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Simultaneous in- and out-of-plane Mitral Valve Annular Force Measurements

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Abstract

Mitral valve repair with annuloplasty is often favoured over total valve replacement. In order to develop and optimize new annuloplasty ring designs, it is important to study the complex biomechanical behaviour of the valve annulus and the subvalvular apparatus with simultaneous in- and out-of-plane restraining force measurements. A new flat D-shaped mitral valve annular force transducer was developed. The transducer was mounted with strain gauges to measure strain and calibrated to provide simultaneous restraining forces in- and out of the mitral annular plane. The force transducer was implanted and evaluated in an 80 kg porcine experimental model. Accumulation of out-of-plane restraining forces, creating strain in the anterior segment were 0.7 ± 0.0 N (towards apex) and an average force accumulation of 1.5 ± 0.3 N, creating strain in the commissural segments (away from apex). The accumulations of in-plane restraining forces, creating strain on the inner side of the ring were 1.7 ± 0.2 N (away from ring center). A new mitral annular force transducer was successfully developed and evaluated in vivo. The transducer was able to measure forces simultaneously in different planes. Initial indications point towards overall agreement with previous individual force measurements in- and out-of the mitral annular plane. This can provide more detailed insight into the annular force distribution, and could potentially improve the level of evidence based mitral valve repair and support the development of future mitral annuloplasty devices.

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References

  1. Bothe, W., J. C. Swanson, N. B. Ingels, and D. C. Miller. How much septal-lateral mitral annular reduction do you get with new ischemic/functional mitral regurgitation annuloplasty rings? J. Thorac. Cardiovasc. Surg. 2010;140:117–21; 121.e1–3.

  2. Carpentier-Edwards Physio II Annuloplasty Ring [Internet] [cited 2014 Aug. 14]; Available from: http://www.edwards.com/products/rings/pages/physioii.aspx.

  3. Freed, L. A., D. Levy, R. A. Levine, M. G. Larson, J. C. Evans, D. L. Fuller, B. Lehman, and E. J. Benjamin. Prevalence and clinical outcome of mitral-valve prolapse. N. Engl. J. Med. 341:1–7, 1999.

    Article  Google Scholar 

  4. Gammie, J. S., S. Sheng, B. P. Griffith, E. D. Peterson, J. S. Rankin, S. M. O’Brien, and J. M. Brown. Trends in mitral valve surgery in the United States: Results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann. Thorac. Surg. 2009;87:1431–7; discussion 1437–9.

  5. Hasenkam, J. M., H. Nygaard, P. K. Paulsen, W. Y. Kim, and O. K. Hansen. What force can the myocardium generate on a prosthetic mitral valve ring? An animal experimental study. J. Heart Valve Dis. 3:324–329, 1994.

    Google Scholar 

  6. Jensen, M. O., H. Jensen, S. L. Nielsen, M. Smerup, P. Johansen, A. P. Yoganathan, H. Nygaard, and J. M. Hasenkam. What forces act on a flat rigid mitral annuloplasty ring? J. Heart Valve Dis. 2008; 17:267–75; discussion 275.

  7. Jensen, M. O., A. A. Fontaine, and A. P. Yoganathan. Improved in vitro quantification of the force exerted by the papillary muscle on the left ventricular wall: three-dimensional force vector measurement system. Annals of Biomedical Engineering. 29:406–413, 2001.

    Article  Google Scholar 

  8. Jensen, M. O., J. L. Honge, J. A. Benediktsson, A. W. Siefert, H. Jensen, A. P. Yoganathan, T. K. Snow, J. M. Hasenkam, H. Nygaard, and S. L. Nielsen. Mitral valve annular downsizing forces: implications for annuloplasty device development. The Journal of Thoracic and Cardiovascular Surgery. 148:83–89, 2014.

    Article  Google Scholar 

  9. Jensen, M. O., H. Jensen, R. A. Levine, A. P. Yoganathan, N. T. Andersen, H. Nygaard, J. M. Hasenkam, and S. L. Nielsen. Saddle-shaped mitral valve annuloplasty rings improve leaflet coaptation geometry. The Journal of Thoracic and Cardiovascular Surgery. 142:697–703, 2011.

    Article  Google Scholar 

  10. Jensen, M. O., H. Jensen, M. Smerup, R. A. Levine, A. P. Yoganathan, H. Nygaard, J. M. Hasenkam, and S. L. Nielsen. Saddle-shaped mitral valve annuloplasty rings experience lower forces compared with flat rings. Circulation. 118:S250–S255, 2008.

    Article  Google Scholar 

  11. Jimenez, J. H., D. D. Soerensen, Z. He, S. He, and A. P. Yoganathan. Effects of a saddle shaped annulus on mitral valve function and chordal force distribution: an in vitro study. Annals of Biomedical Engineering. 31:1171–1181, 2003.

    Article  Google Scholar 

  12. Kragsnaes, E. S., J. L. Honge, J. B. Askov, J. M. Hasenkam, H. Nygaard, S. L. Nielsen, and M. O. Jensen. In-plane tricuspid valve force measurements: development of a strain gauge instrumented annuloplasty ring. Cardiovascular Engineering and technology. 4:131–138, 2013.

