Effect of leaflet-to-chordae contact interaction on computational mitral valve evaluation

BioMedical Engineering OnLine

Yonghoon Rim¹  David D McPherson¹  Hyunggun Kim¹ 

[1] Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA

关键词: Echocardiography;    Coaptation;    Contact interaction;    Finite element;    Mitral valve;   

Others  :  795088
DOI  :  10.1186/1475-925X-13-31

 received in 2013-12-18, accepted in 2014-03-17,  发布年份 2014

【 摘 要 】

Background

Computational simulation using numerical analysis methods can help to assess the complex biomechanical and functional characteristics of the mitral valve (MV) apparatus. It is important to correctly determine physical contact interaction between the MV apparatus components during computational MV evaluation. We hypothesize that leaflet-to-chordae contact interaction plays an important role in computational MV evaluation, specifically in quantitating the degree of leaflet coaptation directly related to the severity of mitral regurgitation (MR). In this study, we have performed dynamic finite element simulations of MV function with and without leaflet-to-chordae contact interaction, and determined the effect of leaflet-to-chordae contact interaction on the computational MV evaluation.

Methods

Computational virtual MV models were created using the MV geometric data in a patient with normal MV without MR and another with pathologic MV with MR obtained from 3D echocardiography. Computational MV simulation with full contact interaction was specified to incorporate entire physically available contact interactions between the leaflets and chordae tendineae. Computational MV simulation without leaflet-to-chordae contact interaction was specified by defining the anterior and posterior leaflets as the only contact inclusion.

Results

Without leaflet-to-chordae contact interaction, the computational MV simulations demonstrated physically unrealistic contact interactions between the leaflets and chordae. With leaflet-to-chordae contact interaction, the anterior marginal chordae retained the proper contact with the posterior leaflet during the entire systole. The size of the non-contact region in the simulation with leaflet-to-chordae contact interaction was much larger than for the simulation with only leaflet-to-leaflet contact.

Conclusions

We have successfully demonstrated the effect of leaflet-to-chordae contact interaction on determining leaflet coaptation in computational dynamic MV evaluation. We found that physically realistic contact interactions between the leaflets and chordae should be considered to accurately quantitate leaflet coaptation for MV simulation. Computational evaluation of MV function that allows precise quantitation of leaflet coaptation has great potential to better quantitate the severity of MR.

