Measurement of mitral leaflet and annular geometry and stress after repair of posterior leaflet prolapse: Virtual repair using a patient-specific finite element simulation

Liang Ge, William G. Morrel, Alison Ward, Rakesh Mishra, Zhihong Zhang, Julius M. Guccione, Eugene A. Grossi, Mark B. Ratcliffe

Research output: Contribution to journalArticle

Abstract

Background Recurrent mitral regurgitation after mitral valve (MV) repair for degenerative disease occurs at a rate of 2.6% per year and reoperation rate progressively reaches 20% at 19.5 years. We believe that MV repair durability is related to initial postoperative leaflet and annular geometry with subsequent leaflet remodeling due to stress. We tested the hypothesis that MV leaflet and annular stress is increased after MV repair. Methods Magnetic resonance imaging was performed before and intraoperative three-dimensional (3D) transesophageal echocardiography was performed before and after repair of posterior leaflet prolapse in a single patient. The repair consisted of triangular resection and annuloplasty band placement. Images of the heart were manually co-registered. The left ventricle and MV were contoured, surfaced, and a 3D finite element (FE) model was created. Elements of the posterior leaflet region were removed to model leaflet resection and virtual sutures were used to repair the leaflet defect and attach the annuloplasty ring. Results The principal findings of the current study are the following: (1) FE simulation of MV repair is able to accurately predict changes in MV geometry including changes in annular dimensions and leaflet coaptation; (2) average posterior leaflet stress is increased; and (3) average anterior leaflet and annular stress are reduced after triangular resection and mitral annuloplasty. Conclusions We successfully conducted virtual mitral valve prolapse repair using FE modeling methods. Future studies will examine the effects of leaflet resection type as well as annuloplasty ring size and shape.

Original languageEnglish (US)
Pages (from-to)1496-1503
Number of pages8
JournalAnnals of Thoracic Surgery
Volume97
Issue number5
DOIs
StatePublished - May 2014
Externally publishedYes

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Prolapse
Mitral Valve
Mitral Valve Annuloplasty
Three-Dimensional Echocardiography
Mitral Valve Prolapse
Transesophageal Echocardiography
Mitral Valve Insufficiency
Reoperation
Sutures
Heart Ventricles
Magnetic Resonance Imaging

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Measurement of mitral leaflet and annular geometry and stress after repair of posterior leaflet prolapse : Virtual repair using a patient-specific finite element simulation. / Ge, Liang; Morrel, William G.; Ward, Alison; Mishra, Rakesh; Zhang, Zhihong; Guccione, Julius M.; Grossi, Eugene A.; Ratcliffe, Mark B.

In: Annals of Thoracic Surgery, Vol. 97, No. 5, 05.2014, p. 1496-1503.

Research output: Contribution to journalArticle

Ge, Liang ; Morrel, William G. ; Ward, Alison ; Mishra, Rakesh ; Zhang, Zhihong ; Guccione, Julius M. ; Grossi, Eugene A. ; Ratcliffe, Mark B. / Measurement of mitral leaflet and annular geometry and stress after repair of posterior leaflet prolapse : Virtual repair using a patient-specific finite element simulation. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 5. pp. 1496-1503.
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