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Modelling of Lesions Associated with Functional Mitral Regurgitation in an Ex Vivo Platform

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Abstract

Functional mitral regurgitation (FMR) is a complex pathology involving valvular and subvalvular structures reconfiguration, and its treatment is considered challenging. There is a lack of experimental models allowing for reliable preclinical FMR treatments’ evaluation in a realistic setting. A novel approach to simulate FMR was developed and incorporated into an ex vivo passive beating heart platform. FMR was obtained by dilating the mitral annulus (MA) mainly in the antero-posterior direction and displacing the papillary muscles (PMs) apically and laterally by ad hoc designed and 3D printed dilation and displacing devices. It caused hemodynamic and valve morphology alterations. Isolated MA dilation (MAD) led to significantly increased antero-posterior distance (A-P) and decreased coaptation height (CH), tenting area (TA) and systolic leaflets angulation, resembling clinically recognized type I of mitral regurgitation with normal leaflet motion. Whereas concomitant MAD with PM displacement caused an increase in A-P, TA, CH. This geometrical configuration replicated typical determinants of type IIIb lesion with restricted leaflet motion. The proposed methods provided a realistic and repeatable ex vivo FMR model featuring two lesions clinically associated with the pathology. It bears a promise to be successfully utilized in preclinical studies, clinical training and medical education.

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Abbreviations

MV:

Mitral valve

FMR:

Functional mitral regurgitation

MA:

Mitral annulus

PM:

Papillary muscle

CMV:

Competent mitral valve

MAD:

Mitral annulus dilation

PMD:

Papillary muscle displacement

CO :

Cardiac output

AoP :

Mean aortic pressure

LAP :

Left atrial pressure

LAP tot :

Mean whole-cycle left atrial pressure

LAP syst :

Mean systolic left atrial pressure

LAP diast :

Mean diastolic left atrial pressure

ABF :

Aortic backflow fraction

Δp :

Differential systolic pressure across mitral valve

A-P :

Antero-posterior distance

CH :

Coaptation height

TA :

Tenting area

PLA :

Posterior leaflet angle

ALA :

Anterior leaflet angle

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Acknowledgments

The authors would like to thank Valeria Quattrocchi (Philips SpA Healthcare, Monza, Italy) for the technical support in obtaining the echocardiographic images.

Disclosures

None.

Funding

This work was supported in part by the European Commission within the Horizon 2020 Framework through the MSCA-ITN-ETN European Training Networks (Project Number 642458) and by Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.

Author information

Authors and Affiliations

  1. Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy

    Michal Jaworek, Federico Lucherini, Gianfranco B. Fiore & Riccardo Vismara

  2. ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy

    Michal Jaworek, Federico Lucherini, Claudia Romagnoni, Guido Gelpi, Monica Contino, Carlo Antona, Gianfranco B. Fiore & Riccardo Vismara

  3. Cardiovascular Department, ‘Luigi Sacco’ General Hospital, Milan, Italy

    Claudia Romagnoni, Guido Gelpi, Monica Contino & Carlo Antona

  4. Abbott Vascular International, Brussels, Belgium

    Paolo Romitelli

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  1. Michal Jaworek
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  2. Federico Lucherini
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  3. Claudia Romagnoni
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  4. Guido Gelpi
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  8. Gianfranco B. Fiore
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Corresponding author

Correspondence to Michal Jaworek.

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Associate Editor Scott I. Simon oversaw the review of this article.

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Jaworek, M., Lucherini, F., Romagnoni, C. et al. Modelling of Lesions Associated with Functional Mitral Regurgitation in an Ex Vivo Platform. Ann Biomed Eng 45, 2324–2334 (2017). https://doi.org/10.1007/s10439-017-1885-6

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  • DOI: https://doi.org/10.1007/s10439-017-1885-6

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