Skip to main content
SpringerLink
Log in
Book cover

International Symposium on Computer Methods in Biomechanics and Biomedical Engineering

CMBBE 2019: Computer Methods, Imaging and Visualization in Biomechanics and Biomedical Engineering pp 24–35Cite as

Hypertrophic Cardiomyopathy Treatment – A Numerical Study

  • Conference paper
  • First Online:

Part of the book series: Lecture Notes in Computational Vision and Biomechanics ((LNCVB,volume 36))

Abstract

Considered the leading cause of sudden cardiac death (SCD) in athletes, Hypertrophic Cardiomyopathy (HCM) is diagnosed in up to one of 200 people of the general population, regardless of prior medical condition. A common complication of HCM is Hypertrophic Obstructive Cardiomyopathy (HOCM). This complication is characterized by the obstructive motion of the anterior mitral leaflet causing mitral regurgitation, compromising systolic left ventricular (LV) reduced ejection fraction, and may lead to a significant outflow pressure gradients (>30 mmHg). Common treatment for HCM patients is medication, managing the symptoms. However, this treatment impairs the patient’s quality of life restricting their daily activities. Some patients who are unresponsive to medication are prone to highly invasive surgery: myectomy or ablation, exposing them to high mortality and morbidity rates. Our research is aimed at offering a new minimally invasive approach to the treatment of HOCM patients, utilizing a percutaneous device placed in the LV which locally modifies the wall structure and mitral orientation, thus reducing the outflow pressure gradient. In this study we prove the concept using numerical simulations. Models of healthy, pathological and treated LV are used as geometry for computational fluid dynamics (CFD) simulations of the time-dependent flow in the LV. The results analyses show that the suggested procedure may dramatically reduce the pressure gradients during systole and allow better flow during diastole, advising on the improvement of the current treatment and feasibility of the recommended device.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kramer, C.M., et al.: Hypertrophic cardiomyopathy registry (HCMR). Am. Heart J. 170(2), 223–230 (2015)

    Article  Google Scholar 

  2. McIlvennan, C.K., Eapen, Z.J., Allen, L.: Hospital readmissions reduction program. Circulation 131(20), 1796–1803 (2016). HHS Public Access

    Article  Google Scholar 

  3. Maron, B.J., et al.: The 50-year history, controversy, and clinical implications of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy: from idiopathic hypertrophic subaortic stenosis to hypertrophic cardiomyopathy. J. Am. Coll. Cardiol. 54(3), 191–200 (2009)

    Article  Google Scholar 

  4. Leviner, D.B., Hochhauser, E., Arad, M.: Inherited cardiomyopathies - novel therapies. Pharmacol. Ther. 155, 36–48 (2015)

    Article  Google Scholar 

  5. Gersh, B.J., et al.: 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: Executive summary. J. Thorac. Cardiovasc. Surg. 142(6), 1303–1338 (2011)

    Article  Google Scholar 

  6. Sherrid, M.V., Balaram, S., Kim, B., Axel, L., Swistel, D.G.: The mitral valve in obstructive hypertrophic cardiomyopathy a test in context. J. Am. Coll. Cardiol. 67(15), 1846–1858 (2016)

    Article  Google Scholar 

  7. Nishimura, R.A., Seggewiss, H., Schaff, H.V.: Hypertrophic obstructive cardiomyopathy: surgical myectomy and septal ablation. Circ. Res. 121(7), 771–783 (2017)

    Article  Google Scholar 

  8. Ferrazzi, P., et al.: Transaortic chordal cutting mitral valve repair for obstructive hypertrophic cardiomyopathy with mild septal hypertrophy. J. Am. Coll. Cardiol. 66(15), 1687–1696 (2015)

    Article  Google Scholar 

  9. Hazan, O., et al.: An innovative appendage invagination procedure to reduce thrombus formation–a numerical model. Comput. Methods Biomech. Biomed. Eng. 21(4), 370–378 (2018)

    Article  Google Scholar 

  10. Brand, M., Avrahami, I., Einav, S., Ryvkin, M.: Numerical models of net-structure stents inserted into arteries. Comput. Biol. Med. 52, 102–110 (2014)

    Article  Google Scholar 

  11. Van Slochteren, F.J., et al.: Left ventricular PV loop estimation using 3D echo. Internal report BMTE 07.42, Eindhoven University of Technology (2007)

