title: Stress-strain behavior of mitral valve leaflets in the beating ovine heart.
abstract: Excised anterior mitral leaflets exhibit anisotropic, non-linear material behavior with pre-transitional stiffness ranging from 0.06 to 0.09 N/mm(2) and post-transitional stiffness from 2 to 9 N/mm(2). We used inverse finite element (FE) analysis to test, for the first time, whether the anterior mitral leaflet (AML), in vivo, exhibits similar non-linear behavior during isovolumic relaxation (IVR). Miniature radiopaque markers were sewn to the mitral annulus, AML, and papillary muscles in 8 sheep. Four-dimensional marker coordinates were obtained using biplane videofluoroscopic imaging during three consecutive cardiac cycles. A FE model of the AML was developed using marker coordinates at the end of isovolumic relaxation (when pressure difference across the valve is approximately zero), as the reference state. AML displacements were simulated during IVR using measured left ventricular and atrial pressures. AML elastic moduli in the radial and circumferential directions were obtained for each heartbeat by inverse FEA, minimizing the difference between simulated and measured displacements. Stress-strain curves for each beat were obtained from the FE model at incrementally increasing transmitral pressure intervals during IVR. Linear regression of 24 individual stress-strain curves (8 hearts, 3 beats each) yielded a mean (+/-SD) linear correlation coefficient (r(2)) of 0.994+/-0.003 for the circumferential direction and 0.995+/-0.003 for the radial direction. Thus, unlike isolated leaflets, the AML, in vivo, operates linearly over a physiologic range of pressures in the closed mitral valve.
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Krishnamurthy
authors.forename: Akinobu
authors.initials: A
authors.lastname: Itoh
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bothe
authors.forename: Julia C
authors.initials: JC
authors.lastname: Swanson
authors.forename: Ellen
authors.initials: E
authors.lastname: Kuhl
authors.forename: Matts
authors.initials: M
authors.lastname: Karlsson
authors.forename: D
authors.initials: D
authors.lastname: Craig Miller
authors.forename: Neil B
authors.initials: NB
authors.lastname: Ingels
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D020342:Finite Element Analysis; D005471:Fluoroscopy; D006321:Heart / Q000502:physiology*; D008297:Male; D008943:Mitral Valve / Q000502:physiology*; D012756:Sheep; D014741:Video Recording