Computer simulation of human mitral valve mechanics and motion

Fluid-structure interaction models of the mitral valve: function in normal and pathological states

Successful mitral valve repair is dependent upon a full understanding of normal and abnormal mitral valve anatomy and function. Computational analysis is one such method that can be applied to simulate mitral valve function in order to analyse the roles of individual components and evaluate proposed surgical repair. We developed the first three-dimensional finite element computer model of the mitral valve including leaflets and chordae tendineae; however, one critical aspect that has been missing until the last few years was the evaluation of fluid flow, as coupled to the function of the mitral valve structure. We present here our latest results for normal function and specific pathological changes using a fluid-structure interaction model. Normal valve function was first assessed, followed by pathological material changes in collagen fibre volume fraction, fibre stiffness, fibre splay and isotropic stiffness. Leaflet and chordal stress and strain and papillary muscle force were determined. In addition, transmitral flow, time to leaflet closure and heart valve sound were assessed. Model predictions in the normal state agreed well with a wide range of available in vivo and in vitro data. Further, pathological material changes that preserved the anisotropy of the valve leaflets were found to preserve valve function. By contrast, material changes that altered the anisotropy of the valve were found to profoundly alter valve function. The addition of blood flow and an experimentally driven microstructural description of mitral tissue represent significant advances in computational studies of the mitral valve, which allow further insight to be gained. This work is another building block in the foundation of a computational framework to aid in the refinement and development of a truly non-invasive diagnostic evaluation of the mitral valve. Ultimately, it represents the basis for simulation of surgical repair of pathological valves in a clinical and educational setting.

Effects of hemodynamic alterations on anterior mitral leaflet curvature during systole

OBJECTIVES

The application of repair techniques to treat mitral valve incompetence has increased progressively during the past 20 years. Unfortunately, recent reports have demonstrated the longevity of these repairs to be less than previously believed. Most repair failures are stress related. Computational models to optimize valve repair are in development, but to be brought to fruition, a better understanding of dynamic leaflet geometry is necessary. In this study, sonomicrometry was used in an ovine model to compute systolic leaflet curvature at varying afterloads and states of contractility.

METHODS

The anterior leaflet of 12 sheep was instrumented with 5 piezoelectric transducers in a cruciate array. Systolic blood pressure ranged from 90 to 200 mm Hg with increasing phenylephrine hydrochloride infusion. Epinephrine was used to vary contractile state. Leaflet curvature was calculated continuously (200 Hz) during systole.

RESULTS

Anterior leaflet curvature in the septolateral direction was double that in the intercommisural direction. There were also significant changes in leaflet curvature during systole. Curvature in neither direction was affected by afterload. Epinephrine augmented intercommisural curvature in a dose-independent fashion, whereas it had no effect on curvature in the septolateral direction.

CONCLUSIONS

Dynamic mitral anterior leaflet geometry was found to be amazingly constant over a wide range of hemodynamic conditions. These data provide information about leaflet geometry that will aid in the construction of realistic computational models. Such models may facilitate the design of annuloplasty rings and surgical techniques that minimize leaflet stress and increase mitral valve repair longevity.

Structural effects of an innovative surgical technique to repair heart valve defects

The structural and functional effects of the "edge-to-edge" technique on the human mitral valve have been investigated, paying particular attention to the diastolic phase. An advanced finite element model of the valve has been developed, using a hyperelastic material schematization, suitable geometry and constraint conditions, and an effective fluidodynamic analysis. The edge-to-edge suture has been applied on this model and the diastolic phase has been simulated. The results of this calculation show that the operation increases the transvalvular pressure and the maximum stress in the leaflets, which reaches a level similar to that of the systolic phase. The influence of suture position and extension, and the mitral annulus dimension has also been investigated. The results indicate that a lateral location of the stitch is better than a central one, both regarding valve functionality (pressure level and mobility) and internal stresses level, that a longer suture worsens the valve functionality but reduces the stresses level, finally, that the dilatation of the mitral annulus does not affect the valve functionality but increases the stresses level.

A constitutive law for mitral valve tissue

Biaxial mechanical testing and theoretical continuum mechanics analysis are employed to formulate a constitutive law for cardiac mitral valve anterior and posterior leaflets. A strain energy description is formulated based on the fibrous architecture of the tissue, accurately describing the large deformation, highly nonlinear transversely isotropic material behavior. The results show that a simple three-coefficient exponential constitutive law provides an accurate prediction of stress-stretch behavior over a wide range of deformations. Regional heterogenity may be accommodated by spatially varying a single coefficient and incorporating collagen fiber angle. The application of this quantitative information to mechanical models and bioprosthetic development could provide substantial improvement in the evaluation and treatment of valvular disease, surgery, and replacement.

Replacement of mitral valve posterior chordae tendineae with expanded polytetrafluoroethylene suture: a finite element study

BACKGROUND AND AIMS

Expanded polytetrafluoroethylene (ePTFE) suture has been used clinically for replacement of ruptured mitral valve chordae tendineae. The purpose of this study was to assess mitral valve function after posterior chordal replacement with ePTFE suture.

METHODS

A three-dimensional finite element computer model of the mitral valve was used, which incorporated geometry, regional tissue thickness, collagen fiber orientation, and anisotropic material properties for the leaflets, interface, and chordae tendineae. To simulate chordal rupture, four marginal and four basal chordae were removed from the posterior leaflet. Chordal replacement was simulated using two elements with the physical and material properties of 2-0 ePTFE suture. Systolic loading pressures were applied.

RESULTS

The chordal rupture model demonstrated posterior leaflet prolapse, abnormal stress concentrations, potential regurgitation, and elevated chordal stress. Conversely, the chordal replacement model corrected the prolapse and returned chordal stress to normal levels. However, stress concentrations were shown at suture attachment points.

CONCLUSIONS

This integrated mitral valve finite element model provides a tool to investigate the performance of the valve system. In this study, we have shown that 2-0 ePTFE suture replacement of ruptured posterior chordae tendineae returns the valve to a near normal state, in terms of leaflet stress and coaptation, and chordal stresses.