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Ooida J, Kiyohara N, Noguchi H, Oguchi Y, Nagane K, Sakaguchi T, Aoyama G, Shige F, Chapman JV, Asami M, Kofoed KF, Pham MHC, Suzuki K. An In Silico Model for Predicting the Efficacy of Edge-to-Edge Repair for Mitral Regurgitation. J Biomech Eng 2024; 146:021004. [PMID: 37978048 DOI: 10.1115/1.4064055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
In recent years, transcatheter edge-to-edge repair (TEER) has been widely adopted as an effective treatment for mitral regurgitation (MR). The aim of this study is to develop a personalized in silico model to predict the effect of edge-to-edge repair in advance to the procedure for each individual patient. For this purpose, we propose a combination of a valve deformation model for computing the mitral valve (MV) orifice area (MVOA) and a lumped parameter model for the hemodynamics, specifically mitral regurgitation volume (RVol). Although we cannot obtain detailed information on the three-dimensional flow field near the mitral valve, we can rapidly simulate the important medical parameters for the clinical decision support. In the present method, we construct the patient-specific pre-operative models by using the parameter optimization and then simulate the postoperative state by applying the additional clipping condition. The computed preclip MVOAs show good agreement with the clinical measurements, and the correlation coefficient takes 0.998. In addition, the MR grade in terms of RVol also has good correlation with the grade by ground truth MVOA. Finally, we try to investigate the applicability for the predicting the postclip state. The simulated valve shapes clearly show the well-known double orifice and the improvement of the MVOA, compared with the preclip state. Similarly, we confirmed the improved reverse flow and MR grade in terms of RVol. A total computational time is approximately 8 h by using general-purpose PC. These results obviously indicate that the present in silico model has good capability for the assessment of edge-to-edge repair.
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Affiliation(s)
- Junichi Ooida
- Canon Inc., 3-30-2 Shimomaruko, Ota-ku, Tokyo 146-8501, Japan
| | - Naoki Kiyohara
- Canon Inc., 3-30-2 Shimomaruko, Ota-ku, Tokyo 146-8501, Japan
| | | | - Yuichiro Oguchi
- Canon Inc., 3-30-2 Shimomaruko, Ota-ku, Tokyo 146-8501, Japan
| | - Kohei Nagane
- Canon Inc., 3-30-2 Shimomaruko, Ota-ku, Tokyo 146-8501, Japan
| | - Takuya Sakaguchi
- Canon Medical Systems Corporation, 1385 Shimoishigami, Ohtawara, Tochigi 324-8550, Japan
| | - Gakuto Aoyama
- Canon Medical Systems Corporation, 1385 Shimoishigami, Ohtawara, Tochigi 324-8550, Japan
| | - Fumimasa Shige
- Canon Medical Systems Corporation, 1385 Shimoishigami, Ohtawara, Tochigi 324-8550, Japan
| | - James V Chapman
- Canon Medical Informatics, Inc., 5850 Opus Parkway, Suite 300, Minnetonka, MN 55343
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, 1 Kandaizumi-cho, Chiyoda-ku, Tokyo 101-8643, Japan
| | - Klaus Fuglsang Kofoed
- Department of Cardiology and Radiology, Rigshospitalet & University of Copenhagen, Blegdamsvej 9, København 2100, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Rigshospitalet & University of Copenhagen, Blegdamsvej 9, København 2100, Denmark
| | - Michael Huy Cuong Pham
- Department of Cardiology and Radiology, Rigshospitalet & University of Copenhagen, Blegdamsvej 9, København 2100, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Rigshospitalet & University of Copenhagen, Blegdamsvej 9, København 2100, Denmark
| | - Koshiro Suzuki
- Canon Inc., 3-30-2 Shimomaruko, Ota-ku, Tokyo 146-8501, Japan
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Scuoppo R, Cannata S, Gentile G, Gandolfo C, Pasta S. Parametric analysis of transcatheter aortic valve replacement in transcatheter aortic valve replacement: evaluation of coronary flow obstruction. Front Bioeng Biotechnol 2023; 11:1267986. [PMID: 37885451 PMCID: PMC10598678 DOI: 10.3389/fbioe.2023.1267986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly being considered for use in younger patients having longer life expectancy than those who were initially treated. The TAVR-in-TAVR procedure represents an appealing strategy to treat failed transcatheter heart valves (THV) likely occurring in young patients. However, the permanent displacement of first THV can potentially compromise the coronary access and ultimately inhibit the blood flow circulation. The objective of this study was to use finite-element analysis (FEA) to quantify coronary flow in a patient who underwent TAVR-in-TAVR. A parametric investigation was carried out to determine the impact of both the implantation depth and device size on coronary flow for several deployment configurations. The FEAs consisted of first delivering the SAPIEN 3 Ultra THV and then positioning the Evolut PRO device. Findings indicates that high implantation depth and device undersize of the second THV could significantly reduce coronary flow to 20% of its estimated level before TAVR. Additionally, a positive correlation was observed between coronary flow and the valve-to-coronary distance (R = 0.86 and p = 0.032 for the left coronary artery, and R = 0.93 and p = 0.014 for the right coronary artery). This study demonstrated that computational modeling can provide valuable insights to improve the pre-procedural planning of TAVR-in-TAVR.
