Skip to main content

Towards Cognition-Guided Patient-Specific FEM-Based Cardiac Surgery Simulation

Part of the Lecture Notes in Computer Science book series (LNIP,volume 10263)


Biomechanical surgery simulation can provide surgeons with useful ancillary information for intervention planning, diagnosis and therapy. The simulation therefore most importantly needs to be patient-specific, surgical knowledge-based and comprehensive in terms of the underlying simulation model and the patient’s data. Moreover, the simulation setup and execution should be largely automated and integrated into the surgical treatment workflow. However, this still rarely holds and simulation-based surgery support is not yet commonly established in the clinic. In this work, we address this problem in the context of cardiac surgery, and present the setup and results of a prototypic cognition-guided, patient-specific FEM-based cardiac surgery simulation system. We have designed a semantic data infrastructure and implemented cognitive software components that autonomously interact with the medical data via a common ontology. Using this setup, we anable the creation of knowledge-based, patient-specific surgery simulation scenarios for mitral valve reconstruction surgery, that are executed by means of the FEM simulation software HiFlow3. The obtained simulation results are provided to the surgeon in order to support surgical decision making.


  • Cognition-guidance
  • Surgical information processing
  • FEM surgery simulation
  • Biomechanical modeling and simulation workflow
  • Cardiac surgery
  • Mitral valve reconstruction

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions


  1. Bathe, K.-J.: Finite Element Procedures. Prentice Hall, Englewood Cliffs (1996)

    MATH  Google Scholar 

  2. Berners-Lee, T.: Linked Data. W3C. Design Issues, 27 July 2006

    Google Scholar 

  3. Biem, A., Butrico, M., Feblowitz, M., Klinger, T., Malitsky, Y., Ng, K., Perer, A., Reddy, C., Riabov, A., Samulowitz, H., Sow, D., Tesauro, G., Turaga, D.: Towards cognitive automation of data science. In: Proceedings of AAAI Conference on Artificial Intelligence 2015 (2015)

    Google Scholar 

  4. Carpentier, A.: Cardiac valve surgery the ‘French’ correction. J. Thorac. Cardiovasc. Surg. 86, 323–337 (1983)

    Google Scholar 

  5. Chandran, K., Kim, H.: Computational mitral valve evaluation and potential clinical applications. Ann. Biomed. Eng. 43(6), 1348–1362 (2014)

    CrossRef  Google Scholar 

  6. Choi, A., Rim, Y., Mun, J.S., Kim, H.: A novel finite element-based patient-specific mitral valve repair: virtual ring annuloplasty. Biomed. Mater. Eng. 24(1), 341–347 (2014)

    Google Scholar 

  7. Engelhardt, S., Lichtenberg, N., Al-Maisary, S., Simone, R., Rauch, H., Roggenbach, J., Müller, S., Karck, M., Meinzer, H.-P., Wolf, I.: Towards automatic assessment of the mitral valve coaptation zone from 4D ultrasound. In: van Assen, H., Bovendeerd, P., Delhaas, T. (eds.) FIMH 2015. LNCS, vol. 9126, pp. 137–145. Springer, Cham (2015). doi:10.1007/978-3-319-20309-6_16

    CrossRef  Google Scholar 

  8. Fedak, P.W.M., McCarthy, P.M., Bonow, R.O.: Evolving concepts and technologies in mitral valve repair. Circulation 117(7), 963–974 (2008)

    CrossRef  Google Scholar 

  9. Fetzer, A., Metzger, J., Katic, D., Mrz, K., Wagner, M., Philipp, P., Engelhardt, S., Weller, T., Zelzer, S., Franz, A.M., Schoch, N., Heuveline, V., Maleshkova, M., Rettinger, A., Speidel, S., Wolf, I., Kenngott, H., Mehrabi, A., Mller, B., Maier-Hein, L., Meinzer, H.-P., Nolden, M.: Towards an open-source semantic data infrastructure for integrating clinical and scientific data in cognition-guided surgery. In: Proceedings of SPIE 9789 Medical Imaging 2016, vol. 9789, pp. 978900–978908 (2016)

    Google Scholar 

  10. Augustin, W., Baumann, M., Gengenbach, T., Hahn, T., Helfrich-Schkarbanenko, A., Heuveline, V., Ketelaer, E., Lukarski, D., Nestler, A., Ritterbusch, S., Ronnas, S., Schick, M., Schmidtobreick, M., Subramanian, C., Weiss, J.-P., Wilhelm, F., Wlotzka, M.: HiFlow3- a hardware-aware parallel finite element package. In: Brunst, H., Müller, M., Nagel, W., Resch, M. (eds.) Tools for High Performance Computing, pp. 139–151. Springer, Heidelberg (2012)

    Google Scholar 

  11. Mansi, T., Voigt, I., Georgescu, B., Zheng, X., Mengue, E.A., Hackl, M., Ionasec, R.I., Noack, T., Seeburger, J., Comaniciu, D.: An integrated framework for finite element modeling of mitral valve biomechanics from medical images. J. Med. Image. Anal. 16(7), 1330–1346 (2012)

    CrossRef  Google Scholar 

  12. Morgan, A.E., Pantoja, J.L., Weinsaft, J., Grossi, E., Guccione, J.M., Ge, L., Ratcliffe, M.: Finite Element modeling of mitral valve repair. J. Biomech. Eng. 138(2), 021009 (2016)

