In vivo assessment of mitral valve leaflet remodelling following myocardial infarction
Abstract Each year, more than 40,000 people undergo mitral valve (MV) repair surgery domestically to treat regurgitation caused by myocardial infarction (MI). Although continual MV tissue remodelling following repair is believed to be a major contributor to regurgitation recurrence, the effects of t...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2022-10-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-022-22790-0 |
| _version_ | 1811197989648072704 |
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| author | Bruno V. Rego Amir H. Khalighi Eric K. Lai Robert C. Gorman Joseph H. Gorman Michael S. Sacks |
| author_facet | Bruno V. Rego Amir H. Khalighi Eric K. Lai Robert C. Gorman Joseph H. Gorman Michael S. Sacks |
| author_sort | Bruno V. Rego |
| collection | DOAJ |
| description | Abstract Each year, more than 40,000 people undergo mitral valve (MV) repair surgery domestically to treat regurgitation caused by myocardial infarction (MI). Although continual MV tissue remodelling following repair is believed to be a major contributor to regurgitation recurrence, the effects of the post-MI state on MV remodelling remain poorly understood. This lack of understanding limits our ability to predict the remodelling of the MV both post-MI and post-surgery to facilitate surgical planning. As a necessary first step, the present study was undertaken to noninvasively quantify the effects of MI on MV remodelling in terms of leaflet geometry and deformation. MI was induced in eight adult Dorset sheep, and real-time three-dimensional echocardiographic (rt-3DE) scans were collected pre-MI as well as at 0, 4, and 8 weeks post-MI. A previously validated image-based morphing pipeline was used to register corresponding open- and closed-state scans and extract local in-plane strains throughout the leaflet surface at systole. We determined that MI induced permanent changes in leaflet dimensions in the diastolic configuration, which increased with time to 4 weeks, then stabilised. MI substantially affected the systolic shape of the MV, and the range of stretch experienced by the MV leaflet at peak systole was substantially reduced when referred to the current time-point. Interestingly, when we referred the leaflet strains to the pre-MI configuration, the systolic strains remained very similar throughout the post-MI period. Overall, we observed that post-MI ventricular remodeling induced permanent changes in the MV leaflet shape. This predominantly affected the MV’s diastolic configuration, leading in turn to a significant decrease in the range of stretch experienced by the leaflet when referenced to the current diastolic configuration. These findings are consistent with our previous work that demonstrated increased plastic (i.e. non-recoverable) leaflet deformations post-MI, that was completely accounted for by the associated changes in collagen fiber structure. Moreover, we demonstrated through noninvasive methods that the state of the MV leaflet can elucidate the progression and extent of MV adaptation following MI and is thus highly relevant to the design of current and novel patient specific minimally invasive surgical repair strategies. |
| first_indexed | 2024-04-12T01:23:38Z |
| format | Article |
| id | doaj.art-f131bd5421044b7fa1bbf0c0e2cf54fa |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-12T01:23:38Z |
| publishDate | 2022-10-01 |
| publisher | Nature Portfolio |
| record_format | Article |
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| spelling | doaj.art-f131bd5421044b7fa1bbf0c0e2cf54fa2022-12-22T03:53:43ZengNature PortfolioScientific Reports2045-23222022-10-0112111610.1038/s41598-022-22790-0In vivo assessment of mitral valve leaflet remodelling following myocardial infarctionBruno V. Rego0Amir H. Khalighi1Eric K. Lai2Robert C. Gorman3Joseph H. Gorman4Michael S. Sacks5James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, and the Department of Biomedical Engineering, The University of Texas at AustinJames T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, and the Department of Biomedical Engineering, The University of Texas at AustinGorman Cardiovascular Research Group, Department of Surgery, Perelman School of Medicine, University of PennsylvaniaGorman Cardiovascular Research Group, Department of Surgery, Perelman School of Medicine, University of PennsylvaniaGorman Cardiovascular Research Group, Department of Surgery, Perelman School of Medicine, University of PennsylvaniaJames T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, and the Department of Biomedical Engineering, The University of Texas at AustinAbstract Each year, more than 40,000 people undergo mitral valve (MV) repair surgery domestically to treat regurgitation caused by myocardial infarction (MI). Although continual MV tissue remodelling following repair is believed to be a major contributor to regurgitation recurrence, the effects of the post-MI state on MV remodelling remain poorly understood. This lack of understanding limits our ability to predict the remodelling of the MV both post-MI and post-surgery to facilitate surgical planning. As a necessary first step, the present study was undertaken to noninvasively quantify the effects of MI on MV remodelling in terms of leaflet geometry and deformation. MI was induced in eight adult Dorset sheep, and real-time three-dimensional echocardiographic (rt-3DE) scans were collected pre-MI as well as at 0, 4, and 8 weeks post-MI. A previously validated image-based morphing pipeline was used to register corresponding open- and closed-state scans and extract local in-plane strains throughout the leaflet surface at systole. We determined that MI induced permanent changes in leaflet dimensions in the diastolic configuration, which increased with time to 4 weeks, then stabilised. MI substantially affected the systolic shape of the MV, and the range of stretch experienced by the MV leaflet at peak systole was substantially reduced when referred to the current time-point. Interestingly, when we referred the leaflet strains to the pre-MI configuration, the systolic strains remained very similar throughout the post-MI period. Overall, we observed that post-MI ventricular remodeling induced permanent changes in the MV leaflet shape. This predominantly affected the MV’s diastolic configuration, leading in turn to a significant decrease in the range of stretch experienced by the leaflet when referenced to the current diastolic configuration. These findings are consistent with our previous work that demonstrated increased plastic (i.e. non-recoverable) leaflet deformations post-MI, that was completely accounted for by the associated changes in collagen fiber structure. Moreover, we demonstrated through noninvasive methods that the state of the MV leaflet can elucidate the progression and extent of MV adaptation following MI and is thus highly relevant to the design of current and novel patient specific minimally invasive surgical repair strategies.https://doi.org/10.1038/s41598-022-22790-0 |
| spellingShingle | Bruno V. Rego Amir H. Khalighi Eric K. Lai Robert C. Gorman Joseph H. Gorman Michael S. Sacks In vivo assessment of mitral valve leaflet remodelling following myocardial infarction Scientific Reports |
| title | In vivo assessment of mitral valve leaflet remodelling following myocardial infarction |
| title_full | In vivo assessment of mitral valve leaflet remodelling following myocardial infarction |
| title_fullStr | In vivo assessment of mitral valve leaflet remodelling following myocardial infarction |
| title_full_unstemmed | In vivo assessment of mitral valve leaflet remodelling following myocardial infarction |
| title_short | In vivo assessment of mitral valve leaflet remodelling following myocardial infarction |
| title_sort | in vivo assessment of mitral valve leaflet remodelling following myocardial infarction |
| url | https://doi.org/10.1038/s41598-022-22790-0 |
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