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Affiliation(s)
- Roberta Scuoppo
- Department of Engineering, Università Degli Studi di Palermo, Palermo, Italy
| | - Stefano Cannata
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Giovanni Gentile
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Caterina Gandolfo
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Salvatore Pasta
- Department of Engineering, Università Degli Studi di Palermo, Palermo, Italy
- Department of Research, IRCCS-ISMETT, Palermo, Italy
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Simonian NT, Liu H, Vakamudi S, Pirwitz MJ, Pouch AM, Gorman JH, Gorman RC, Sacks MS. Patient-Specific Quantitative In-Vivo Assessment of Human Mitral Valve Leaflet Strain Before and After MitraClip Repair. Cardiovasc Eng Technol 2023; 14:677-693. [PMID: 37670097 DOI: 10.1007/s13239-023-00680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Mitral regurgitation (MR) is a highly prevalent and deadly cardiac disease characterized by improper mitral valve (MV) leaflet coaptation. Among the plethora of available treatment strategies, the MitraClip is an especially safe option, but optimizing its long-term efficacy remains an urgent challenge. METHODS We applied our noninvasive image-based strain computation pipeline [1] to intraoperative transesophageal echocardiography datasets taken from ten patients undergoing MitraClip repair, spanning a range of MR etiologies and MitraClip configurations. We then analyzed MV leaflet strains before and after MitraClip implementation to develop a better understanding of (1) the pre-operative state of human regurgitant MV, and (2) the MitraClip's impact on the MV leaflet deformations. RESULTS The MV pre-operative strain fields were highly variable, underscoring both the heterogeneity of the MR in the patient population and the need for patient-specific treatment approaches. Similarly, there were no consistent overall post-operative strain patterns, although the average A2 segment radial strain difference between pre- and post-operative states was consistently positive. In contrast, the post-operative strain fields were better correlated to their respective pre-operative strain fields than to the inter-patient post-operative strain fields. This quantitative result implies that the patient specific pre-operative state of the MV guides its post-operative deformation, which suggests that the post-operative state can be predicted using pre-operative data-derived modelling alone. CONCLUSIONS The pre-operative MV leaflet strain patterns varied considerably across the range of MR disease states and after MitraClip repair. Despite large inter-patient heterogeneity, the post-operative deformation appears principally dictated by the pre-operative deformation state. This novel finding suggests that though the variation in MR functional state and MitraClip-induced deformation were substantial, the post-operative state can be predicted from the pre-operative data alone. This study suggests that, with use of larger patient cohort and corresponding long-term outcomes, quantitative predictive factors of MitraClip durability can be identified.
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Affiliation(s)
- Natalie T Simonian
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, The University of Texas at Austin , 201 East 24th St., Stop C0200, Austin, TX, 78712-1229, USA
| | - Hao Liu
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, The University of Texas at Austin , 201 East 24th St., Stop C0200, Austin, TX, 78712-1229, USA
| | - Sneha Vakamudi
- Ascension Texas Cardiovascular & Division of Cardiology, Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
| | - Mark J Pirwitz
- Ascension Texas Cardiovascular & Division of Cardiology, Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
| | - Alison M Pouch
- Gorman Cardiovascular Research Group, Smilow Center for Translational Research, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, Smilow Center for Translational Research, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Smilow Center for Translational Research, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael S Sacks
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, The University of Texas at Austin , 201 East 24th St., Stop C0200, Austin, TX, 78712-1229, USA.
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van Kampen A, Morningstar JE, Goudot G, Ingels N, Wenk JF, Nagata Y, Yaghoubian KM, Norris RA, Borger MA, Melnitchouk S, Levine RA, Jensen MO. Utilization of Engineering Advances for Detailed Biomechanical Characterization of the Mitral-Ventricular Relationship to Optimize Repair Strategies: A Comprehensive Review. Bioengineering (Basel) 2023; 10:601. [PMID: 37237671 PMCID: PMC10215167 DOI: 10.3390/bioengineering10050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
The geometrical details and biomechanical relationships of the mitral valve-left ventricular apparatus are very complex and have posed as an area of research interest for decades. These characteristics play a major role in identifying and perfecting the optimal approaches to treat diseases of this system when the restoration of biomechanical and mechano-biological conditions becomes the main target. Over the years, engineering approaches have helped to revolutionize the field in this regard. Furthermore, advanced modelling modalities have contributed greatly to the development of novel devices and less invasive strategies. This article provides an overview and narrative of the evolution of mitral valve therapy with special focus on two diseases frequently encountered by cardiac surgeons and interventional cardiologists: ischemic and degenerative mitral regurgitation.
