Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 1.246, Houston, TX, 77030, USA.
Ann Biomed Eng. 2014 Jan;42(1):139-48. doi: 10.1007/s10439-013-0908-1. Epub 2013 Sep 26.
Mitral valve (MV) repair using expanded polytetrafluoroethylene sutures is an established and preferred interventional method to resolve the complex pathophysiologic problems associated with chordal rupture. We developed a novel computational evaluation protocol to determine the effect of the artificial sutures on restoring MV function following valve repair. A virtual MV was created using three-dimensional echocardiographic data in a patient with ruptured mitral chordae tendineae (RMCT). Virtual repairs were designed by adding artificial sutures between the papillary muscles and the posterior leaflet where the native chordae were ruptured. Dynamic finite element simulations were performed to evaluate pre- and post-repair MV function. Abnormal posterior leaflet prolapse and mitral regurgitation was clearly demonstrated in the MV with ruptured chordae. Following virtual repair to reconstruct ruptured chordae, the severity of the posterior leaflet prolapse decreased and stress concentration was markedly reduced both in the leaflet tissue and the intact native chordae. Complete leaflet coaptation was restored when four or six sutures were utilized. Computational simulations provided quantitative information of functional improvement following MV repair. This novel simulation strategy may provide a powerful tool for evaluation and prediction of interventional treatment for RMCT.
使用膨体聚四氟乙烯缝线修复二尖瓣 (MV) 是一种成熟且优选的介入方法，可解决与腱索断裂相关的复杂病理生理问题。我们开发了一种新的计算评估方案，以确定人工缝线在修复瓣膜后恢复 MV 功能的效果。使用三维超声心动图数据在患有二尖瓣腱索断裂 (RMCT) 的患者中创建了一个虚拟 MV。通过在乳头肌和后瓣之间添加人工缝线来设计虚拟修复，在那里天然腱索断裂。进行动态有限元模拟以评估修复前后 MV 的功能。在腱索断裂的 MV 中，明显显示出后瓣异常脱垂和二尖瓣反流。在虚拟修复以重建断裂的腱索后，后瓣脱垂的严重程度降低，并且在瓣叶组织和完整的天然腱索中，应力集中明显减少。当使用四个或六个缝线时，完全恢复了瓣叶对合。计算模拟提供了 MV 修复后功能改善的定量信息。这种新的模拟策略可能为 RMCT 的介入治疗的评估和预测提供一种强大的工具。
