Neochordoplasty vs. Chordal Transposition for Anterior Leaflet Prolapse: Can Patient-specific Computational Biomechanics Predict Post-repair Mitral Valve Function?
Presented During:
Friday, May 5, 2023: 8:15AM - 8:20AM
New York Hilton Midtown
Posted Room Name:
Petit Trianon
Abstract No:
MO071
Submission Type:
Abstract Submission
Authors:
Hyunggun Kim (1), Soohwan Jeong (1), Woojae Hong (1), Seong-Min Kim (1), David McPherson (2), Danny Ramzy (2)
Institutions:
(1) Sungkyunkwan University, Suwon, Gyeonggi, Korea, (2) The University of Texas Health Science Center at Houston, Houston, TX
Submitting Author:
Hyunggun Kim
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Sungkyunkwan University
Sungkyunkwan University
Co-Author(s):
Soohwan Jeong
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Sungkyunkwan University
Sungkyunkwan University
Woojae Hong
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Sungkyunkwan University
Sungkyunkwan University
Seong-Min Kim
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Sungkyunkwan University
Sungkyunkwan University
David McPherson
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The University of Texas Health Science Center at Houston
The University of Texas Health Science Center at Houston
*Danny Ramzy
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The University of Texas Health Science Center at Houston
The University of Texas Health Science Center at Houston
Presenting Author:
Hyunggun Kim
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Samsung Hospital
Samsung Hospital
Abstract:
OBJECTIVE: Mitral valve (MV) repair for anterior leaflet prolapse is relatively more challenging to repair and requires further skilled surgical techniques and experiences. It is difficult to predict and compare the extent of restored MV function for two different repair techniques for a particular case. We have developed a novel 3D echocardiography-based computational tool to perform patient-specific MV repair simulations. In this study, we investigated, visualized, and compared the pre- and post-repair biomechanical characteristics of MV function following virtual neochordoplasty and chordal transposition for anterior leaflet prolapse.
METHODS: A patient-specific MV model having severe mitral regurgitation (MR) due to ruptured A2 chordae was created using 3D echocardiographic data (Fig. 1A). Standard surgical protocols of neochordoplasty and chordal transposition were rigorously designed to perform virtual MV repair simulations (Fig. 1B). Following each repair procedure, virtual ring annuloplasty was conducted to restore a normal size and shape for the annulus. Computational dynamic simulations over the full cardiac cycle were performed to determine the physiologic and biomechanical characteristics of the pre- and post-repair MV function.
RESULTS: Virtual neochordoplasty and chordal transposition successfully demonstrated patient-specific MV repair simulations (Fig. 1C-1D). The pre-repair MV revealed large leaflet malcoaptation and excessive stress distribution in the anterior leaflet where the chordae were ruptured. Virtual neochordoplasty clearly demonstrated markedly reduced prolapse and sufficiently restored leaflet coaptation with relatively uniform stress distribution across both leaflets. While virtual chordal transposition showed sufficiently recovered leaflet coaptation with reduced stresses in the posterior leaflet, the post-repair MV model exhibited concentrated leaflet stresses near the aortomitral junction.
CONCLUSIONS: We have developed a novel computational simulation strategy to evaluate and predict MV function before and after neochordoplasty and chordal transposition in a patient with anterior chordal rupture and severe MR. Both virtual neochordoplasty and chordal transposition techniques decreased anterior leaflet prolapse, restored leaflet coaptation, and lessened stress concentration. This virtual MV repair strategy has the potential for improved pre-surgical planning to predict and optimize post-repair MV function.
METHODS: A patient-specific MV model having severe mitral regurgitation (MR) due to ruptured A2 chordae was created using 3D echocardiographic data (Fig. 1A). Standard surgical protocols of neochordoplasty and chordal transposition were rigorously designed to perform virtual MV repair simulations (Fig. 1B). Following each repair procedure, virtual ring annuloplasty was conducted to restore a normal size and shape for the annulus. Computational dynamic simulations over the full cardiac cycle were performed to determine the physiologic and biomechanical characteristics of the pre- and post-repair MV function.
RESULTS: Virtual neochordoplasty and chordal transposition successfully demonstrated patient-specific MV repair simulations (Fig. 1C-1D). The pre-repair MV revealed large leaflet malcoaptation and excessive stress distribution in the anterior leaflet where the chordae were ruptured. Virtual neochordoplasty clearly demonstrated markedly reduced prolapse and sufficiently restored leaflet coaptation with relatively uniform stress distribution across both leaflets. While virtual chordal transposition showed sufficiently recovered leaflet coaptation with reduced stresses in the posterior leaflet, the post-repair MV model exhibited concentrated leaflet stresses near the aortomitral junction.
CONCLUSIONS: We have developed a novel computational simulation strategy to evaluate and predict MV function before and after neochordoplasty and chordal transposition in a patient with anterior chordal rupture and severe MR. Both virtual neochordoplasty and chordal transposition techniques decreased anterior leaflet prolapse, restored leaflet coaptation, and lessened stress concentration. This virtual MV repair strategy has the potential for improved pre-surgical planning to predict and optimize post-repair MV function.
Mitral Conclave:
Mitral Repair Techniques & Strategies
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