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Affiliation(s)
- Antonia van Kampen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Leipzig Heart Centre, University Clinic of Cardiac Surgery, 02189 Leipzig, Germany
| | - Jordan E. Morningstar
- Department of Regenerative Medicine and Cell Biology, University of South Carolina, Charleston, SC 29425, USA
| | - Guillaume Goudot
- Cardiac Ultrasound Laboratory, Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Neil Ingels
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
| | - Jonathan F. Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY 40508, USA;
| | - Yasufumi Nagata
- Cardiac Ultrasound Laboratory, Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Koushiar M. Yaghoubian
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, University of South Carolina, Charleston, SC 29425, USA
| | - Michael A. Borger
- Leipzig Heart Centre, University Clinic of Cardiac Surgery, 02189 Leipzig, Germany
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory, Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Morten O. Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Dabiri Y, Mahadevan VS, Guccione JM, Kassab GS. Machine learning used for simulation of MitraClip intervention: A proof-of-concept study. Front Genet 2023; 14:1142446. [PMID: 36968590 PMCID: PMC10033889 DOI: 10.3389/fgene.2023.1142446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction: Severe mitral regurgitation (MR) is a mitral valve disease that can lead to lifethreatening complications. MitraClip (MC) therapy is a percutaneous solution for patients who cannot tolerate surgical solutions. In MC therapy, a clip is implanted in the heart to reduce MR. To achieve optimal MC therapy, the cardiologist needs to foresee the outcomes of different scenarios for MC implantation, including the location of the MC. Although finite element (FE) modeling can simulate the outcomes of different MC scenarios, it is not suitable for clinical usage because it requires several hours to complete.Methods: In this paper, we used machine learning (ML) to predict the outcomes of MC therapy in less than 1 s. Two ML algorithms were used: XGBoost, which is a decision tree model, and a feed-forward deep learning (DL) model. The MC location, the geometrical attributes of the models and baseline stress and MR were the features of the ML models, and the predictions were performed for MR and maximum von Mises stress in the leaflets. The parameters of the ML models were determined to achieve the minimum errors obtained by applying the ML models on the validation set.Results: The results for the test set (not used during training) showed relative agreement between ML predictions and ground truth FE predictions. The accuracy of the XGBoost models were better than DL models. Mean absolute percentage error (MAPE) for the XGBoost predictions were 0.115 and 0.231, and the MAPE for DL predictions were 0.154 and 0.310, for MR and stress, respectively.Discussion: The ML models reduced the FE runtime from 6 hours (on average) to less than 1 s. The accuracy of ML models can be increased by increasing the dataset size. The results of this study have important implications for improving the outcomes of MC therapy by providing information about the outcomes of MC implantation in real-time.
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Affiliation(s)
- Yaghoub Dabiri
- California Medical Innovations Institute, San Diego, CA, United States
| | | | | | - Ghassan S. Kassab
- California Medical Innovations Institute, San Diego, CA, United States
- *Correspondence: Ghassan S. Kassab,
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Vellguth K, Barbieri F, Reinthaler M, Kasner M, Landmesser U, Kuehne T, Hennemuth A, Walczak L, Goubergrits L. Effect of transcatheter edge-to-edge repair device position on diastolic hemodynamic parameters: An echocardiography-based simulation study. Front Cardiovasc Med 2022; 9:915074. [PMID: 36093164 PMCID: PMC9449143 DOI: 10.3389/fcvm.2022.915074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTranscatheter edge-to-edge repair (TEER) has developed from innovative technology to an established treatment strategy of mitral regurgitation (MR). The risk of iatrogenic mitral stenosis after TEER is, however, a critical factor in the conflict of interest between maximal reduction of MR and minimal impairment of left ventricular filling. We aim to investigate systematically the impact of device position on the post treatment hemodynamic outcome by involving the patient-specific segmentation of the diseased mitral valve.Materials and methodsTransesophageal echocardiographic image data of ten patients with severe MR (age: 57 ± 8 years, 20% female) were segmented and virtually treated with TEER at three positions by using a position based dynamics approach. Pre- and post-interventional patient geometries were preprocessed for computational fluid dynamics (CFD) and simulated at peak-diastole with patient-specific blood flow boundary conditions. Simulations were performed with boundary conditions mimicking rest and stress. The simulation results were compared with clinical data acquired for a cohort of 21 symptomatic MR patients (age: 79 ± 6 years, 43% female) treated with TEER.ResultsVirtual TEER reduces the mitral valve area (MVA) from 7.5 ± 1.6 to 2.6 ± 0.6 cm2. Central device positioning resulted in a 14% smaller MVA than eccentric device positions. Furthermore, residual MVA is better predictable for central than for eccentric device positions (R2 = 0.81 vs. R2 = 0.49). The MVA reduction led to significantly higher maximal diastolic velocities (pre: 0.9 ± 0.2 m/s, post: 2.0 ± 0.5 m/s) and pressure gradients (pre: 1.5 ± 0.6 mmHg, post: 16.3 ± 9 mmHg) in spite of a mean flow rate reduction by 23% due to reduced MR after the treatment. On average, velocities were 12% and pressure gradients were 25% higher with devices in central compared to lateral or medial positions.ConclusionVirtual TEER treatment combined with CFD is a promising tool for predicting individual morphometric and hemodynamic outcomes. Such a tool can potentially be used to support clinical decision making, procedure planning, and risk estimation to prevent post-procedural iatrogenic mitral stenosis.
