Development of a modeling pipeline for the prediction of hemodynamic outcome after virtual mitral valve repair using image-based CFD
- 107 Downloads
Severe mitral valve regurgitation can either be treated by a replacement or a repair of the valve. The latter is recommended due to lower perioperative mortality and better long-term survival. On the other hand, recurrence rates after mitral valve repair are high compared to those after replacements and the repair intervention can cause induced mitral valve stenosis. So far, there are no methods to predict the hemodynamic outcome of a chosen treatment or to compare different treatment options in advance. To overcome this, diastolic mitral valve hemodynamics are simulated using computational fluid dynamics after different virtual treatments of the valve.
The left ventricular geometry of one patient was reconstructed using trans-esophageal echocardiography and computed tomography data. Pre-op hemodynamics are simulated using a referenced wall model to avoid expansive modeling of wall motion. Subsequently, the flow structures are compared to in vivo measurements. After manipulating the patient-specific geometry in order to mimic a restrictive mitral annuloplasty as well as a MitraClip intervention, hemodynamics results are calculated.
Good agreements exist between calculated pre-op hemodynamics and in vivo measurements. The virtual annuloplasty did not result in any remarkable change of hemodynamics. Neither the pressure drop nor the velocity field showed strong differences. In contrast, the virtual MitraClip intervention led to a complete change in blood flow structures as well as an elevated pressure drop across the valve.
The presented approach allows fast simulation of the diastolic hemodynamic situation before and after treatment of a mitral valve insufficiency. However, this approach is limited to the early diastolic phase of the cardiac cycle and needs to be validated using a larger sample size.
KeywordsMitral valve insufficiency Patient specific Hemodynamic Virtual treatment planning CFD
Compliance with ethical standards
This work is part of the BMBF VIP+ project DSSMitral (funded by the German Federal Ministry of Education and Research under grant 03VP00851).
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Acker MA, Parides MK, Perrault LP, Moskowitz AJ, Gelijns AC, Voisine P, Smith PK, Hung JW, Blackstone EH, Puskas JD, Argenziano M, Gammie JS, Mack M, Ascheim DD, Bagiella E, Moquete EG, Ferguson TB, Horvath KA, Geller NL, Miller MA, Woo YJ, D’Alessandro DA, Ailawadi G, Dagenais F, Gardner TJ, O’Gara PT, Michler RE, Kron IL (2014) Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med 370(1):23–32 (PMID: 24245543)CrossRefPubMedGoogle Scholar
- 3.Bach DS (2010) Echo/doppler evaluation of hemodynamics after aortic valve replacement: principles of interrogation and evaluation of high gradients. JACC: Cardiovasc Imaging 3(3):296–304Google Scholar
- 4.Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL (2017) 2017 esc/eacts guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791CrossRefPubMedGoogle Scholar
- 14.Goldstein D, Moskowitz AJ, Gelijns AC, Ailawadi G, Parides MK, Perrault LP, Hung JW, Voisine P, Dagenais F, Gillinov AM, Thourani V, Argenziano M, Gammie JS, Mack M, Demers P, Atluri P, Rose EA, OSullivan K, Williams DL, Bagiella E, Michler RE, Weisel RD, Miller MA, Geller NL, Taddei-Peters WC, Smith PK, Moquete E, Overbey JR, Kron IL, OGara PT, Acker MA (2016) Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med 374(4):344–353 (PMID: 26550689)CrossRefPubMedGoogle Scholar
- 23.Neugebauer M, Tautz L, Hüllebrand M, Sündermann S, Degener F, Kuehne T, Falk V, Hennemuth A (2018) Virtual downsizing for decision support in mitral valve repair. In: Proceedings of CARS 2018 (Accepted)Google Scholar
- 29.Tautz L, Hüllebrand M, Vellguth K, Sündermann S, Degener F, Kuehne T, Falk V, Hennemuth A (2018) Development of a modeling pipeline for the prediction of hemodynamic outcome after virtual mitral valve repair using image based CFD. In: Proceedings of CARS 2018 (Accepted)Google Scholar
- 31.Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, Khandheria BK, Levine RA, Marx GR, Miller FA, Nakatani S, Quiones MA, Rakowski H, Rodriguez LL, Swaminathan M, Waggoner AD, Weissman NJ, Zabalgoitia M (2009) Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound. J Am Soc Echocardiogr 22(9):975–1014CrossRefPubMedGoogle Scholar