Biomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet Prolapse
Background: Surgical management of an anterior leaflet prolapse remains comparatively challenging and has led to the lack of any firmly established standard repair techniques, as seen in cases of posterior leaflet prolapse. Chordal transposition repair is widely acknowledged as a remarkably durable...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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IMR Press
2023-12-01
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| Series: | Reviews in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.imrpress.com/journal/RCM/24/12/10.31083/j.rcm2412367 |
| _version_ | 1827390127000780800 |
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| author | Soohwan Jeong Seong-Min Kim Woojae Hong Minsung Ko David D. McPherson Hyunggun Kim |
| author_facet | Soohwan Jeong Seong-Min Kim Woojae Hong Minsung Ko David D. McPherson Hyunggun Kim |
| author_sort | Soohwan Jeong |
| collection | DOAJ |
| description | Background: Surgical management of an anterior leaflet prolapse remains comparatively challenging and has led to the lack of any firmly established standard repair techniques, as seen in cases of posterior leaflet prolapse. Chordal transposition repair is widely acknowledged as a remarkably durable technique that utilizes the patient’s native chordae. This study aims to evaluate and predict the biomechanical and functional characteristics of a normal mitral valve (MV) model and a pathological MV model featuring anterior ruptured mitral chordae tendineae (RMCT), and to assess the effectiveness of the chordal transposition repair in the pathological MV model. Methods: There are four stages in the proposed virtual MV repair evaluation protocol: (1) modeling the virtual pathological MV model with an anterior (A2) RMCT; (2) performing chordal transposition as the virtual MV repair procedure; (3) dynamic finite element simulation of the normal (control) MV model, the pre-repair (pathological) MV model, and the post-repair (chorda transposition) MV model; (4) assessment and comparison of the physiological and biomechanical features among the normal, pre-repair, and post-repair cases. Results: The pathological MV model with anterior RMCT clearly demonstrated a substantial flail, a marked increase in chordal stresses on the two intact chordae adjacent to the ruptured A2 chordae, and severe anterior leaflet prolapse due to the A2 chordal rupture. The virtual chordal transposition demonstrated remarkable efficacy in mitigating the stress concentrations in the leaflet and chordae, restoring leaflet coaptation, and resolving anterior leaflet prolapse. Conclusions: This virtual MV surgery strategy offers a valuable means to predict, evaluate, and quantify functional and biomechanical improvements before and after MV repair, thereby empowering informed decision-making in the planning of chordal transposition interventions. |
| first_indexed | 2024-03-08T16:46:54Z |
| format | Article |
| id | doaj.art-3dca057b6954419e950320a3bfe542a7 |
| institution | Directory Open Access Journal |
| issn | 1530-6550 |
| language | English |
| last_indexed | 2024-03-08T16:46:54Z |
| publishDate | 2023-12-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj.art-3dca057b6954419e950320a3bfe542a72024-01-05T09:04:31ZengIMR PressReviews in Cardiovascular Medicine1530-65502023-12-01241236710.31083/j.rcm2412367S1530-6550(23)01164-XBiomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet ProlapseSoohwan Jeong0Seong-Min Kim1Woojae Hong2Minsung Ko3David D. McPherson4Hyunggun Kim5Department of Biomechatronic Engineering, Sungkyunkwan University, 16419 Suwon, Gyeonggi, Republic of KoreaDepartment of Biomechatronic Engineering, Sungkyunkwan University, 16419 Suwon, Gyeonggi, Republic of KoreaDepartment of Biomechatronic Engineering, Sungkyunkwan University, 16419 Suwon, Gyeonggi, Republic of KoreaDepartment of Biomechatronic Engineering, Sungkyunkwan University, 16419 Suwon, Gyeonggi, Republic of KoreaDivision of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USADepartment of Biomechatronic Engineering, Sungkyunkwan University, 16419 Suwon, Gyeonggi, Republic of KoreaBackground: Surgical management of an anterior leaflet prolapse remains comparatively challenging and has led to the lack of any firmly established standard repair techniques, as seen in cases of posterior leaflet prolapse. Chordal transposition repair is widely acknowledged as a remarkably durable technique that utilizes the patient’s native chordae. This study aims to evaluate and predict the biomechanical and functional characteristics of a normal mitral valve (MV) model and a pathological MV model featuring anterior ruptured mitral chordae tendineae (RMCT), and to assess the effectiveness of the chordal transposition repair in the pathological MV model. Methods: There are four stages in the proposed virtual MV repair evaluation protocol: (1) modeling the virtual pathological MV model with an anterior (A2) RMCT; (2) performing chordal transposition as the virtual MV repair procedure; (3) dynamic finite element simulation of the normal (control) MV model, the pre-repair (pathological) MV model, and the post-repair (chorda transposition) MV model; (4) assessment and comparison of the physiological and biomechanical features among the normal, pre-repair, and post-repair cases. Results: The pathological MV model with anterior RMCT clearly demonstrated a substantial flail, a marked increase in chordal stresses on the two intact chordae adjacent to the ruptured A2 chordae, and severe anterior leaflet prolapse due to the A2 chordal rupture. The virtual chordal transposition demonstrated remarkable efficacy in mitigating the stress concentrations in the leaflet and chordae, restoring leaflet coaptation, and resolving anterior leaflet prolapse. Conclusions: This virtual MV surgery strategy offers a valuable means to predict, evaluate, and quantify functional and biomechanical improvements before and after MV repair, thereby empowering informed decision-making in the planning of chordal transposition interventions.https://www.imrpress.com/journal/RCM/24/12/10.31083/j.rcm2412367mitral valvechordal transpositionbiomechanicalsimulationmitral valve repair |
| spellingShingle | Soohwan Jeong Seong-Min Kim Woojae Hong Minsung Ko David D. McPherson Hyunggun Kim Biomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet Prolapse Reviews in Cardiovascular Medicine mitral valve chordal transposition biomechanical simulation mitral valve repair |
| title | Biomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet Prolapse |
| title_full | Biomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet Prolapse |
| title_fullStr | Biomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet Prolapse |
| title_full_unstemmed | Biomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet Prolapse |
| title_short | Biomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet Prolapse |
| title_sort | biomechanical evaluation of mitral valve repair virtual chordal transposition to restore anterior leaflet prolapse |
| topic | mitral valve chordal transposition biomechanical simulation mitral valve repair |
| url | https://www.imrpress.com/journal/RCM/24/12/10.31083/j.rcm2412367 |
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