    Article  Google Scholar 

  13. Levine, R. A., M. D. Handschumacher, A. J. Sanfilippo, A. A. Hagege, P. Harrigan, J. E. Marshall, and A. E. Weyman. Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse. Circulation. 80:589–598, 1989.

    Article  Google Scholar 

  14. Nichols, W., M. O’Rourke, and C. Vlachopoulos, editors. McDonald’s Blood Flow in Arteries, Sixth Edition: Theoretical, Experimental and Clinical Principles. 6th ed. CRC Press, 2011.

  15. Nkomo, V. T., J. M. Gardin, T. N. Skelton, J. S. Gottdiener, C. G. Scott, and M. Enriquez-Sarano. Burden of valvular heart diseases: a population-based study. Lancet. 368:1005–1011, 2006.

    Article  Google Scholar 

  16. Rausch, M. K., W. Bothe, J.-P. E. Kvitting, J. C. Swanson, D. C. Miller, E. Kuhl. Mitral valve annuloplasty: a quantitative clinical and mechanical comparison of different annuloplasty devices. Ann. Biomed. Eng. 2012;40:750–761.

  17. Ryan, L. P., B. M. Jackson, H. Hamamoto, T. J. Eperjesi, T. J. Plappert, M. St John-Sutton, R. C. Gorman, and J. H. Gorman. The influence of annuloplasty ring geometry on mitral leaflet curvature. Ann. Thorac. Surg. 2008;86:749–60; discussion 749–60.

  18. Siefert, A. W., J. H. Jimenez, K. J. Koomalsingh, F. Aguel, D. S. West, T. Shuto, T. K. Snow, R. C. Gorman, J. H. Gorman, and A. P. Yoganathan. Contractile mitral annular forces are reduced with ischemic mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery. 146:422–428, 2013.

    Article  Google Scholar 

  19. Siefert, A. W., J. H. Jimenez, K. J. Koomalsingh, D. S. West, F. Aguel, T. Shuto, R. C. Gorman, J. H. Gorman, and A. P. Yoganathan. Dynamic assessment of mitral annular force profile in an ovine model. Ann. Thorac. Surg. 94:59–65, 2012.

    Article  Google Scholar 

  20. Siefert, A. W., J. H. Jimenez, D. S. West, K. J. Koomalsingh, R. C. Gorman, J. H. Gorman, and A. P. Yoganathan. In-vivo transducer to measure dynamic mitral annular forces. J Biomech. 45:1514–1516, 2012.

    Article  Google Scholar 

  21. Siefert, A. W., S. A. Touchton, J. R. McGarvey, S. Takebayashi, J. P. M. Rabbah, J. H. Jimenez, N. Saikrishnan, R. C. Gorman, J. H. Gorman, and A. P. Yoganathan. In-vivo mitral annuloplasty ring transducer: implications for implantation and annular downsizing. J Biomech. 46:2550–2553, 2013.

    Article  Google Scholar 

  22. Simulus Semi-Rigid Annuloplasty Valve Repair System—Medtronic [Internet] [cited 2014 Aug. 14];Available from: http://www.medtronic.com/for-healthcare-professionals/products-therapies/cardiovascular/heart-valves-surgical/simulus-semi-rigid-annuloplasty-system/.

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Acknowledgments

This project was funded by the Danish Heart Foundation Grant #14-R97-A5166-22830, Karen Elise Jensens Fond, Arvid Nilssons Fond, Helga og Peter Kornings Fond.

Statement of Human Studies

No human studies were carried out by the authors for this article.

Statement of Animal Studies

All institutional and national guidelines for the care and use of laboratory animals were followed and approved by the appropriate institutional committees.

Conflict of interest

Sten L. Nielsen is a co-owner of Enovacor ApS. Søren N. Skov, Diana M. Røpcke, Kristine Telling, Christine Ilkjær, Marcell J. Tjørnild, Hans Nygaard and Morten O. Jensen declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark

    Søren N. Skov, Diana M. Røpcke, Kristine Telling, Christine Ilkjær, Marcell J. Tjørnild, Hans Nygaard, Sten L. Nielsen & Morten O. Jensen

  2. Department of Engineering, Faculty of Science and Technology, Aarhus University, Aarhus, Denmark

    Søren N. Skov, Kristine Telling & Morten O. Jensen

Authors
  1. Søren N. Skov
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  2. Diana M. Røpcke
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  3. Kristine Telling
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  4. Christine Ilkjær
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  5. Marcell J. Tjørnild
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  6. Hans Nygaard
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  7. Sten L. Nielsen
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  8. Morten O. Jensen
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Correspondence to Søren N. Skov.

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Associate Editor Karyn Kunzelman oversaw the review of this article.

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Skov, S.N., Røpcke, D.M., Telling, K. et al. Simultaneous in- and out-of-plane Mitral Valve Annular Force Measurements. Cardiovasc Eng Tech 6, 185–192 (2015). https://doi.org/10.1007/s13239-015-0227-9

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  • DOI: https://doi.org/10.1007/s13239-015-0227-9

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