Research Papers

A Computational Procedure for Prediction of Structural Effects of Edge-to-Edge Repair on Mitral Valve

[+] Author and Article Information
Andrea Avanzini

Department of Mechanical and Industrial Engineering, University of Brescia, Italy, Via Branze 38, 25123 Brescia, Italyandrea.avanzini@ing.unibs.it

J Biomech Eng 130(3), 031015 (May 01, 2008) (10 pages) doi:10.1115/1.2913235 History: Received March 27, 2007; Revised January 11, 2008; Published May 01, 2008

Edge-to-edge technique is a surgical procedure for the correction of mitral valve leaflets prolapse by suturing the edge of the prolapsed leaflet to the free edge of the opposing one. Suture presence modifies valve mechanical behavior and orifice flow area in the diastolic phase, when the valve opens and blood flows into the ventricle. In the present work, in order to support identification of potentially critical conditions, a computational procedure is described to evaluate the effects of changing suture length and position in combination with valve size and shape. The procedure is based on finite element method analyses applied to a range of different mitral valves, investigating for each configuration the influence of repair on functional parameters, such as mitral valve orifice area and transvalvular pressure gradient, and on structural parameters, such as stress in the leaflets and stitch tension. This kind of prediction would ideally require a coupled fluid-structural analysis, where the interactions between blood flows and mitral apparatus deformation are simultaneously considered. In the present study, however, an alternative approach is proposed, in which results obtained by purely structural finite element analyses are elaborated and interpreted taking into account the Bernoulli type equations available in literature to describe blood flow through mitral orifice. In this way, the effects of each parameter in terms of orifice flow area, suture loads, and leaflets stresses can be expressed as functions of atrioventricular pressure gradient and then correlated to blood flow rate. Results obtained by using this procedure for different configurations are finally discussed.

Copyright © 2008 by American Society of Mechanical Engineers
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Figure 1

Schematic representation of a section of heart left ventricle and mitral apparatus

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Figure 2

Schematic representation of edge-to-edge suture (central position)

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Figure 3

Mitral valve geometric features

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Figure 4

Dilated mitral valves

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Figure 5

Nonlinear stress-strain relation for leaflets soft tissues

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Figure 6

Suture configurations

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Figure 7

FEM model of the mitral valve

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Figure 8

Relations between Δpmax and MVA, Qpeak

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Figure 9

Effect of suture length and position and valve dilatation on MVA

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Figure 10

Effect of suture Length and position on Δpmean

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Figure 11

Combined effect of suture valve size and suture length and position on MVA

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Figure 12

Comparison between model prediction and literature data

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Figure 13

Qualitative stress distribution in the leaflets

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Figure 14

Evaluation scheme for determination of stress in the leaflets




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