MO71. Neochordoplasty vs. Chordal Transposition for Anterior Leaflet Prolapse: Can Patient-specific Computational Biomechanics Predict Post-repair Mitral Valve Function?
Presented During: Mini-Orals: Translational Research, Innovation, Predictive Modeling
Samsung Hospital
United States - Contact Me
Hyunggun Kim is an Associate Professor of the Department of Biomechatronic Engineering at Sungkyunkwan University, Korea, and an Adjunct Associate Professor of the Department of Internal Medicine at The University of Texas Health Science Center at Houston. He received his PhD degree in Biomedical Engineering from The University of Iowa. His research interests include the development of advanced computational techniques for patient-specific heart valve evaluation and the development of artificial intelligence-based medical data analysis algorithms.
Friday, May 5, 2023: 8:15 AM - 8:20 AM
5 Minutes
New York Hilton Midtown
Room: Petit Trianon
Description
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.
Presentation Duration
3-minute presentation; 2-minute discussion