First finite element model of the left ventricle with mitral valve: insights into ischemic mitral regurgitation.
BACKGROUND
Left ventricular remodeling after posterobasal myocardial infarction can lead to ischemic mitral regurgitation. This occurs as a consequence of leaflet tethering due to posterior papillary muscle displacement.


METHODS
A finite element model of the left ventricle, mitral apparatus, and chordae tendineae was created from magnetic resonance images from a sheep that developed moderate mitral regurgitation after posterobasal myocardial infarction. Each region of the model was characterized by a specific constitutive law that captured the material response when subjected to physiologic pressure loading.


RESULTS
The model simulation produced a gap between the posterior and anterior leaflets, just above the infarcted posterior papillary muscle, which is indicative of mitral regurgitation. When the stiffness of the infarct region was reduced, this caused the wall to distend and the gap area between the leaflets to increase by 33%. Additionally, the stress in the leaflets increased around the chordal connection points near the gap.


CONCLUSIONS
The methodology outlined in this work will allow a finite element model of both the left ventricle and mitral valve to be generated using noninvasive techniques.
Wenk
Jonathan F
JF
Department of Surgery, University of California, San Francisco, California, USA.
Zhang
Zhihong
Z
Cheng
Guangming
G
Malhotra
Deepak
D
Acevedo-Bolton
Gabriel
G
Burger
Mike
M
Suzuki
Takamaro
T
Saloner
David A
DA
Wallace
Arthur W
AW
Guccione
Julius M
JM
Ratcliffe
Mark B
MB
D000818:Animals; D001783:Blood Flow Velocity; D002815:Chordae Tendineae / Q000473:pathology / Q000503:physiopathology; D004195:Disease Models, Animal; D018618:Echocardiography, Doppler, Color; D020342:Finite Element Analysis; D006352:Heart Ventricles / Q000503:physiopathology; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology*; D008955:Models, Cardiovascular; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D010210:Papillary Muscles / Q000503:physiopathology; D012680:Sensitivity and Specificity; D012756:Sheep; D020257:Ventricular Remodeling / Q000502:physiology*