    CrossRef  Google Scholar 

  13. Philipp, P., Maleshkova, M., Katic, D., Weber, C., Goetz, M., Rettinger, A., Speidel, S., Kaempgen, B., Nolden, M., Wekerle, A.-L., Dillmann, R., Kenngott, H., Mueller, B., Studer, R.: Toward cognitive pipelines of medical assistance algorithms. Int. J. CARS 11(9), 1743–1753 (2015)

    CrossRef  Google Scholar 

  14. Prot, V., Skallerud, B.: Nonlinear solid finite element analysis of mitral valves with heterogeneous leaflet layers. J. Comput. Mech. 43, 353–368 (2009)

    CrossRef  MATH  Google Scholar 

  15. Prot, V., Skallerud, B., Sommer, G., Holzapfel, G.A.: On modelling and analysis of healthy and pathological human mitral valves: two case studies. J. Mech. Behav. Biomed. Mater. 3, 167–177 (2010)

    CrossRef  Google Scholar 

  16. Schoch, N., Engelhardt, S., De Simone, R., Wolf, I., Heuveline, V.: High performance computing for cognition-guided cardiac surgery: soft tissue simulation for mitral valve reconstruction in knowledge-based surgery assistance. In: Proceedings of High Performance Scientific Computing (HPSC) (2015, in press)

    Google Scholar 

  17. Schoch, N., Engelhardt, S., Zimmermann, N., Speidel, S., de Simone, R., Wolf, I., Heuveline, V.: Integration of a biomechanical simulation for mitral valve reconstruction into a knowledge-based surgery assistance system. In: Proceedings of SPIE 9415 Medical Imaging 2015, vol. 9415, pp. 941502–941502-7 (2015)

    Google Scholar 

  18. Schoch, N., Kissler, F., Stoll, M., Engelhardt, S., de Simone, R., Wolf, I., Bendl, R., Heuveline, V.: Comprehensive patient-specific information preprocessing for cardiac surgery simulations. Int. J. CARS 11(6), 1051–1059 (2016). (Special Issue IPCAI)

    CrossRef  Google Scholar 

  19. Schoch, N., Philipp, P., Weller, T., Engelhardt, S., Volovyk, M., Fetzer, A., Nolden, M., de Simone, R., Wolf, I., Maleshkova, M., Rettinger, A., Studer, R., Heuveline, V.: Cognitive tools pipeline for assistance of mitral valve surgery. In: Proceedings of SPIE 9786 Medical Imaging 2016, 9786: 978603–978603-8 (2016)

    Google Scholar 

  20. Schoch, N., Speidel, S., Sure-Vetter, Y., Heuveline, V.: Towards semantic simulation for patient-specific surgery assistance. In: Online-Proceedings of Surgical Data Science 2016 (2016)

    Google Scholar 

  21. Suwelack, S., Stoll, M., Schalck, S., Schoch, N., Dillmann, R., Berndl, R., Heuveline, V., Speidel, S.: The medical simulation markup language - simplifying the biomechanical modeling workflow. J. Stud. Health. Techn. Inf. 196, 394–400 (2014)

    Google Scholar 

  22. Votta, E., Le, T.B., Stevanella, M., Fusini, L., Caiani, E.G., Redaelli, A., Sotiropoulos, F.: Toward patient-specific simulations of cardiac valves: state-of-the-art and future directions. J. Biomech. 46, 217–228 (2013)

    CrossRef  Google Scholar 

  23. Zhang, F., Kanik, J., Mansi, T., Voigt, I., Sharma, P., Ionasec, R.I., Subrahmanyan, L., Lin, B.A., Sugeng, L., Yuh, D., Comaniciu, D., Duncan, J.: Towards patient-specific modeling of mitral valve repair: 3D transesophageal echocardiography-derived parameter estimation. J. Med. Image Anal. 35, 599–609 (2017)

    CrossRef  Google Scholar 

Download references


This work was carried out with the support of the German Research Foundation (DFG) in the framework of the Collaborative Research Center SFB/TRR 125 ‘Cognition-Guided Surgery’. We particularly thank our colleagues Sandy Engelhardt, Ivo Wolf (Institute of Informatics, University of Applied Science, Mannheim, Germany) and Raffaele de Simone (Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany) in the context of cardiac surgery and medical imaging, for the fruitful cooperation and for valuable explanations and discussions concerning our work. Also, we thank Patrick Philipp and York Sure-Vetter (Institute of Applied Informatics and Formal Description Methods (AIFB), Karlsruhe Institute of Technology, Karlsruhe, Germany) for the help and experience with respect to the cognitive semantic software and data infrastructure. We performed all simulations on the bwUniCluster, funded by the Ministry of Science, Research and the Arts Baden-Wuerttemberg and the Universities of the State of Baden-Wuerttemberg, Germany, within the framework program bwHPC.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Nicolai Schoch .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2017 Springer International Publishing AG

About this paper

Cite this paper

Schoch, N., Heuveline, V. (2017). Towards Cognition-Guided Patient-Specific FEM-Based Cardiac Surgery Simulation. In: Pop, M., Wright, G. (eds) Functional Imaging and Modelling of the Heart. FIMH 2017. Lecture Notes in Computer Science(), vol 10263. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59447-7

  • Online ISBN: 978-3-319-59448-4

  • eBook Packages: Computer ScienceComputer Science (R0)