title: Augmented mitral valve leaflet area decreases leaflet stress: a finite element simulation.
abstract: BACKGROUND
  Using human mitral valve (MV) models derived from three-dimensional echocardiography, finite element analysis was used to predict mechanical leaflet and chordal stress. Subsequently, valve geometries were altered to examine the effects on stresses of the following: (1) varying coaptation area; (2) varying noncoapted leaflet tissue area; and (3) varying interleaflet coefficient of friction (μ).
  
  
  METHODS
  Three human MV models were loaded with a transvalvular pressure of 80 mm Hg using finite element analysis. Initially leaflet coaptation was set to 10%, 50%, or 100% of actual coaptation length to test the influence of coaptation length on stress distribution. Next, leaflet surface areas were augmented by 1% overall and by 2% in the noncoapted "belly" region to test the influence of increased leaflet billowing without changing the gross geometry of the MV. Finally, the coefficient of friction between the coapted leaflets was set to μ = 0, 0.05, or 0.3, to assess the influence of friction on MV function.
  
  
  RESULTS
  Leaflet coaptation length did not affect stress distribution in either the coapted or noncoapted leaflet regions; peak leaflet stress was 0.36 ± 0.17 MPa at 100%, 0.35 ± 0.14 MPa at 50%, and 0.35 ± 0.15 MPa at 10% coaptation lengths (p = 0.85). Similarly, coaptation length did not affect peak chordal tension (p = 0.74). Increasing the noncoapted leaflet area decreased the peak valvular stresses by 5 ± 2% (p = 0.02). Varying the coefficient of friction between leaflets did not alter leaflet or chordal stress distribution (p = 0.18).
  
  
  CONCLUSIONS
  Redundant MV leaflet tissue reduces mechanical stress on the noncoapted leaflets; the extent of coaptation or frictional interleaflet interaction does not independently influence leaflet stresses. Repair techniques that increase or preserve noncoapted leaflet area may decrease mechanical stresses and thereby enhance repair durability.
authors.affiliation: Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania, USA.
authors.forename: Chun
authors.initials: C
authors.lastname: Xu
authors.forename: Arminder S
authors.initials: AS
authors.lastname: Jassar
authors.forename: Derek P
authors.initials: DP
authors.lastname: Nathan
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Eperjesi
authors.forename: Clayton J
authors.initials: CJ
authors.lastname: Brinster
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Levack
authors.forename: Mathieu
authors.initials: M
authors.lastname: Vergnat
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
mesh_terms: D001696:Biomechanical Phenomena; D020342:Finite Element Analysis; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008955:Models, Cardiovascular; D013314:Stress, Mechanical; D014463:Ultrasonography