title: Is it possible to assess the best mitral valve repair in the individual patient? Preliminary results of a finite element study from magnetic resonance imaging data.
abstract: OBJECTIVE
  Finite element modeling was adopted to quantitatively compare, for the first time and on a patient-specific basis, the biomechanical effects of a broad spectrum of different neochordal implantation techniques for the repair of isolated posterior mitral leaflet prolapse.
  
  
  METHODS
  Cardiac magnetic resonance images were acquired from 4 patients undergoing surgery. A patient-specific 3-dimensional model of the mitral apparatus and the motion of the annulus and papillary muscles were reconstructed. The location and extent of the prolapsing region were confirmed by intraoperative findings, and the mechanical properties of the mitral leaflets, chordae tendineae and expanded polytetrafluoroethylene neochordae were included. Mitral systolic biomechanics was simulated under preoperative conditions and after 5 different neochordal procedures: single neochorda, double neochorda, standard neochordal loop with 3 neochordae of the same length and 2 premeasured loops with 1 common neochordal loop and 3 different branched neochordae arising from it, alternatively one third and two thirds of the entire length.
  
  
  RESULTS
  The best repair in terms of biomechanics was achieved with a specific neochordal technique in the single patient, according to the location of the prolapsing region. However, all techniques achieved a slight reduction in papillary muscle forces and tension relief in intact native chordae proximal to the prolapsing region. Multiple neochordae implantation improved the repositioning of the prolapsing region below the annular plane and better redistributed mechanical stresses on the leaflet.
  
  
  CONCLUSIONS
  Although applied on a small cohort of patients, systematic biomechanical differences were noticed between neochordal techniques, potentially affecting their short- to long-term clinical outcomes. This study opens the way to patient-specific optimization of neochordal techniques.
authors: Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy; Department of Electronics, Informatics and Bioengineering, Politecnico di Milano, Milan, Italy. Electronic address: francesco.sturla@univr.it.
authors: Francesco
authors: F
authors: Sturla
authors: Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy.
authors: Francesco
authors: F
authors: Onorati
authors: Department of Electronics, Informatics and Bioengineering, Politecnico di Milano, Milan, Italy.
authors: Emiliano
authors: E
authors: Votta
authors: Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy.
authors: Konstantinos
authors: K
authors: Pechlivanidis
authors: Department of Electronics, Informatics and Bioengineering, Politecnico di Milano, Milan, Italy.
authors: Marco
authors: M
authors: Stevanella
authors: Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy.
authors: Aldo D
authors: AD
authors: Milano
authors: Department of Radiology, Università degli Studi di Verona, Verona, Italy.
authors: Giovanni
authors: G
authors: Puppini
authors: Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy.
authors: Alessandro
authors: A
authors: Mazzucco
authors: Department of Electronics, Informatics and Bioengineering, Politecnico di Milano, Milan, Italy.
authors: Alberto
authors: A
authors: Redaelli
authors: Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy.
authors: Giuseppe
authors: G
authors: Faggian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002815:Chordae Tendineae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D003198:Computer Simulation; D005260:Female; D020342:Finite Element Analysis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation; D008945:Mitral Valve Prolapse / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008955:Models, Cardiovascular; D018579:Patient Selection; D011138:Polytetrafluoroethylene; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D020127:Recovery of Function; D013314:Stress, Mechanical; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene