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Patient-Specific Three-Dimensional Ultrasound Derived Computational Modeling of the Mitral Valve

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Abstract

Several new techniques to repair the mitral valve affected by functional mitral regurgitation are in development. However, due to the heterogeneity of valve lesions between patients, predicting the outcomes of novel treatment approaches is challenging. We present a patient-specific, 3D ultrasound-derived computational model of the mitral valve for procedure planning, that faithfully mimics the pathological valve dynamics. 3D ultrasound images were obtained in three pigs induced with heart failure and which developed functional mitral regurgitation. For each case, images were segmented, and finite element model of mitral valve was constructed. Annular and papillary muscle dynamics were extracted and imposed as kinematic boundary conditions, and the chordae were pre-strained to induce valve tethering. Valve closure was simulated by applying physiologic transvalvular pressure on the leaflets. Agreement between simulation results and truth datasets was confirmed, with accurate location of regurgitation jets and coaptation defects. Inclusion of kinematic patient-specific boundary conditions was necessary to achieve these results, whereas use of idealized boundary conditions deviated from the truth dataset. Due to the impact of boundary conditions on the model, the effect of repair strategies on valve closure varied as well, indicating that our approach of using patient-specific boundary conditions for mitral valve modeling is valid.

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Acknowledgments

This work was funded by the National Heart, Lung and Blood Institute through Grants HL133667, HL135145, and HL140325, an American Heart Association Grant #834086, and an infrastructure grant from the Carlyle Fraser Heart Center to M.P. Some parts of the mitral valve modeling approach presented in this study were developed based on the code created by Biomechanics Group at DEIB, Politecnico di Milano (Italy). We would like to acknowledge their effort and thank them for sharing the code.

Conflict of interest

M.P. and K.S.S. disclose equity interest in Nyra Medical Inc. M.P. receives consulting fees from Heart Repair Technologies Inc. None of these entities funded or reviewed this work. G.G. and D.X. has no financial relationships to disclose.

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Authors and Affiliations

  1. Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at Emory University Hospital Midtown, 380B Northyards Blvd NW, Atlanta, GA, 30313, USA

    Gediminas Gaidulis, Kirthana Sreerangathama Suresh, Dongyang Xu & Muralidhar Padala

  2. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Gediminas Gaidulis & Muralidhar Padala

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  1. Gediminas Gaidulis
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  2. Kirthana Sreerangathama Suresh
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Correspondence to Muralidhar Padala.

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Associate Editor Ender A. Finol oversaw the review of this article.

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Gaidulis, G., Suresh, K.S., Xu, D. et al. Patient-Specific Three-Dimensional Ultrasound Derived Computational Modeling of the Mitral Valve. Ann Biomed Eng 50, 847–859 (2022). https://doi.org/10.1007/s10439-022-02960-x

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