Korean J Physiol Pharmacol.  2019 Jan;23(1):63-70. 10.4196/kjpp.2019.23.1.63.

Computational analysis of the electromechanical performance of mitral valve cerclage annuloplasty using a patient-specific ventricular model

• Lee KE
• Kim KT
• Lee JH
• Jung S
• Kim JH
• Shim EB

• KMID: 2443617
• DOI: http://doi.org/10.4196/kjpp.2019.23.1.63

Abstract

We aimed to propose a novel computational approach to predict the electromechanical performance of pre- and post-mitral valve cerclage annuloplasty (MVCA). Furthermore, we tested a virtual estimation method to optimize the left ventricular basement tightening scheme using a pre-MVCA computer model. The present model combines the three-dimensional (3D) electromechanics of the ventricles with the vascular hemodynamics implemented in a lumped parameter model. 3D models of pre- and post-MVCA were reconstructed from the computed tomography (CT) images of two patients and simulated by solving the electromechanical-governing equations with the finite element method. Computed results indicate that reduction of the dilated heart chambers volume (reverse remodeling) appears to be dependent on ventricular stress distribution. Reduced ventricular stresses in the basement after MVCA treatment were observed in the patients who showed reverse remodeling of heart during follow up over 6 months. In the case who failed to show reverse remodeling after MVCA, more virtual tightening of the ventricular basement diameter than the actual model can induce stress unloading, aiding in heart recovery. The simulation result that virtual tightening of the ventricular basement resulted in a marked increase of myocardial stress unloading provides in silico evidence for a functional impact of MVCA treatment on cardiac mechanics and post-operative heart recovery. This technique contributes to establishing a pre-operative virtual rehearsal procedure before MVCA treatment by using patient-specific cardiac electromechanical modeling of pre-MVCA.

Keyword

Lumped parameter model; Mitral valve cerclage annuloplasty; Patient-specific model; Ventricular electromechanical model

MeSH Terms

Computer Simulation
Follow-Up Studies
Heart
Hemodynamics
Humans
Mechanics
Methods
Mitral Valve*

Figure

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  Fig. 1 Ventricular electromechanical model of MVCA. (A) Schematic of mitral valve cerclage annuloplasty. (B) Pre- and post-MVCA models of the electromechanical modeling of patient-specific ventricles.

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  Fig. 2 Schematic diagram of the 3D finite-element ventricular electromechanical model coupled with the circulatory model. PRV, right ventricular pressure; VRV, right ventricular volume; PLV, left ventricular pressure; VLV, left ventricular volume; RPA, pulmonary artery resistance; CPA, pulmonary artery compliance; RPV, pulmonary vein resistance; CPV, pulmonary vein compliance; RMI, forward resistance of mitral valve; CLA, left atrial compliance; RAO, forward resistance of aortic valve; RSA, systemic artery resistance; CSA, systemic artery compliance; RSV, systemic vein resistance; CSV, systemic vein compliance; RTR, tricuspid valve resistance; CRA, right atrium compliance; and RPU, pulmonary valve resistance.

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  Fig. 3 Computed transient solutions of blood pressure and LV volume from the patient-specific pre-MVCA model, post-MVCA 1M FU model and post-MVCA 6M FU model in Case I.

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  Fig. 4 Computed transient solutions of blood pressure and LV volume from the patient-specific pre-MVCA model, post-MVCA 1M FU model and virtual post-MVCA model in Case II.

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  Fig. 5 Ventricular stress distribution of the pre- and post-MVCA models (1-month follow-up (1M FU) and 6-month follow-up (6M FU)) and virtual post-MVCA model in (A) Case I and (B) Case II. Here, stress means von-Mises stress.

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