title: The effect of mitral annuloplasty shape in ischemic mitral regurgitation: a finite element simulation.
abstract: 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.
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA 94121, USA.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Wong
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Wenk
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Zhang
authors.forename: Guangming
authors.initials: G
authors.lastname: Cheng
authors.forename: Gabriel
authors.initials: G
authors.lastname: Acevedo-Bolton
authors.forename: Mike
authors.initials: M
authors.lastname: Burger
authors.forename: David A
authors.initials: DA
authors.lastname: Saloner
authors.forename: Arthur W
authors.initials: AW
authors.lastname: Wallace
authors.forename: Julius M
authors.initials: JM
authors.lastname: Guccione
authors.forename: Mark B
authors.initials: MB
authors.lastname: Ratcliffe
authors.forename: Liang
authors.initials: L
authors.lastname: Ge
mesh_terms: D000818:Animals; D020342:Finite Element Analysis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications; D011474:Prosthesis Design; D013314:Stress, Mechanical