The Effect of Mitral Annuloplasty Shape in Ischemic Mitral Regurgitation: a Finite Element Simulation

Overview

Journal Ann Thorac Surg

Publisher Elsevier

Specialties General Surgery
Pulmonary Medicine

Date 2012 Jan 17

PMID 22245588

Citations 33

Authors

Vincent M Wong

Jonathan F Wenk

Zhihong Zhang

Guangming Cheng

Gabriel Acevedo-Bolton

Mike Burger

David A Saloner

Arthur W Wallace

Julius M Guccione

Mark B Ratcliffe

Liang Ge

Affiliations

Soon will be listed here.

Abstract

Background: Undersized mitral annuloplasty (MA) is the preferred surgical treatment for chronic ischemic mitral regurgitation. However, the preferred shape of undersized MA is unclear.

Methods: A previously described finite element model of the left ventricle with mitral valve based on magnetic resonance images of a sheep with chronic ischemic mitral regurgitation after posterolateral myocardial infarction was used. Saddle-shape (Edwards Physio II) and asymmetric (IMR ETlogix) MA rings were digitized and meshed. Virtual annuloplasty was performed using virtual sutures to attach the MA ring. Left ventricular diastole and systole were performed before and after virtual MA of each type.

Results: Both types of MA reduced the septolateral dimension of the mitral annulus and abolished mitral regurgitation. The asymmetric MA was associated with lower virtual suture force in the P2 region but higher force in P1 and P3 regions. Although both types of MA reduced fiber stress at the left ventricular base, fiber stress reduction after asymmetric MA was slightly greater. Neither type of MA affected fiber stress at the left ventricular equator or apex. Although both types of MA increased leaflet curvature and reduced leaflet stress, stress reduction with saddle-shape MA was slightly greater. Both MA types reduced stress on the mitral chordae.

Conclusions: The effects of saddle-shape and asymmetric MA rings are similar. Finite element simulations are a powerful tool that may reduce the need for animal and clinical trials.

Citing Articles

Guidelines for mechanistic modeling and analysis in cardiovascular research.

Colebank M, Oomen P, Witzenburg C, Grosberg A, Beard D, Husmeier D Am J Physiol Heart Circ Physiol. 2024; 327(2):H473-H503.

PMID: 38904851 PMC: 11442102. DOI: 10.1152/ajpheart.00766.2023.

Simulated Effects of Acute Left Ventricular Myocardial Infarction on Mitral Regurgitation in an Ovine Model.

Liu H, Sacks M, Simonian N, Gorman 3rd J, Gorman R J Biomech Eng. 2024; 146(10).

PMID: 38652602 PMC: 11225881. DOI: 10.1115/1.4065376.

A Computational Pipeline for Patient-Specific Prediction of the Postoperative Mitral Valve Functional State.

Liu H, Simonian N, Pouch A, Iaizzo P, Gorman J, Gorman R J Biomech Eng. 2023; 145(11).

PMID: 37382900 PMC: 10405284. DOI: 10.1115/1.4062849.

Computational Modeling of the Subject-Specific Effects of Annuloplasty Ring Sizing on the Mitral Valve to Repair Functional Mitral Regurgitation.

Gaidulis G, Padala M Ann Biomed Eng. 2023; 51(9):1984-2000.

PMID: 37344691 PMC: 10826925. DOI: 10.1007/s10439-023-03219-9.

Utilization of Engineering Advances for Detailed Biomechanical Characterization of the Mitral-Ventricular Relationship to Optimize Repair Strategies: A Comprehensive Review.

van Kampen A, Morningstar J, Goudot G, Ingels N, Wenk J, Nagata Y Bioengineering (Basel). 2023; 10(5).

PMID: 37237671 PMC: 10215167. DOI: 10.3390/bioengineering10050601.

References

Cheng A, Nguyen T, Malinowski M, Liang D, Daughters G, Ingels Jr N . Effects of undersized mitral annuloplasty on regional transmural left ventricular wall strains and wall thickening mechanisms. Circulation. 2006; 114(1 Suppl):I600-9. DOI: 10.1161/CIRCULATIONAHA.105.001529. View

Kunzelman K, Quick D, Cochran R . Altered collagen concentration in mitral valve leaflets: biochemical and finite element analysis. Ann Thorac Surg. 1999; 66(6 Suppl):S198-205. DOI: 10.1016/s0003-4975(98)01106-0. View

Zhang Z, Tendulkar A, Sun K, Saloner D, Wallace A, Ge L . Comparison of the Young-Laplace law and finite element based calculation of ventricular wall stress: implications for postinfarct and surgical ventricular remodeling. Ann Thorac Surg. 2010; 91(1):150-6. PMC: 3058250. DOI: 10.1016/j.athoracsur.2010.06.132. View

Tibayan F, Rodriguez F, Langer F, Zasio M, Bailey L, Liang D . Annular remodeling in chronic ischemic mitral regurgitation: ring selection implications. Ann Thorac Surg. 2003; 76(5):1549-54. DOI: 10.1016/s0003-4975(03)00880-4. View

