title: Measurement of mitral leaflet and annular geometry and stress after repair of posterior leaflet prolapse: virtual repair using a patient-specific finite element simulation.
abstract: BACKGROUND
  Recurrent mitral regurgitation after mitral valve (MV) repair for degenerative disease occurs at a rate of 2.6% per year and reoperation rate progressively reaches 20% at 19.5 years. We believe that MV repair durability is related to initial postoperative leaflet and annular geometry with subsequent leaflet remodeling due to stress. We tested the hypothesis that MV leaflet and annular stress is increased after MV repair.
  
  
  METHODS
  Magnetic resonance imaging was performed before and intraoperative three-dimensional (3D) transesophageal echocardiography was performed before and after repair of posterior leaflet prolapse in a single patient. The repair consisted of triangular resection and annuloplasty band placement. Images of the heart were manually co-registered. The left ventricle and MV were contoured, surfaced, and a 3D finite element (FE) model was created. Elements of the posterior leaflet region were removed to model leaflet resection and virtual sutures were used to repair the leaflet defect and attach the annuloplasty ring.
  
  
  RESULTS
  The principal findings of the current study are the following: (1) FE simulation of MV repair is able to accurately predict changes in MV geometry including changes in annular dimensions and leaflet coaptation; (2) average posterior leaflet stress is increased; and (3) average anterior leaflet and annular stress are reduced after triangular resection and mitral annuloplasty.
  
  
  CONCLUSIONS
  We successfully conducted virtual mitral valve prolapse repair using FE modeling methods. Future studies will examine the effects of leaflet resection type as well as annuloplasty ring size and shape.
authors.affiliation: Department of Surgery, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Liang
authors.initials: L
authors.lastname: Ge
authors.affiliation: School of Medicine, University of California, San Francisco, California.
authors.forename: William G
authors.initials: WG
authors.lastname: Morrel
authors.affiliation: Department of Cardiothoracic Surgery, New York School of Medicine, New York, New York.
authors.forename: Alison
authors.initials: A
authors.lastname: Ward
authors.affiliation: Department of Medicine, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Mishra
authors.affiliation: Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Julius M
authors.initials: JM
authors.lastname: Guccione
authors.affiliation: Department of Cardiothoracic Surgery, New York School of Medicine, New York, New York.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
authors.affiliation: Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California. Electronic address: mark.ratcliffe@va.gov.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Ratcliffe
mesh_terms: D003198:Computer Simulation; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004502:Education, Medical, Continuing; D005260:Female; D020342:Finite Element Analysis; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects* / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D013314:Stress, Mechanical; D016896:Treatment Outcome