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Affiliation(s)
- Katharina Vellguth
- Institute of Computer-Assisted Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- *Correspondence: Katharina Vellguth
| | - Fabian Barbieri
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus Reinthaler
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Teltow, Germany
| | - Mario Kasner
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kuehne
- Institute of Computer-Assisted Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Anja Hennemuth
- Institute of Computer-Assisted Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer MEVIS, Bremen, Germany
| | - Lars Walczak
- Institute of Computer-Assisted Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer MEVIS, Bremen, Germany
| | - Leonid Goubergrits
- Institute of Computer-Assisted Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
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Kronborg J, Svelander F, Eriksson-Lidbrink S, Lindström L, Homs-Pons C, Lucor D, Hoffman J. Computational Analysis of Flow Structures in Turbulent Ventricular Blood Flow Associated With Mitral Valve Intervention. Front Physiol 2022; 13:806534. [PMID: 35846019 PMCID: PMC9280136 DOI: 10.3389/fphys.2022.806534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac disease and clinical intervention may both lead to an increased risk for thrombosis events due to a modified blood flow in the heart, and thereby a change in the mechanical stimuli of blood cells passing through the chambers of the heart. Specifically, the degree of platelet activation is influenced by the level and type of mechanical stresses in the blood flow. In this article we analyze the blood flow in the left ventricle of the heart through a computational model constructed from patient-specific data. The blood flow in the ventricle is modelled by the Navier-Stokes equations, and the flow through the mitral valve by a parameterized model which represents the projected opening of the valve. A finite element method is used to solve the equations, from which a simulation of the velocity and pressure of the blood flow is constructed. The intraventricular blood flow is complex, in particular in diastole when the inflow jet from the atrium breaks down into turbulent flow on a range of scales. A triple decomposition of the velocity gradient tensor is then used to distinguish between rigid body rotational flow, irrotational straining flow, and shear flow. The triple decomposition enables the separation of three fundamentally different flow structures, that each generates a distinct type of mechanical stimulus on the blood cells in the flow. We compare the results in a simulation where a mitral valve clip intervention is modelled, which leads to a significant modification of the intraventricular flow. Further, we perform a sensitivity study of the results with respect to the positioning of the clip. It was found that the shear in the simulation cases treated with clips increased more compared to the untreated case than the rotation and strain did. A decrease in valve opening area of 64% in one of the cases led to a 90% increase in rotation and strain, but a 150% increase in shear. The computational analysis opens up for improvements in models of shear-induced platelet activation, by offering an algorithm to distinguish shear from other modalities in intraventricular blood flow.
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Affiliation(s)
- Joel Kronborg
- Department of Computational Science and Technology, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
- *Correspondence: Joel Kronborg,
| | - Frida Svelander
- Department of Computational Science and Technology, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Samuel Eriksson-Lidbrink
- Department of Computational Science and Technology, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ludvig Lindström
- Department of Computational Science and Technology, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Carme Homs-Pons
- Department of Computational Science and Technology, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Didier Lucor
- Laboratoire Interdisciplinaire des Sciences du Numérique (LISN), CNRS, Université Paris-Saclay, Orsay, France
| | - Johan Hoffman
- Department of Computational Science and Technology, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
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8
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Gooden SCM, Hatoum H, Boudoulas KD, Vannan MA, Dasi LP. Effects of MitraClip Therapy on Mitral Flow Patterns and Vortex Formation: An In Vitro Study. Ann Biomed Eng 2022; 50:680-690. [PMID: 35411431 PMCID: PMC11070279 DOI: 10.1007/s10439-022-02944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/03/2022] [Indexed: 11/01/2022]
Abstract
MitraClip transcatheter edge-to-edge repair is used to treat mitral regurgitation (MR). While MR is reduced, diastolic left ventricular flows are altered. An in vitro left heart simulator was used to assess a porcine mitral valve in the native, MR, and MR plus MitraClip cases. Velocity, vorticity, and Reynolds shear stress (RSS) were quantified by particle image velocimetry. Peak velocity increased from 1.20 m/s for native to 1.30 m/s with MR. With MitraClip, two divergent jets of 1.18 and 0.61 m/s emerged. Higher vorticity was observed with MR than native and lessened with MitraClip. MitraClip resulted in shear layer formation and downstream vortex formation. Native RSS decreased from 33 Pa in acceleration to 29 Pa at peak flow, then increased to 31 Pa with deceleration. MR RSS increased from 27 Pa in acceleration to 40 Pa at peak flow to 59 Pa during deceleration. MitraClip RSS increased from 79 Pa in acceleration to 162 Pa during peak flow, then decreased to 45 Pa during deceleration. After MitraClip, two divergent jets of reduced velocity emerged, accompanied by shear layers and recirculation. Chaotic flow developed, resulting in elevated RSS magnitude and coverage. Findings help understand consequences of MitraClip on left ventricular flow dynamics.
