Document Detail


Patient-specific finite element-based analysis of ventricular myofiber stress after Coapsys: importance of residual stress.
MedLine Citation:
PMID:  22560323     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We sought to determine regional myofiber stress after Coapsys device (Myocor, Inc, Maple Grove, MN) implantation using a finite element model of the left ventricle (LV). Chronic ischemic mitral regurgitation is caused by LV remodeling after posterolateral myocardial infarction. The Coapsys device consists of a single trans-LV chord placed below the mitral valve such that when tensioned it alters LV shape and decreases chronic ischemic mitral regurgitation.
METHODS: Finite element models of the LV were based on magnetic resonance images obtained before (preoperatively) and after (postoperatively) coronary artery bypass grafting with Coapsys implantation in a single patient. To determine the effect of Coapsys and LV before stress, virtual Coapsys was performed on the preoperative model. Diastolic and systolic material variables in the preoperative, postoperative, and virtual Coapsys models were adjusted so that model LV volume agreed with magnetic resonance imaging data. Chronic ischemic mitral regurgitation was abolished in the postoperative models. In each case, myofiber stress and pump function were calculated.
RESULTS: Both postoperative and virtual Coapsys models shifted end-systolic and end-diastolic pressure-volume relationships to the left. As a consequence and because chronic ischemic mitral regurgitation was reduced after Coapsys, pump function was unchanged. Coapsys decreased myofiber stress at end-diastole and end-systole in both the remote and infarct regions of the myocardium. However, knowledge of Coapsys and LV prestress was necessary for accurate calculation of LV myofiber stress, especially in the remote zone.
CONCLUSIONS: Coapsys decreases myofiber stress at end-diastole and end-systole. The improvement in myofiber stress may contribute to the long-term effect of Coapsys on LV remodeling.
Authors:
Richard Carrick; Liang Ge; Lik Chuan Lee; Zhihong Zhang; Rakesh Mishra; Leon Axel; Julius M Guccione; Eugene A Grossi; Mark B Ratcliffe
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Publication Detail:
Type:  Case Reports; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-05-05
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  93     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-28     Completed Date:  2012-07-26     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1964-71     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
College of Medicine of the University of Vermont, Burlington, Vermont, USA.
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure / physiology*
Cardiac Volume / physiology
Computer Simulation
Contrast Media
Coronary Artery Bypass*
Diastole / physiology
Equipment Design
Finite Element Analysis*
Gadolinium DTPA / diagnostic use
Humans
Magnetic Resonance Imaging, Cine / methods
Male
Middle Aged
Mitral Valve Annuloplasty / instrumentation*
Mitral Valve Insufficiency / physiopathology*,  surgery*
Myocardial Infarction / physiopathology*,  surgery*
Myofibrils / physiology*
Postoperative Complications / physiopathology*
Systole / physiology
Ventricular Dysfunction, Left / physiopathology*,  surgery*
Ventricular Remodeling / physiology*
Grant Support
ID/Acronym/Agency:
R01 HL063348/HL/NHLBI NIH HHS; R01 HL084431/HL/NHLBI NIH HHS; R01-HL077921/HL/NHLBI NIH HHS; R01-HL084431/HL/NHLBI NIH HHS; R01-HL086400/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Contrast Media; 80529-93-7/Gadolinium DTPA
Comments/Corrections

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