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Beating heart implantation of transventricular artificial cordae: how can access site selection and leaflet insertion improve mitral regurgitation correction? Med Eng Phys 2022; 101:103773. [DOI: 10.1016/j.medengphy.2022.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 12/04/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022]
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2
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The neochord mitral valve repair procedure: Numerical simulation of different neochords tensioning protocols. Med Eng Phys 2019; 74:121-128. [DOI: 10.1016/j.medengphy.2019.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/01/2019] [Accepted: 09/16/2019] [Indexed: 01/09/2023]
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Pappalardo O, Sturla F, Onorati F, Puppini G, Selmi M, Luciani G, Faggian G, Redaelli A, Votta E. Mass-spring models for the simulation of mitral valve function: Looking for a trade-off between reliability and time-efficiency. Med Eng Phys 2017; 47:93-104. [DOI: 10.1016/j.medengphy.2017.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/23/2017] [Accepted: 07/03/2017] [Indexed: 11/27/2022]
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Sturla F, Vismara R, Jaworek M, Votta E, Romitelli P, Pappalardo OA, Lucherini F, Antona C, Fiore GB, Redaelli A. In vitro and in silico approaches to quantify the effects of the Mitraclip ® system on mitral valve function. J Biomech 2016; 50:83-92. [PMID: 27863743 DOI: 10.1016/j.jbiomech.2016.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 12/01/2022]
Abstract
Mitraclip® implantation is widely used as a valid alternative to conventional open-chest surgery in high-risk patients with severe mitral valve (MV) regurgitation. Although effective in reducing mitral regurgitation (MR) in the majority of cases, the clip implantation produces a double-orifice area that can result in altered MV biomechanics, particularly in term of hemodynamics and mechanical stress distribution on the leaflets. In this scenario, we combined the consistency of in vitro experimental platforms with the versatility of numerical simulations to investigate clip impact on MV functioning. The fluid dynamic determinants of the procedure were experimentally investigated under different working conditions (from 40bpm to 100bpm of simulated heart rate) on six swine hearts; subsequently, fluid dynamic data served as realistic boundary conditions in a computational framework able to quantitatively assess the post-procedural MV biomechanics. The finite element model of a human mitral valve featuring an isolated posterior leaflet prolapse was reconstructed from cardiac magnetic resonance. A complete as well as a marginal, sub-optimal grasping of the leaflets were finally simulated. The clipping procedure resulted in a properly coapting valve from the geometrical perspective in all the simulated configurations. Symmetrical complete grasping resulted in symmetrical distribution of the mechanical stress, while uncomplete asymmetrical grasping resulted in higher stress distribution, particularly on the prolapsing leaflet. This work pinpointed that the mechanical stress distribution following the clipping procedure is dependent on the cardiac hemodynamics and has a correlation with the proper execution of the grasping procedure, requiring accurate evaluation prior to clip delivery.
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Affiliation(s)
- Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | | | - Omar A Pappalardo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy; Division of cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy
| | - Federico Lucherini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Carlo Antona
- Forcardiolab, Fondazione per la ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Surgery Department, "Luigi Sacco" University general Hospital, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Gianfranco B Fiore
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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Skornitzke S, Schummers G, Schreckenberg M, Ender J, Eibel S, Bungartz HJ, Kauczor HU, Stiller W. Mass-spring systems for simulating mitral valve repair using 3D ultrasound images. Comput Med Imaging Graph 2015; 45:26-35. [PMID: 26241162 DOI: 10.1016/j.compmedimag.2015.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/08/2015] [Accepted: 07/13/2015] [Indexed: 11/25/2022]
Abstract
Mitral valve (MV) diseases are among the most common types of heart diseases, while heart diseases are the most common cause of death worldwide. MV repair surgery is connected to higher survival rates and fewer complications than the total replacement of the MV, but MV repair requires extensive patient-specific therapy planning. The simulation of MV repair with a patient-specific model could help to optimize surgery results and make MV repair available to more patients. However, current patient-specific simulations are difficult to transfer to clinical application because of time-constraints or prohibitive requirements on the resolution of the image data. As one possible solution to the problem of patient-specific MV modeling, we present a mass-spring MV model based on 3D transesophageal echocardiographic (TEE) images already routinely acquired for MV repair therapy planning. Our novel approach to the rest-length estimation of springs allows us to model the global support of the MV leaflets through the chordae tendinae without the need for high-resolution image data. The model is used to simulate MV annuloplasty for five patients undergoing MV repair, and the simulated results are compared to post-surgical TEE images. The comparison shows that our model is able to provide a qualitative estimate of annuloplasty surgery. In addition, the data suggests that the model might also be applied to simulating the implantation of artificial chordae.
