title: Finite Element Analysis of Patient-Specific Mitral Valve with Mitral Regurgitation.
abstract: Functional mitral regurgitation (FMR) is a significant complication of left ventricular dysfunction and strongly associated with a poor prognosis. In this study, we developed a patient-specific finite element (FE) model of the mitral apparatus in a FMR patient which included: both leaflets with thickness, annulus, chordae tendineae, and chordae insertions on the leaflets and origins on the papillary muscles. The FE model incorporated human age- and gender-matched anisotropic hyperelastic material properties, and MV closure at systole was simulated. The model was validated by comparing the FE results from valve closure simulation with the in vivo geometry of the MV at systole. It was found that the FE model could not replicate the in vivo MV geometry without the application of tethering pre-tension force in the chordae at diastole. Upon applying the pre-tension force and performing model optimization by adjusting the chordal length, position, and leaflet length, a good agreement between the FE model and the in vivo model was established. Not only were the chordal forces high at both diastole and systole, but the tethering force on the anterior papillary muscle was higher than that of the posterior papillary muscle, which resulted in an asymmetrical gap with a larger orifice area at the anterolateral commissure resulting in MR. The analyses further show that high peak stress and strain were found at the chordal insertions where large chordal tethering forces were found. This study shows that the pre-tension tethering force plays an important role in accurately simulating the MV dynamics in this FMR patient, particularly in quantifying the degree of leaflet coaptation and stress distribution. Due to the complexity of the disease, the patient-specific computational modeling procedure of FMR patients presented should be further evaluated using a large patient cohort. However, this study provides useful insights into the MV biomechanics of a FMR patient, and could serve as a tool to assist in pre-operative planning for MV repair or replacement surgical or interventional procedures.
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
authors.forename: Thuy
authors.initials: T
authors.lastname: Pham
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
authors.forename: Fanwei
authors.initials: F
authors.lastname: Kong
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Martin
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Cardiology Department of Hartford Hospital, Hartford, CT, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Primiano
authors.affiliation: Cardiology Department of Hartford Hospital, Hartford, CT, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: McKay
authors.affiliation: Aortic Institute of Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: John
authors.initials: J
authors.lastname: Elefteriades
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA. wei.sun@bme.gatech.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
mesh_terms: D000368:Aged; D002815:Chordae Tendineae / Q000503:physiopathology; D020342:Finite Element Analysis; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008954:Models, Biological; D061330:Multidetector Computed Tomography / Q000379:methods; D010210:Papillary Muscles / Q000503:physiopathology; D015203:Reproducibility of Results; D013599:Systole / Q000502:physiology
keywords: Chordae tendineae; Finite element simulation; Mitral regurgitation; Mitral valve; Multi-slice computed tomography; Patient-specific