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Affiliation(s)
- Shelley Chee-Mei Gooden
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | | | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Lakshmi P Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA.
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9
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Toma M, Singh-Gryzbon S, Frankini E, Wei Z(A, Yoganathan AP. Clinical Impact of Computational Heart Valve Models. MATERIALS (BASEL, SWITZERLAND) 2022; 15:3302. [PMID: 35591636 PMCID: PMC9101262 DOI: 10.3390/ma15093302] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 12/17/2022]
Abstract
This paper provides a review of engineering applications and computational methods used to analyze the dynamics of heart valve closures in healthy and diseased states. Computational methods are a cost-effective tool that can be used to evaluate the flow parameters of heart valves. Valve repair and replacement have long-term stability and biocompatibility issues, highlighting the need for a more robust method for resolving valvular disease. For example, while fluid-structure interaction analyses are still scarcely utilized to study aortic valves, computational fluid dynamics is used to assess the effect of different aortic valve morphologies on velocity profiles, flow patterns, helicity, wall shear stress, and oscillatory shear index in the thoracic aorta. It has been analyzed that computational flow dynamic analyses can be integrated with other methods to create a superior, more compatible method of understanding risk and compatibility.
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Affiliation(s)
- Milan Toma
- Department of Osteopathic Manipulative Medicine, New York Institute of Technology College of Osteopathic Medicine, Northern Boulevard, P.O. Box 8000, Old Westbury, NY 11568, USA;
| | - Shelly Singh-Gryzbon
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (S.S.-G.); (A.P.Y.)
| | - Elisabeth Frankini
- Department of Osteopathic Manipulative Medicine, New York Institute of Technology College of Osteopathic Medicine, Northern Boulevard, P.O. Box 8000, Old Westbury, NY 11568, USA;
| | - Zhenglun (Alan) Wei
- Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA;
| | - Ajit P. Yoganathan
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (S.S.-G.); (A.P.Y.)
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Computational Methods for Fluid-Structure Interaction Simulation of Heart Valves in Patient-Specific Left Heart Anatomies. FLUIDS 2022. [DOI: 10.3390/fluids7030094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Given the complexity of human left heart anatomy and valvular structures, the fluid–structure interaction (FSI) simulation of native and prosthetic valves poses a significant challenge for numerical methods. In this review, recent numerical advancements for both fluid and structural solvers for heart valves in patient-specific left hearts are systematically considered, emphasizing the numerical treatments of blood flow and valve surfaces, which are the most critical aspects for accurate simulations. Numerical methods for hemodynamics are considered under both the continuum and discrete (particle) approaches. The numerical treatments for the structural dynamics of aortic/mitral valves and FSI coupling methods between the solid Ωs and fluid domain Ωf are also reviewed. Future work toward more advanced patient-specific simulations is also discussed, including the fusion of high-fidelity simulation within vivo measurements and physics-based digital twining based on data analytics and machine learning techniques.
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Dabiri Y, Mahadevan VS, Guccione JM, Kassab GS. A Simulation Study of the Effects of Number and Location of MitraClips on Mitral Regurgitation. JACC. ADVANCES 2022; 1:100015. [PMID: 38939090 PMCID: PMC11198285 DOI: 10.1016/j.jacadv.2022.100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 06/29/2024]
Abstract
Background MitraClip (MC) is a device that is implanted on the mitral valve (MV) percutaneously to treat severe mitral regurgitation (MR). It is common practice to place the MCs at the site of the most significant MR jets identified by echocardiography. Objectives We used computational modeling to examine changes in MR after MC placement. Methods Echocardiographic images from 29 patients with MR were analyzed to reconstruct geometries for finite element simulations and created fluid structure interaction models of the MV with deformable hyperelastic material, the left ventricle as the surrounding geometry, and blood flow. Blood flow was modelled with smoothed particle hydrodynamics. The number of blood particles on the atrial side of MV was used to estimate MR. MC placement was based on the MR jets (jet-based strategy using primary and secondary jets) and simulation models using various MCs locations. Results Computational modelling was able to quantitate reductions in MR after MC placement. Reduction in MR was related to the number of MCs used: 42% reduction with 1 MC, 62% with 2 MCs, and 88% with 3 MCs. Using 2 MCs did not always result in an MR reduction greater than with a single MC. In 31% (9 of 29) of patients, the jet-based strategy did not lead to maximum MR reduction. The majority of patients (89%) who did not have maximal MR reduction with the MC placement using the jet-based strategy, had wide jets, and/or had multiple jets. Conclusions Subject-specific simulation models may be helpful to identify optimal locations for MC placement in patients with MR.
