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Influence of Mitral Valve Anterior Leaflet in vivo Shape on Left Ventricular Ejection

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Abstract

Recent studies have demonstrated that, due to the active involvement of leaflet contractile elements, the anterior mitral leaflet (AML) is very stiff and maintains a compound curvature during ventricular systole. Studies based on structural mechanics have shown that both leaflet stiffness and compound curvature are key factors limiting AML deformation in the presence of high left ventricular (LV) systolic pressures. In the present study, we tested the hypothesis that maintenance of this physiological AML compound curvature also plays a role in the optimization of LV outflow during ejection. The LV cavity, mitral valve and aortic root of a healthy human were reconstructed from cardiac magnetic resonance images on 18 evenly rotated long-axis cut-planes at peak systole. Computational fluid dynamics was used to assess hemodynamics within the ventricular outflow tract in the presence of three different AML profiles: (i) physiologically compound as measured in vivo, (ii) flat, (iii) concave (i.e., prolapsed) towards the ventricle. Relative to the physiologic profile, AML flat and concave profiles induced progressively increasing hemodynamic alterations at the LV outflow and immediately downstream to the aortic valve, characterized at peak systole by flow detachment, a mean vorticity increase of 15.6 and 53.1% and an instantaneous power loss increase of 12 and 46%, respectively. These results support the hypothesis that the physiological AML shape plays an important role in optimizing LV ejection. This implies that AML profile alterations associated with valvular disease or surgical repair procedures can significantly reduce LV ejection efficiency.

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Acknowledgments

The present work has been supported by Regione Lombardia and CILEA Consortium through a LISA Initiative (Laboratory for Interdisciplinary Advanced Simulation) 2010 Grant (http://lisa.cilea.it).

Conflict of interest

The authors declare that they do not have any conflict of interest and financial and personal relationships with other people or organisations that could inappropriately influence their work.

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Authors and Affiliations

  1. Bioengineering Department, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy

    Annalisa Dimasi, Emanuele Cattarinuzzi, Marco Stevanella, Carlo A. Conti, Emiliano Votta, Francesco Maffessanti & Alberto Redaelli

  2. Centro Cardiologico Monzino IRCCS, Milan, Italy

    Francesco Maffessanti

  3. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Neil B. Ingels Jr.

  4. Department of Cardiovascular Physiology and Biophysics, Research Institute of the Palo Alto Medical Foundation, Palo Alto, CA, USA

    Neil B. Ingels Jr.

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  1. Annalisa Dimasi
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  2. Emanuele Cattarinuzzi
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  3. Marco Stevanella
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  4. Carlo A. Conti
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  5. Emiliano Votta
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  6. Francesco Maffessanti
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  7. Neil B. Ingels Jr.
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  8. Alberto Redaelli
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Correspondence to Marco Stevanella.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

Annalisa Dimasi and Emanuele Cattarinuzzi equally contributed to this study.

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Dimasi, A., Cattarinuzzi, E., Stevanella, M. et al. Influence of Mitral Valve Anterior Leaflet in vivo Shape on Left Ventricular Ejection. Cardiovasc Eng Tech 3, 388–401 (2012). https://doi.org/10.1007/s13239-012-0105-7

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