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. 2014 Mar 1;5(1):35-43.
doi: 10.1007/s13239-014-0175-9.

Quantitative Evaluation of Annuloplasty on Mitral Valve Chordae Tendineae Forces to Supplement Surgical Planning Model Development

Andrew W Siefert  1 , Jean-Pierre M Rabbah  1 , Eric L Pierce  1 , Karyn S Kunzelman  2 , Ajit P Yoganathan  1
Affiliations

Quantitative Evaluation of Annuloplasty on Mitral Valve Chordae Tendineae Forces to Supplement Surgical Planning Model Development

Andrew W Siefert et al. Cardiovasc Eng Technol. .

Abstract

Purpose: Computational models of the heart's mitral valve (MV) exhibit potential for preoperative surgical planning in ischemic mitral regurgitation (IMR). However challenges exist in defining boundary conditions to accurately model the function and response of the chordae tendineae to both IMR and surgical annuloplasty repair. Towards this goal, a ground-truth data set was generated by quantifying the isolated effects of IMR and mitral annuloplasty on leaflet coaptation, regurgitation, and tethering forces of the anterior strut and posterior intermediary chordae tendineae.

Methods: MVs were excised from ovine hearts (N=15) and mounted in a pulsatile heart simulator which has been demonstrated to mimic the systolic MV geometry and coaptation of healthy and chronic IMR sheep. Strut and intermediary chordae from both MV leaflets (N=4) were instrumented with force transducers. Tested conditions included a healthy control, IMR, oversized annuloplasty, true-sized annuloplasty, and undersized mitral annuloplasty. A2-P2 leaflet coaptation length, regurgitation, and chordal tethering were quantified and statistically compared across experimental conditions.

Results: IMR was successfully simulated with significant increases in MR, tethering forces for each of the chordae, and decrease in leaflet coaptation (p<.05). Compared to the IMR condition, increasing levels of downsized annuloplasty significantly reduced regurgitation, increased coaptation, reduced posteromedial papillary muscle strut chordal forces, and reduced intermediary chordal forces from the anterolateral papillary muscle (p<.05).

Conclusions: These results provide for the first time a novel comprehensive data set for refining the ability of computational MV models to simulate IMR and varying sizes of complete rigid ring annuloplasty.

Keywords: Annuloplasty; Chordae Tendineae; Computational Methods; Heart Valve; Mitral Regurgitation; Mitral Valve.

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Conflict of interest statement

Conflict of Interest Statement

None.

Figures

FIGURE 1
FIGURE 1
Summary of experimental conditions progressing from control to ischemic mitral regurgiation (IMR), oversized mitral annuloplasty, true-sized mitral annuloplasty, and undersized mitral annuloplasty (UMA). (Please note images are not drawn to scale)
FIGURE 2
FIGURE 2
Chordal forces from the posteromedial papillary muscle (PMPM) and anterolateral papillary muscle (ALPM) were normalized to the forces observed during the healthy control condition to demonstrate relative changes in cyclic chordal tethering with ischemic mitral regurgitation (IMR) and increasing degrees of annular under sizing.
FIGURE 3
FIGURE 3
Example iterative scheme for improving modeling of idealized chordal structures and geometry with the results of this study
See this image and copyright information in PMC

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