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Eqbal A, Gupta S, Fam N, Ong G, Bisleri G. The impact of transcatheter edge-to-edge repair on mitral valve annular geometry. Curr Opin Cardiol 2022; 37:150-155. [PMID: 35058414 DOI: 10.1097/hco.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Mitral valve transcatheter edge-to-edge repair (TEER) is becoming increasingly common to treat severe mitral regurgitation. However, the lack of concomitant annuloplasty raises concerns regarding its durability. As a result, there is an emerging body of literature evaluating the impacts of TEER on mitral annular geometry. In this review, we summarize the most recent literature evaluating the impacts of TEER on annular geometry in the acute, intermediate and long-term. We also review the relationship between changes in annular geometry and clinical endpoints. RECENT FINDINGS Current evidence suggests that TEER acutely induces favourable changes in mitral annular size and shape, which may persist for at least up to 1 year. Few studies suggest that TEER-induced annular remodelling is associated with positive clinical outcomes. SUMMARY The current body of literature is sparse and limited to primarily small case series. Data from the surgical literature suggest that ringless edge-to-edge repair is associated with eventual failure. Unfortunately, few studies evaluate TEER-induced annular changes beyond the acute postprocedural phase. Future research needs to focus on and evaluate the significance of TEER-induced changes in annular dimensions in the long-term.
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Affiliation(s)
- Adam Eqbal
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton
| | - Neil Fam
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Géraldine Ong
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gianluigi Bisleri
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Power JE, Reiff C, Tsangaris A, Hall A, Raveendran G, Yannopoulos D, Gurevich S. Invasive hemodynamics are equivocal for functional outcomes after MitraClip. Health Sci Rep 2022; 5:e471. [PMID: 35036576 PMCID: PMC8753491 DOI: 10.1002/hsr2.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/07/2021] [Accepted: 11/24/2021] [Indexed: 11/08/2022] Open
Abstract
Objectives To evaluate invasive hemodynamics in assessing MC therapy success as well as evaluate its effectiveness as a predictor of functional outcomes. Background Mitral regurgitation grade is a poor predictor of functional outcomes after a MitraClip. There is a paucity of data on invasive hemodynamics as a predictor of outcomes. Methods Sixty-nine patients underwent MC between 2015 and 2018 at the University of Minnesota Medical Center and were retrospectively analyzed. Invasive hemodynamics were performed before and after device deployment with transesophageal echocardiographic guidance. Statistical analysis was performed using STATA version 16. Student's t test was used for continuous variables and Pearson's chi-squared test for categorical variables. Mann-Whitney test was performed for continuous variables where data were not normally distributed. Logistic and linear regression were used to investigate relationships between variables and outcomes. Results A total of 69 patients were included in the study. The mean age was 83 (75-87) years and 38 (55%) were male. Eighty-one percentage had >/= NYHA III symptoms. Eighty-seven percentage had severe MR. Pulmonary capillary wedge pressure was 20 (15-24). Overall, there was significant improvement in left atrial pressure including mean left atrial pressure index, MR, and NYHA class after MC (<.001). There was no significant association between invasive hemodynamics (including left atrial mean pressure index or its reduction rate) and functional outcomes (p = NS). MR grade was also not predictive of functional outcomes. Conclusion Left atrial pressure may not be a significant predictor of functional outcomes, and, in isolation, may not be an improvement over MR grade.
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Affiliation(s)
- Juliette E Power
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Chris Reiff
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Adamantios Tsangaris
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Alexandra Hall
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Ganesh Raveendran
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Demetris Yannopoulos
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Sergey Gurevich
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
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Dabiri Y, Yao J, Mahadevan VS, Gruber D, Arnaout R, Gentzsch W, Guccione JM, Kassab GS. Mitral Valve Atlas for Artificial Intelligence Predictions of MitraClip Intervention Outcomes. Front Cardiovasc Med 2021; 8:759675. [PMID: 34957251 PMCID: PMC8709129 DOI: 10.3389/fcvm.2021.759675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022] Open
Abstract
Severe mitral regurgitation (MR) is a cardiac disease that can lead to fatal consequences. MitraClip (MC) intervention is a percutaneous procedure whereby the mitral valve (MV) leaflets are connected along the edge using MCs. The outcomes of the MC intervention are not known in advance, i.e., the outcomes are quite variable. Artificial intelligence (AI) can be used to guide the cardiologist in selecting optimal MC scenarios. In this study, we describe an atlas of shapes as well as different scenarios for MC implantation for such an AI analysis. We generated the MV geometrical data from three different sources. First, the patients' 3-dimensional echo images were used. The pixel data from six key points were obtained from three views of the echo images. Using PyGem, an open-source morphing library in Python, these coordinates were used to create the geometry by morphing a template geometry. Second, the dimensions of the MV, from the literature were used to create data. Third, we used machine learning methods, principal component analysis, and generative adversarial networks to generate more shapes. We used the finite element (FE) software ABAQUS to simulate smoothed particle hydrodynamics in different scenarios for MC intervention. The MR and stresses in the leaflets were post-processed. Our physics-based FE models simulated the outcomes of MC intervention for different scenarios. The MR and stresses in the leaflets were computed by the FE models for a single clip at different locations as well as two and three clips. Results from FE simulations showed that the location and number of MCs affect subsequent residual MR, and that leaflet stresses do not follow a simple pattern. Furthermore, FE models need several hours to provide the results, and they are not applicable for clinical usage where the predicted outcomes of MC therapy are needed in real-time. In this study, we generated the required dataset for the AI models which can provide the results in a matter of seconds.