【 授权许可】

   
2014 Rim et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Ho SY: Anatomy of the mitral valve. Heart 2002, 88(Suppl 4):v5-v10.
• [2]Silbiger JJ, Bazaz R: Contemporary insights into the functional anatomy of the mitral valve. Am Heart J 2009, 158(6):887-895.
• [3]Turi ZG: Cardiology patient page: mitral valve disease. Circulation 2004, 109(6):e38-e41.
• [4]Muresian H, Diena M, Cerin G, Filipoiu F: The mitral valve: new insights into the clinical anatomy. J Clin Med 2006, 1(4):80-87.
• [5]Fabricius AM, Walther T, Falk V, Mohr FW: Three-dimensional echocardiography for planning of mitral valve surgery: current applicability? Ann Thorac Surg 2004, 78(2):575-578.
• [6]Hung J, Lang R, Flachskampf F, Shernan SK, McCulloch ML, Adams DB, Thomas J, Vannan M, Ryan T: 3D echocardiography: a review of the current status and future directions. J Am Soc Echocardiogr 2007, 20(3):213-233.
• [7]Aupart MR, Babuty DG, Guesnier L, Meurisse YA, Sirinelli AL, Marchand MA: Double valve replacement with the Carpentier-Edwards pericardial valve: 10-year results. J Heart Valve Dis 1996, 5(3):312-316.
• [8]Prot V, Haaverstad R, Skallerud B: Finite element analysis of the mitral apparatus: annulus shape effect and chordal force distribution. Biomech Model Mechanobiol 2009, 8(1):43-55.
• [9]Sacks MS: The biomechanical effects of fatigue on the porcine bioprosthetic heart valve. J Long Term Eff Med Implants 2001, 11(3–4):231-247.
• [10]Sacks MS, Schoen FJ: Collagen fiber disruption occurs independent of calcification in clinically explanted bioprosthetic heart valves. J Biomed Mater Res 2002, 62(3):359-371.
• [11]Chandran KB: Role of computational simulations in heart valve dynamics and design of valvular prostheses. Cardiovasc Eng Technol 2010, 1(1):18-38.
• [12]Kim H, Chandran KB, Sacks MS, Lu J: An experimentally derived stress resultant shell model for heart valve dynamic simulations. Ann Biomed Eng 2007, 35(1):30-44.
• [13]Kim H, Lu J, Sacks MS, Chandran KB: Dynamic simulation pericardial bioprosthetic heart valve function. J Biomech Eng 2006, 128(5):717-724.
• [14]Kim H, Lu J, Sacks MS, Chandran KB: Dynamic simulation of bioprosthetic heart valves using a stress resultant shell model. Ann Biomed Eng 2008, 36(2):262-275.
• [15]Kunzelman KS, Cochran RP: Stress/strain characteristics of porcine mitral valve tissue: parallel versus perpendicular collagen orientation. J Card Surg 1992, 7(1):71-78.
• [16]Kunzelman KS, Quick DW, Cochran RP: Altered collagen concentration in mitral valve leaflets: biochemical and finite element analysis. Ann Thorac Surg 1998, 66(6 Suppl):S198-S205.
• [17]Rim Y, Laing ST, Kee P, McPherson DD, Kim H: Evaluation of mitral valve dynamics. J Am Coll Cardiol Img 2013, 6(2):263-268.
• [18]Rim Y, McPherson DD, Chandran KB, Kim H: The effect of patient-specific annular motion on dynamic simulation of mitral valve function. J Biomech 2013, 46(6):1104-1112.
• [19]Prot V, Skallerud B, Sommer G, Holzapfel GA: On modelling and analysis of healthy and pathological human mitral valves: two case studies. J Mech Behav Biomed Mater 2010, 3(2):167-177.
• [20]Stevanella M, Votta E, Redaelli A: Mitral valve finite element modeling: implications of tissues’ nonlinear response and annular motion. J Biomech Eng 2009, 131(12):121010.
• [21]Votta E, Maisano F, Bolling SF, Alfieri O, Montevecchi FM, Redaelli A: The Geoform disease-specific annuloplasty system: a finite element study. Ann Thorac Surg 2007, 84(1):92-101.
• [22]May-Newman K, Yin FC: A constitutive law for mitral valve tissue. J Biomech Eng 1998, 120(1):38-47.
• [23]May-Newman K, Yin FC: Biaxial mechanical behavior of excised porcine mitral valve leaflets. Am J Physiol 1995, 269(4 Pt 2):H1319-H1327.
• [24]Abaqus 6.11 documentation [ http://abaqus.me.chalmers.se/v6.11/books/usi/usi-link.htm webcite]
• [25]Stefancu A, Melenciuc S, Budescu M: Penalty based algorithms for frictional contact problems. Bulletin of the Polytechnic Inst of Iasi - Construction & A 2011, 61(3):119-129.
• [26]Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ, American Society of Echocardiography: Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003, 16(7):777-802.
• [27]Votta E, Le TB, Stevanella M, Fusini L, Caiani EG, Redaelli A, Sotiropoulos F: Toward patient-specific simulations of cardiac valves: state-of-the-art and future directions. J Biomech 2013, 46(2):217-228.
• [28]Wang Q, Sun W: Finite element modeling of mitral valve dynamic deformation using patient-specific multi-slices computed tomography scans. Ann Biomed Eng 2013, 41(1):142-153.
• [29]Xu C, Jassar AS, Nathan DP, Eperjesi TJ, Brinster CJ, Levack MM, Vergnat M, Gorman RC, Gorman JH 3rd, Jackson BM: Augmented mitral valve leaflet area decreases leaflet stress: a finite element simulation. Ann Thorac Surg 2012, 93(4):1141-1145.