title: Human Cardiac Function Simulator for the Optimal Design of a Novel Annuloplasty Ring with a Sub-valvular Element for Correction of Ischemic Mitral Regurgitation.
abstract: Ischemic mitral regurgitation is associated with substantial risk of death. We sought to: (1) detail significant recent improvements to the Dassault Systèmes human cardiac function simulator (HCFS); (2) use the HCFS to simulate normal cardiac function as well as pathologic function in the setting of posterior left ventricular (LV) papillary muscle infarction; and (3) debut our novel device for correction of ischemic mitral regurgitation. We synthesized two recent studies of human myocardial mechanics. The first study presented the robust and integrative finite element HCFS. Its primary limitation was its poor diastolic performance with an LV ejection fraction below 20% caused by overly stiff ex vivo porcine tissue parameters. The second study derived improved diastolic myocardial material parameters using in vivo MRI data from five normal human subjects. We combined these models to simulate ischemic mitral regurgitation by computationally infarcting an LV region including the posterior papillary muscle. Contact between our novel device and the mitral valve apparatus was simulated using Dassault Systèmes SIMULIA software. Incorporating improved cardiac geometry and diastolic myocardial material properties in the HCFS resulted in a realistic LV ejection fraction of 55%. Simulating infarction of posterior papillary muscle caused regurgitant mitral valve mechanics. Implementation of our novel device corrected valve dysfunction. Improvements in the current study to the HCFS permit increasingly accurate study of myocardial mechanics. The first application of this simulator to abnormal human cardiac function suggests that our novel annuloplasty ring with a sub-valvular element will correct ischemic mitral regurgitation.
authors.affiliation: Dassault Systèmes Simulia Corporation, Fremont, CA USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Baillargeon
authors.affiliation: Graduate Program in Material Science (PPG-CIMA), Faculty UnB Planaltina, University of Brasilia, Brasília, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Costa
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Leach
authors.affiliation: Department of Mechanical Engineering, Michigan State University, East Lansing, MI USA.
authors.forename: Lik Chuan
authors.initials: LC
authors.lastname: Lee
authors.affiliation: Institute for Biomedical Engineering, University and ETH Zürich, Zurich, Switzerland ; Department of Surgery, University of California at San Francisco, San Francisco, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Genet
authors.affiliation: Department of Surgery, University of California at San Francisco, San Francisco, USA.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Toutain
authors.affiliation: Department of Mechanical Engineering, University of Kentucky, Lexington, KY USA.
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Wenk
authors.affiliation: Departments of Mechanical Engineering, Bioengineering and Cardiothoracic Surgery, Stanford University, Stanford, CA USA.
authors.forename: Manuel K
authors.initials: MK
authors.lastname: Rausch
authors.affiliation: Dassault Systèmes Simulia Corporation, Fremont, CA USA.
authors.forename: Nuno
authors.initials: N
authors.lastname: Rebelo
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, USA ; Department of Surgery, University of California at San Francisco, San Francisco, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Acevedo-Bolton
authors.affiliation: Departments of Mechanical Engineering, Bioengineering and Cardiothoracic Surgery, Stanford University, Stanford, CA USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Kuhl
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Cleveland Clinic, Cleveland, OH USA.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Navia
authors.affiliation: Department of Surgery, University of California at San Francisco, San Francisco, USA ; Division of Adult Cardiothoracic Surgery, Department of Surgery, School of Medicine, Mount Zion Harold Brunn Institute for Cardiovascular Research, UCSF, 1657 Scott St., Room 219, San Francisco, CA 94143 USA.
authors.forename: Julius M
authors.initials: JM
authors.lastname: Guccione
mesh_terms: D000818:Animals; D003198:Computer Simulation; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000033:anatomy & histology* / Q000502:physiology* / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D009203:Myocardial Infarction / Q000503:physiopathology; D012984:Software; D013552:Swine; D014261:Tricuspid Valve / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology
keywords: Finite element method; Ischemic mitral regurgitation; Mitral annuloplasty; Myocardial infarction; Realistic simulation; Ventricular function