title: Effect of leaflet-to-chordae contact interaction on computational mitral valve evaluation.
abstract: BACKGROUND
  Computational simulation using numerical analysis methods can help to assess the complex biomechanical and functional characteristics of the mitral valve (MV) apparatus. It is important to correctly determine physical contact interaction between the MV apparatus components during computational MV evaluation. We hypothesize that leaflet-to-chordae contact interaction plays an important role in computational MV evaluation, specifically in quantitating the degree of leaflet coaptation directly related to the severity of mitral regurgitation (MR). In this study, we have performed dynamic finite element simulations of MV function with and without leaflet-to-chordae contact interaction, and determined the effect of leaflet-to-chordae contact interaction on the computational MV evaluation.
  
  
  METHODS
  Computational virtual MV models were created using the MV geometric data in a patient with normal MV without MR and another with pathologic MV with MR obtained from 3D echocardiography. Computational MV simulation with full contact interaction was specified to incorporate entire physically available contact interactions between the leaflets and chordae tendineae. Computational MV simulation without leaflet-to-chordae contact interaction was specified by defining the anterior and posterior leaflets as the only contact inclusion.
  
  
  RESULTS
  Without leaflet-to-chordae contact interaction, the computational MV simulations demonstrated physically unrealistic contact interactions between the leaflets and chordae. With leaflet-to-chordae contact interaction, the anterior marginal chordae retained the proper contact with the posterior leaflet during the entire systole. The size of the non-contact region in the simulation with leaflet-to-chordae contact interaction was much larger than for the simulation with only leaflet-to-leaflet contact.
  
  
  CONCLUSIONS
  We have successfully demonstrated the effect of leaflet-to-chordae contact interaction on determining leaflet coaptation in computational dynamic MV evaluation. We found that physically realistic contact interactions between the leaflets and chordae should be considered to accurately quantitate leaflet coaptation for MV simulation. Computational evaluation of MV function that allows precise quantitation of leaflet coaptation has great potential to better quantitate the severity of MR.
authors.forename: Yonghoon
authors.initials: Y
authors.lastname: Rim
authors.forename: David D
authors.initials: DD
authors.lastname: McPherson
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA. Hyunggun.Kim@uth.tmc.edu.
authors.forename: Hyunggun
authors.initials: H
authors.lastname: Kim
mesh_terms: D000465:Algorithms; D001698:Biomedical Engineering / Q000379:methods; D002815:Chordae Tendineae / Q000473:pathology*; D003198:Computer Simulation; D004562:Electrocardiography / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D008943:Mitral Valve / Q000473:pathology*; D008944:Mitral Valve Insufficiency / Q000473:pathology* / Q000628:therapy; D008953:Models, Anatomic; D012984:Software; D013314:Stress, Mechanical