Document Detail

The effect of mitral annuloplasty shape in ischemic mitral regurgitation: a finite element simulation.
MedLine Citation:
PMID:  22245588     Owner:  NLM     Status:  MEDLINE    
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.
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
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-01-15
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  93     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-27     Completed Date:  2012-04-23     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  776-82     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Surgery, University of California, San Francisco, San Francisco, CA 94121, USA.
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MeSH Terms
Finite Element Analysis
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation / methods*
Mitral Valve Annuloplasty*
Mitral Valve Insufficiency / etiology,  surgery*
Myocardial Ischemia / complications
Prosthesis Design
Stress, Mechanical
Grant Support
86400//PHS HHS; K25 NS058573/NS/NINDS NIH HHS; R01 HL084431/HL/NHLBI NIH HHS; R01-HL-077921/HL/NHLBI NIH HHS; R01-HL-084431/HL/NHLBI NIH HHS

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