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Affiliation(s)
| | - Jiang Yao
- Dassault Systemes Simulia Corp, Johnston, RI, United States
| | - Vaikom S Mahadevan
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Rima Arnaout
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States.,Center for Intelligent Imaging, University of California, San Francisco, San Francisco, CA, United States.,Biological and Medical Informatics, University of California, San Francisco, San Francisco, CA, United States.,Chan Zuckerberg Biohub, University of California, San Francisco, San Francisco, CA, United States
| | | | - Julius M Guccione
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Ghassan S Kassab
- Department of Medicine, California Medical Innovations Institute, San Diego, CA, United States
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15
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Zhang Y, Adams J, Wang VY, Horwitz L, Tartibi M, Morgan AE, Kim J, Wallace AW, Weinsaft JW, Ge L, Ratcliffe MB. A finite element model of the cardiac ventricles with coupled circulation: Biventricular mesh generation with hexahedral elements, airbags and a functional mockup interface to the circulation. Comput Biol Med 2021; 137:104840. [PMID: 34508972 DOI: 10.1016/j.compbiomed.2021.104840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Finite element (FE) mechanics models of the heart are becoming more sophisticated. However, there is lack of consensus about optimal element type and coupling of FE models to the circulation. We describe biventricular (left (LV) and right (RV) ventricles) FE mechanics model creation using hexahedral elements, airbags and a functional mockup interface (FMI) to lumped-parameter models of the circulation. METHODS Cardiac MRI (CMR) was performed in two healthy volunteers and a single patient with ischemic heart disease (IHD). CMR images were segmented and surfaced, meshing with hexahedral elements was performed with a "thin butterfly with septum" topology. LV and RV inflow and outflow airbags were coupled to lumped-parameter circulation models with an FMI interface. Pulmonary constriction (PAC) and vena cava occlusion (VCO) were simulated and end-systolic pressure-volume relations (ESPVR) were calculated. RESULTS Mesh construction was prompt with representative contouring and mesh adjustment requiring 32 and 26 min Respectively. The numbers of elements ranged from 4104 to 5184 with a representative Jacobian of 1.0026 ± 0.4531. Agreement between CMR-based surfaces and mesh was excellent with root-mean-squared error of 0.589 ± 0.321 mm. The LV ESPVR slope was 3.37 ± 0.09 in volunteers but 2.74 in the IHD patient. The effect of PAC and VCO on LV ESPVR was consistent with ventricular interaction (p = 0.0286). CONCLUSION Successful co-simulation using a biventricular FE mechanics model with hexahedral elements, airbags and an FMI interface to lumped-parameter model of the circulation was demonstrated. Future studies will include comparison of element type and study of cardiovascular pathologies and device therapies.
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Affiliation(s)
- Yue Zhang
- Department of Surgery, University of California, San Francisco, CA, USA; Department of Bioengineering, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jennifer Adams
- School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Vicky Y Wang
- Department of Surgery, University of California, San Francisco, CA, USA; Department of Bioengineering, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Lucas Horwitz
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Ashley E Morgan
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Arthur W Wallace
- Department of Anesthesia, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Liang Ge
- Department of Surgery, University of California, San Francisco, CA, USA; Department of Bioengineering, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Mark B Ratcliffe
- Department of Surgery, University of California, San Francisco, CA, USA; Department of Bioengineering, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
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Computational Analysis of Virtual Echocardiographic Assessment of Functional Mitral Regurgitation for Validation of Proximal Isovelocity Surface Area Methods. J Am Soc Echocardiogr 2021; 34:1211-1223. [PMID: 34214636 DOI: 10.1016/j.echo.2021.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mitral regurgitation (MR) quantification by the proximal isovelocity surface area (PISA) method remains challenging. Using computer models, the authors evaluated the accuracy of different PISA methods and quantified their errors. METHODS Five functional MR computer models of different geometric and tethering abnormalities were created, validated, and treated as phantom models, from which the reference values were directly obtained. Virtual two-dimensional (2D) PISA and three-dimensional (3D) PISA (both peak and integrated values) were performed on these phantom models. By comparing virtual PISA results with reference values, the accuracy of different PISA methods was evaluated, and their sources of errors were quantified. RESULTS Compared with reference values of regurgitant flow rate, excellent correlations were found for true PISA (r = 0.99, bias = 32.3 ± 35.3 mL/sec), 3D PISA (r = 0.97, bias = -24.4 ± 55.5 mL/sec), followed by multiplane 2D hemicylindrical PISA (r = 0.88, bias = -24.1 ± 85.4 mL/sec) and hemiellipsoidal PISA (r = 0.91, bias = -55.7 ± 96.6 mL/sec). Weaker correlations were found for single-plane 2D hemispherical PISA (parasternal long-axis: r = 0.71, bias = -77.6 ± 124.5 mL/sec; apical two-chamber: r = 0.69, bias = -52.0 ± 122.0 mL/sec; apical four-chamber: r = 0.82, bias = -65.5 ± 107.3 mL/sec). For regurgitant volume quantification, integrated PISA was more accurate than peak PISA. The bias of 3D PISA improved from -12.7 ± 7.8 mL (peak PISA) to -2.1 ± 5.3 mL (integrated PISA). CONCLUSIONS For functional MR quantification, 2D hemispherical PISA had significant underestimation, multiplane 2D hemiellipsoidal and hemicylindrical PISA showed improved accuracy, and 3D PISA was the most accurate. The PISA method is subject to both systematic underestimation due to the Doppler angle effect and systematic overestimation when regurgitant flow is not perpendicular to PISA contour. Integrated PISA is able to capture dynamic MR and is therefore more accurate than peak PISA. The sum of regurgitant flow rates is the most feasible way to perform integrated PISA.
