P008. A Computational Analysis of Annuloplasty in Bicuspid Aortic Valve Regurgitation
Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University
Shanghai, Shanghai
China - Contact Me
-Dr Tianyang Yang is currently the resident cardiac surgeon of Shanghai Chest Hospital，he is specialized in heart valve repair surgery including aortic valve and mitral valve repair.
-Coferences participations include:
• AATS Aortic Symposium, New York, 2018, e-poster: Analysis of aortic root configuration with multi-sliced computed tomography: implication for valve sparing aortic root reconstruction
• EACTS Aortic valve repair summit, Paris, 2018, e-poster: Aortic Root Assessment With ECG-gated Multi-sliced Computed Tomography in Chinese Population
• EACTS Aortic valve repair summit, Brussel, 2019, Participation
• Taipei valve summit, online, 2022, Presentation, The Functional Evidence of SCORE Procedure - How to Get Rheumatic Mitral Repair
- Featured publised papers:
(1) Lijian Xu; Tianyang Yang; Lekang Yin; Ye Kong; Yuri Vassilevski; Fuyou Liang ; Numerical Simulation of Blood Flow in Aorta with Dilation: A Comparison between Laminar and LES Modeling Me thods, Computer Modeling in Engineering & Sciences, 2020, 124(2): 509-526
(2) Tianyang Yang; Haini Wen; Ismail El-Hamamsy; Qiming Ni; Yanbin Sun; Dan Zhu ; Relationship Between Leaflets and Root in Normal Aortic Valve Based on Computed Tomography Imaging: Implication for Aortic Valve Repair, Frontier in cardiovascular medicine, 2021, 8(731440)
- His interest is focused on heart valve imaging and its utility in guiding and assessing valve repair procedure and valvular hemodynamics in the simulated settings.
Description
Jiayi Ju1, Tianyang Yang2, Shengzhang Wang1
1 Fudan University, Shanghai, China; 2 Shanghai Chest Hospital, Shanghai, China
Objective: To evaluate the impact of annuloplasty ring sizes on treating bicuspid aortic valve regurgitation through numerical simulation, which may provide insights into determining an optimal annuloplasty range for surgical procedures.
Method: CT images of a patient diagnosed with bicuspid aortic valve regurgitation and underwent annuloplasty surgery were utilized to establish patient-specific models in preoperative and postoperative conditions. The postoperative model was preprocessed to expand the annulus to align with the preoperative model, obtaining a model after procedures such as raphe relaxation and the free margin plication. Subsequently, elastic rings with diameters of 19,21,23,25 and 27 mm were generated, and the annular plane was remolded and constrained by these rings to simulate surgical annuloplasty process. After applying the physiological transvalvular pressure on the leaflets for finite element analysis, computational fluid dynamics method was employed to obtain hemodynamic information of the annuloplasty models at peak systole.
Results: As the annuloplasty ring size decreased, the leaflet coaptation area during early-diastole enhanced from 139 mm² preoperatively to a range of 247-416 mm² post-annuloplasty, concomitant with a reduction in stress at that location. Besides, annuloplasty led to a slight decrease in transvalvular pressure gradient and had minimal effect on the wall shear stress at the aorta. However, when reducing the annuloplasty ring diameter to less than 23 mm, folds manifested at the root of the leaflets, with the most significant folding occurring in case of 19 mm, reaching a ring area of 100 mm². Moreover, with an increased degree of annular remodeling, the annular plane exhibited stress concentration, accompanied by a significant elevation in wall shear stress in the adjacent region.
Conclusion: The computational analysis conducted on the selected patient indicates that annuloplasty by smaller-sized ring have both benefit on improving leaflet coaptation area and the mitigating of leaflet stress and transvalvular pressure gradient. Nevertheless, the use of excessively small ring may result in leaflet folding at the root and wall shear stress increasement at the annular plane region. Personalized annuloplasty simulation may be a valuable tool to provide the optimal size threshold for individual patients before surgery.
Authors
Jiayi Ju (1), Tianyang Yang (2), Shengzhang Wang (1)
Institutions
(1) Fudan University, Shanghai, China, (2) Shanghai Chest Hospital, Shanghai, China