    Google Scholar 

  12. Hagège, A.A., et al.: The mitral valve in hypertrophic cardiomyopathy. J. Cardiovasc. Transl. Res. 4(6), 757–766 (2011)

    Article  Google Scholar 

  13. Maron, B.J., et al.: Systolic anterior motion of the posterior mitral leaflet: a previously unrecognized cause of dynamic subaortic obstruction in patients with hypertrophic cardiomyopathy. Circulation 68(2), 282–293 (1983)

    Article  Google Scholar 

  14. Su, B., et al.: Cardiac MRI based numerical modeling of left ventricular fluid dynamics with mitral valve incorporated. J. Biomech. 49(7), 1199–1205 (2016)

    Article  Google Scholar 

  15. Tang, D., et al.: Image-based patient-specific ventricle models with fluid–structure interaction for cardiac function assessment and surgical design optimization. Prog. Pediatr. Cardiol. 30(1–2), 51–62 (2010)

    Article  Google Scholar 

  16. Bavo, A.M., et al.: Patient-specific CFD simulation of intraventricular haemodynamics based on 3D ultrasound imaging. Biomed. Eng. Online 15, 1–15 (2016). Article number. 107

    Google Scholar 

  17. Chnafa, C., Mendez, S., Nicoud, F.: Image-based simulations show important flow fluctuations in a normal left ventricle: what could be the implications? Ann. Biomed. Eng. 44(11), 3346–3358 (2016)

    Article  Google Scholar 

  18. Khalafvand, S.S., et al.: Assessment of human left ventricle flow using statistical shape modelling and computational fluid dynamics. J. Biomech. 74, 116–125 (2018)

    Article  Google Scholar 

  19. Humphrey, J.D.: Continuum mechanics. In: Cardiovascular Solid Mechanics, pp. 68–106. Springer, New York (2002)‏

    Google Scholar 

  20. Sacks, M.S., Chuong, C.J.: Biaxial mechanical properties of passive right ventricular free wall myocardium. J. Biomech. Eng. 115(2), 202–205 (1993)

    Article  Google Scholar 

  21. Fung, Y.C.: Biomechanics: Mechanical Properties of Living Tissues. Springer, New York (1993)

    Book  Google Scholar 

  22. Bluestein, D., Einav, S.: Techniques in the stability analysis of pulsatile flow through heart valves. In: Leondes, C. (ed.) Cardiovascular Techniques, Biomechanical Systems Techniques and Applications. CRC Press, Boca Raton (2001)

    Google Scholar 

  23. Avrahami, I., Rosenfeld, M., Raz, S., Einav, S.: Numerical model of flow in a sac-type ventricular assist device. Artif. Organs 30(7), 529–538 (2006)

    Article  Google Scholar 

Download references

Acknowledgements

The research was supported by the Ariel grant for advancing women in academia.

Author information

Authors and Affiliations

  1. Ariel University, 40700, Ariel, Israel

    Asaph Nardi, Guy Bar, Naama Retzabi, Michael Firer & Idit Avrahami

Authors
  1. Asaph Nardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guy Bar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naama Retzabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Firer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Idit Avrahami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Idit Avrahami .

Editor information

Editors and Affiliations

  1. Andrew Walz Professor of Mechanical Engineering and Professor of Biomedical Engineering, Columbia University, New York, NY, USA

    Gerard A. Ateshian

  2. Department of Mechanical Engineering, Columbia University, New York, NY, USA

    Kristin M. Myers

  3. Department of Mechanical Engineering, University of Porto, Porto, Portugal

    João Manuel R. S. Tavares

Rights and permissions

Reprints and permissions

Copyright information

© 2020 The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Nardi, A., Bar, G., Retzabi, N., Firer, M., Avrahami, I. (2020). Hypertrophic Cardiomyopathy Treatment – A Numerical Study. In: Ateshian, G., Myers, K., Tavares, J. (eds) Computer Methods, Imaging and Visualization in Biomechanics and Biomedical Engineering. CMBBE 2019. Lecture Notes in Computational Vision and Biomechanics, vol 36. Springer, Cham. https://doi.org/10.1007/978-3-030-43195-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-43195-2_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43194-5

  • Online ISBN: 978-3-030-43195-2

  • eBook Packages: EngineeringEngineering (R0)

Publish with us

Policies and ethics

Search

Navigation