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Development of a modeling pipeline for the prediction of hemodynamic outcome after virtual mitral valve repair using image-based CFD

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Author information

Authors and Affiliations

  1. Charité – Universitätsmedizin Berlin, Berlin, Germany

    Katharina Vellguth, Jan Brüning, Leonid Goubergrits, Lennart Tautz, Anja Hennemuth, Ulrich Kertzscher, Franziska Degener, Marcus Kelm & Titus Kuehne

  2. German Heart Institute Berlin – DHZB, Berlin, Germany

    Franziska Degener, Marcus Kelm, Simon Sündermann & Titus Kuehne

Authors
  1. Katharina Vellguth
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  2. Jan Brüning
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  3. Leonid Goubergrits
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  4. Lennart Tautz
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  5. Anja Hennemuth
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  6. Ulrich Kertzscher
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  7. Franziska Degener
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  8. Marcus Kelm
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  9. Simon Sündermann
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  10. Titus Kuehne
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Correspondence to Katharina Vellguth.

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Funding

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

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Vellguth, K., Brüning, J., Goubergrits, L. et al. Development of a modeling pipeline for the prediction of hemodynamic outcome after virtual mitral valve repair using image-based CFD. Int J CARS 13, 1795–1805 (2018). https://doi.org/10.1007/s11548-018-1821-8

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  • DOI: https://doi.org/10.1007/s11548-018-1821-8

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