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Hahn RT, Kodali SK. State-of-the-art intra-procedural imaging for the mitral and tricuspid PASCAL Repair System. Eur Heart J Cardiovasc Imaging 2021; 23:e94-e110. [PMID: 34136901 PMCID: PMC8863082 DOI: 10.1093/ehjci/jeab040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
Advanced intra-procedural imaging techniques have been integral to technical and procedural success transcatheter devices. A novel leaflet approximation therapy, the PASCAL Transcatheter Valve Repair System (Edwards Lifesciences, Irvine, CA, USA) has demonstrated high procedural success, acceptable safety, and significant clinical improvement in patients with severe mitral and tricuspid regurgitation and has CE mark approval in Europe with pivotal trials underway in the USA. This review outlines the pre-procedural imaging views and advanced transoesophageal imaging protocols both mitral and tricuspid valve device implantation.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, New York Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Susheel K Kodali
- Columbia University Medical Center, New York Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
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Fluid-Structure Interaction Analyses of Biological Systems Using Smoothed-Particle Hydrodynamics. BIOLOGY 2021; 10:biology10030185. [PMID: 33801566 PMCID: PMC8001855 DOI: 10.3390/biology10030185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/21/2022]
Abstract
Due to the inherent complexity of biological applications that more often than not include fluids and structures interacting together, the development of computational fluid-structure interaction models is necessary to achieve a quantitative understanding of their structure and function in both health and disease. The functions of biological structures usually include their interactions with the surrounding fluids. Hence, we contend that the use of fluid-structure interaction models in computational studies of biological systems is practical, if not necessary. The ultimate goal is to develop computational models to predict human biological processes. These models are meant to guide us through the multitude of possible diseases affecting our organs and lead to more effective methods for disease diagnosis, risk stratification, and therapy. This review paper summarizes computational models that use smoothed-particle hydrodynamics to simulate the fluid-structure interactions in complex biological systems.
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Aly AH, Aly AH, Lai EK, Yushkevich N, Stoffers RH, Gorman JH, Cheung AT, Gorman JH, Gorman RC, Yushkevich PA, Pouch AM. In Vivo Image-Based 4D Modeling of Competent and Regurgitant Mitral Valve Dynamics. EXPERIMENTAL MECHANICS 2021; 61:159-169. [PMID: 33776070 PMCID: PMC7988343 DOI: 10.1007/s11340-020-00656-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/05/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND In vivo characterization of mitral valve dynamics relies on image analysis algorithms that accurately reconstruct valve morphology and motion from clinical images. The goal of such algorithms is to provide patient-specific descriptions of both competent and regurgitant mitral valves, which can be used as input to biomechanical analyses and provide insights into the pathophysiology of diseases like ischemic mitral regurgitation (IMR). OBJECTIVE The goal is to generate accurate image-based representations of valve dynamics that visually and quantitatively capture normal and pathological valve function. METHODS We present a novel framework for 4D segmentation and geometric modeling of the mitral valve in real-time 3D echocardiography (rt-3DE), an imaging modality used for pre-operative surgical planning of mitral interventions. The framework integrates groupwise multi-atlas label fusion and template-based medial modeling with Kalman filtering to generate quantitatively descriptive and temporally consistent models of valve dynamics. RESULTS The algorithm is evaluated on rt-3DE data series from 28 patients: 14 with normal mitral valve morphology and 14 with severe IMR. In these 28 data series that total 613 individual 3DE images, each 3D mitral valve segmentation is validated against manual tracing, and temporal consistency between segmentations is demonstrated. CONCLUSIONS Automated 4D image analysis allows for reliable non-invasive modeling of the mitral valve over the cardiac cycle for comparison of annular and leaflet dynamics in pathological and normal mitral valves. Future studies can apply this algorithm to cardiovascular mechanics applications, including patient-specific strain estimation, fluid dynamics simulation, inverse finite element analysis, and risk stratification for surgical treatment.
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Affiliation(s)
- A H Aly
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - A H Aly
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - E K Lai
- Gorman Cardiovascular Research Group, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - N Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - J H Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - A T Cheung
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - J H Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R C Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - P A Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - A M Pouch
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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