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Mitral Valve Chordae Tendineae: Topological and Geometrical Characterization

  • The Pursuit of Engineering the Ideal Heart Valve Replacement or Repair
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Abstract

Mitral valve (MV) closure depends upon the proper function of each component of the valve apparatus, which includes the annulus, leaflets, and chordae tendineae (CT). Geometry plays a major role in MV mechanics and thus highly impacts the accuracy of computational models simulating MV function and repair. While the physiological geometry of the leaflets and annulus have been previously investigated, little effort has been made to quantitatively and objectively describe CT geometry. The CT constitute a fibrous tendon-like structure projecting from the papillary muscles (PMs) to the leaflets, thereby evenly distributing the loads placed on the MV during closure. Because CT play a major role in determining the shape and stress state of the MV as a whole, their geometry must be well characterized. In the present work, a novel and comprehensive investigation of MV CT geometry was performed to more fully quantify CT anatomy. In vitro micro-tomography 3D images of ovine MVs were acquired, segmented, then analyzed using a curve-skeleton transform. The resulting data was used to construct B-spline geometric representations of the CT structures, enriched with a continuous field of cross-sectional area (CSA) data. Next, Reeb graph models were developed to analyze overall topological patterns, along with dimensional attributes such as segment lengths, 3D orientations, and CSA. Reeb graph results revealed that the topology of ovine MV CT followed a full binary tree structure. Moreover, individual chords are mostly planar geometries that together form a 3D load-bearing support for the MV leaflets. We further demonstrated that, unlike flow-based branching patterns, while individual CT branches became thinner as they propagated further away from the PM heads towards the leaflets, the total CSA almost doubled. Overall, our findings indicate a certain level of regularity in structure, and suggest that population-based MV CT geometric models can be generated to improve current MV repair procedures.

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Abbreviations

MV:

Mitral valve

LV:

Left ventricle

PM:

Papillary muscle

CSA:

Cross sectional area

Micro-CT:

Micro computed tomography

TVP:

Trans-valvular pressure

MLE:

Maximum likelihood estimation

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Acknowledgments

Research reported in this publication was supported by National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R01-HL119297. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors gratefully acknowledge Bruno V. Rego for helpful discussions.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX, USA

    Amir H. Khalighi, Andrew Drach & Michael S. Sacks

  2. Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA

    Charles H. Bloodworth IV, Eric L. Pierce & Ajit P. Yoganathan

  3. Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Robert C. Gorman & Joseph H. Gorman III

Authors
  1. Amir H. Khalighi
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  2. Andrew Drach
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  3. Charles H. Bloodworth IV
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  4. Eric L. Pierce
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  5. Ajit P. Yoganathan
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Correspondence to Michael S. Sacks.

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Associate Editor Ellen Kuhl oversaw the review of this article.

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Khalighi, A.H., Drach, A., Bloodworth, C.H. et al. Mitral Valve Chordae Tendineae: Topological and Geometrical Characterization. Ann Biomed Eng 45, 378–393 (2017). https://doi.org/10.1007/s10439-016-1775-3

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