Gorman R, McCaughan J, Ratcliffe M, Gupta K, Streicher J, Ferrari V . Pathogenesis of acute ischemic mitral regurgitation in three dimensions. J Thorac Cardiovasc Surg. 1995; 109(4):684-93. DOI: 10.1016/S0022-5223(95)70349-7. View

Votta E, Maisano F, Bolling S, Alfieri O, Montevecchi F, Redaelli A . The Geoform disease-specific annuloplasty system: a finite element study. Ann Thorac Surg. 2007; 84(1):92-101. DOI: 10.1016/j.athoracsur.2007.03.040. View

Senyo S, Koshman Y, Russell B . Stimulus interval, rate and direction differentially regulate phosphorylation for mechanotransduction in neonatal cardiac myocytes. FEBS Lett. 2007; 581(22):4241-7. PMC: 2031013. DOI: 10.1016/j.febslet.2007.07.070. View

Grossman W, Jones D, McLaurin L . Wall stress and patterns of hypertrophy in the human left ventricle. J Clin Invest. 1975; 56(1):56-64. PMC: 436555. DOI: 10.1172/JCI108079. View

Gopalan S, Flaim C, Bhatia S, Hoshijima M, Knoell R, Chien K . Anisotropic stretch-induced hypertrophy in neonatal ventricular myocytes micropatterned on deformable elastomers. Biotechnol Bioeng. 2003; 81(5):578-87. DOI: 10.1002/bit.10506. View

10.

Gillinov A, Wierup P, Blackstone E, Bishay E, Cosgrove D, White J . Is repair preferable to replacement for ischemic mitral regurgitation?. J Thorac Cardiovasc Surg. 2001; 122(6):1125-41. DOI: 10.1067/mtc.2001.116557. View

11.

Wenk J, Zhang Z, Cheng G, Malhotra D, Acevedo-Bolton G, Burger M . First finite element model of the left ventricle with mitral valve: insights into ischemic mitral regurgitation. Ann Thorac Surg. 2010; 89(5):1546-53. PMC: 2887313. DOI: 10.1016/j.athoracsur.2010.02.036. View

12.

Kwan J, Shiota T, Agler D, Popovic Z, Qin J, Gillinov M . Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study. Circulation. 2003; 107(8):1135-40. DOI: 10.1161/01.cir.0000053558.55471.2d. View

13.

Zhang P, Guccione J, Nicholas S, Walker J, Crawford P, Shamal A . Endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm increases systolic circumferential shortening in sheep. J Thorac Cardiovasc Surg. 2007; 134(4):1017-24. PMC: 2615826. DOI: 10.1016/j.jtcvs.2007.03.060. View

14.

Jackson B, Gorman J, Moainie S, Guy T, Narula N, Narula J . Extension of borderzone myocardium in postinfarction dilated cardiomyopathy. J Am Coll Cardiol. 2002; 40(6):1160-7; discussion 1168-71. DOI: 10.1016/s0735-1097(02)02121-6. View

15.

Kuwahara E, Otsuji Y, Iguro Y, Ueno T, Zhu F, Mizukami N . Mechanism of recurrent/persistent ischemic/functional mitral regurgitation in the chronic phase after surgical annuloplasty: importance of augmented posterior leaflet tethering. Circulation. 2006; 114(1 Suppl):I529-34. DOI: 10.1161/CIRCULATIONAHA.105.000729. View

16.

Levine R, Handschumacher M, Sanfilippo A, Hagege A, Harrigan P, Marshall J . Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse. Circulation. 1989; 80(3):589-98. DOI: 10.1161/01.cir.80.3.589. View

17.

Kunzelman K, Reimink M, Cochran R . Flexible versus rigid ring annuloplasty for mitral valve annular dilatation: a finite element model. J Heart Valve Dis. 1998; 7(1):108-16. View

18.

Bothe W, Kvitting J, Swanson J, Hartnett S, Ingels Jr N, Miller D . Effects of different annuloplasty rings on anterior mitral leaflet dimensions. J Thorac Cardiovasc Surg. 2010; 139(5):1114-22. PMC: 2864008. DOI: 10.1016/j.jtcvs.2009.12.014. View

19.

Gorman 3rd J, Jackson B, Enomoto Y, Gorman R . The effect of regional ischemia on mitral valve annular saddle shape. Ann Thorac Surg. 2004; 77(2):544-8. DOI: 10.1016/S0003-4975(03)01354-7. View

20.

Daimon M, Fukuda S, Adams D, McCarthy P, Gillinov A, Carpentier A . Mitral valve repair with Carpentier-McCarthy-Adams IMR ETlogix annuloplasty ring for ischemic mitral regurgitation: early echocardiographic results from a multi-center study. Circulation. 2006; 114(1 Suppl):I588-93. DOI: 10.1161/CIRCULATIONAHA.105.001347. View