Human Cardiac Function Simulator for the Optimal Design of a Novel Annuloplasty Ring with a Sub-valvular Element for Correction of Ischemic Mitral Regurgitation

被引:49
作者
Baillargeon, Brian [2 ]
Costa, Ivan [3 ]
Leach, Joseph R. [4 ]
Lee, Lik Chuan [5 ]
Genet, Martin [6 ,7 ,8 ]
Toutain, Arnaud [8 ]
Wenk, Jonathan F. [9 ]
Rausch, Manuel K. [10 ,11 ,12 ]
Rebelo, Nuno [2 ]
Acevedo-Bolton, Gabriel [4 ,8 ]
Kuhl, Ellen [10 ,11 ,12 ]
Navia, Jose L. [13 ]
Guccione, Julius M. [1 ,8 ]
机构
[1] UCSF, Sch Med, Mt Zion Harold Brunn Inst Cardiovasc Res, Dept Surg,Div Adult Cardiothorac Surg, 1657 Scott St,Room 219, San Francisco, CA 94143 USA
[2] Dassault Syst Simulia Corp, Fremont, CA USA
[3] Univ Brasilia, Fac UnB Planaltina, Grad Program Mat Sci PPG CIMA, Brasilia, DF, Brazil
[4] Univ Calif San Francisco, Dept Radiol & Biomed Imaging, San Francisco, CA USA
[5] Michigan State Univ, Dept Mech Engn, E Lansing, MI USA
[6] Univ Zurich, Inst Biomed Engn, Zurich, Switzerland
[7] Swiss Fed Inst Technol, Zurich, Switzerland
[8] Univ Calif San Francisco, Dept Surg, San Francisco, CA USA
[9] Univ Kentucky, Dept Mech Engn, Lexington, KY USA
[10] Stanford Univ, Dept Mech Engn, Stanford, CA USA
[11] Stanford Univ, Dept Bioengn, Stanford, CA USA
[12] Stanford Univ, Dept Cardiothorac Surg, Stanford, CA USA
[13] Cleveland Clin, Dept Cardiovasc & Thorac Surg, Cleveland, OH USA
基金
美国国家卫生研究院; 美国国家科学基金会;
关键词
Finite element method; Realistic simulation; Myocardial infarction; Ventricular function; Ischemic mitral regurgitation; Mitral annuloplasty; VALVE;
D O I
10.1007/s13239-015-0216-z
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Ischemic mitral regurgitation is associated with substantial risk of death. We sought to: (1) detail significant recent improvements to the Dassault Systemes human cardiac function simulator (HCFS); (2) use the HCFS to simulate normal cardiac function as well as pathologic function in the setting of posterior left ventricular (LV) papillary muscle infarction; and (3) debut our novel device for correction of ischemic mitral regurgitation. We synthesized two recent studies of human myocardial mechanics. The first study presented the robust and integrative finite element HCFS. Its primary limitation was its poor diastolic performance with an LV ejection fraction below 20% caused by overly stiff ex vivo porcine tissue parameters. The second study derived improved diastolic myocardial material parameters using in vivo MRI data from five normal human subjects. We combined these models to simulate ischemic mitral regurgitation by computationally infarcting an LV region including the posterior papillary muscle. Contact between our novel device and the mitral valve apparatus was simulated using Dassault Systemes SIMULIA software. Incorporating improved cardiac geometry and diastolic myocardial material properties in the HCFS resulted in a realistic LV ejection fraction of 55%. Simulating infarction of posterior papillary muscle caused regurgitant mitral valve mechanics. Implementation of our novel device corrected valve dysfunction. Improvements in the current study to the HCFS permit increasingly accurate study of myocardial mechanics. The first application of this simulator to abnormal human cardiac function suggests that our novel annuloplasty ring with a sub-valvular element will correct ischemic mitral regurgitation.
引用
收藏
页码:105 / 116
页数:12
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