registries and randomized trials would be necessary to prove which procedure is superior. Given the number of proposed procedures and the complexity and duration of such studies, it is highly unlikely that IMR procedure optimization will be achieved by prospective clinical trials. Novel computational approaches directed towards optimized surgical repair procedures can substantially reduce the need for such trial-and-error approaches. We thus present a state-of-the-art means to produce patient-specific MV computational models, which can directly utilize rt-3DE imaging data that can be used develop quantitatively optimized devices and procedures for MV repair.

Keywords

Mitral valve Ischemic mitral regurgitation Finite element modeling Image-based modeling Patient-specific model Chordae tendineae Surgical repair 

Notes

Acknowledgments

This work was supported by National Heart, Lung, and Blood Institute of the National Institutes of Health under grant no. R01-HL119297, the National Science Foundation grant no. DGE-1610403, and the American Heart Association grant no. 18PRE34030258.

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Amir H. Khalighi
    • 1
  • Bruno V. Rego
    • 1
  • Andrew Drach
    • 1
  • Robert C. Gorman
    • 2
  • Joseph H. Gorman
    • 2
  • Michael S. Sacks
    • 3
    Email author
  1. 1.James T. Willerson Center for Cardiovascular Modeling and SimulationInstitute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at AustinAustinUSA
  2. 2.Gorman Cardiovascular Research Group, Smilow Center for Translational Research, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.The Oden Institute and the Department of Biomedical EngineeringThe University of Texas at AustinAustinUSA

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