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Affiliation(s)
- Stephan Skornitzke
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; TomTec Imaging Systems GmbH, Unterschleißheim, Germany.
| | | | | | - Jörg Ender
- Department of Anesthesiology and Intensive Care Medicine II, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Sarah Eibel
- Department of Anesthesiology and Intensive Care Medicine II, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | | | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfram Stiller
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Functional and Biomechanical Effects of the Edge-to-Edge Repair in the Setting of Mitral Regurgitation: Consolidated Knowledge and Novel Tools to Gain Insight into Its Percutaneous Implementation. Cardiovasc Eng Technol 2014; 6:117-40. [PMID: 26577231 DOI: 10.1007/s13239-014-0208-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
Mitral regurgitation is the most prevalent heart valve disease in the western population. When severe, it requires surgical treatment, repair being the preferred option. The edge-to-edge repair technique treats mitral regurgitation by suturing the leaflets together and creating a double-orifice valve. Due to its relative simplicity and versatility, it has become progressively more widespread. Recently, its percutaneous version has become feasible, and has raised interest thanks to the positive results of the Mitraclip(®) device. Edge-to-edge features and evolution have stimulated debate and multidisciplinary research by both clinicians and engineers. After providing an overview of representative studies in the field, here we propose a novel computational approach to the most recent percutaneous evolution of the edge-to-edge technique. Image-based structural finite element models of three mitral valves affected by posterior prolapse were derived from cine-cardiac magnetic resonance imaging. The models accounted for the patient-specific 3D geometry of the valve, including leaflet compound curvature pattern, patient-specific motion of annulus and papillary muscles, and hyperelastic and anisotropic mechanical properties of tissues. The biomechanics of the three valves throughout the entire cardiac cycle was simulated before and after Mitraclip(®) implantation, assessing the biomechanical impact of the procedure. For all three simulated MVs, Mitraclip(®) implantation significantly improved systolic leaflets coaptation, without inducing major alterations in systolic peak stresses. Diastolic orifice area was decreased, by up to 58.9%, and leaflets diastolic stresses became comparable, although lower, to systolic ones. Despite established knowledge on the edge-to-edge surgical repair, latest technological advances make its percutanoues implementation a challenging field of research. The modeling approach herein proposed may be expanded to analyze clinical scenarios that are currently critical for Mitraclip(®) implantation, helping the search for possible solutions.
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Mansi T, Voigt I, Georgescu B, Zheng X, Mengue EA, Hackl M, Ionasec RI, Noack T, Seeburger J, Comaniciu D. An integrated framework for finite-element modeling of mitral valve biomechanics from medical images: application to MitralClip intervention planning. Med Image Anal 2012; 16:1330-46. [PMID: 22766456 DOI: 10.1016/j.media.2012.05.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 04/21/2012] [Accepted: 05/18/2012] [Indexed: 11/17/2022]
Abstract
Treatment of mitral valve (MV) diseases requires comprehensive clinical evaluation and therapy personalization to optimize outcomes. Finite-element models (FEMs) of MV physiology have been proposed to study the biomechanical impact of MV repair, but their translation into the clinics remains challenging. As a step towards this goal, we present an integrated framework for finite-element modeling of the MV closure based on patient-specific anatomies and boundary conditions. Starting from temporal medical images, we estimate a comprehensive model of the MV apparatus dynamics, including papillary tips, using a machine-learning approach. A detailed model of the open MV at end-diastole is then computed, which is finally closed according to a FEM of MV biomechanics. The motion of the mitral annulus and papillary tips are constrained from the image data for increased accuracy. A sensitivity analysis of our system shows that chordae rest length and boundary conditions have a significant influence upon the simulation results. We quantitatively test the generalization of our framework on 25 consecutive patients. Comparisons between the simulated closed valve and ground truth show encouraging results (average point-to-mesh distance: 1.49 ± 0.62 mm) but also the need for personalization of tissue properties, as illustrated in three patients. Finally, the predictive power of our model is tested on one patient who underwent MitralClip by comparing the simulated intervention with the real outcome in terms of MV closure, yielding promising prediction. By providing an integrated way to perform MV simulation, our framework may constitute a surrogate tool for model validation and therapy planning.
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Affiliation(s)
- Tommaso Mansi
- Siemens Corporation, Corporate Research and Technology, Image Analytics and Informatics, Princeton, NJ, USA.
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