Abstract 13431: Comparative Evaluation of Diastolic Left Heart Dynamics Post-Mitral Valve Interventions

Abstract

Introduction: Mitral valve (MV) leaflet morphology plays an important role insuring efficient, unidirectional blood flow from the left atrium (LA) to ventricle (LV). When treating severe mitral regurgitation (MR), surgical repair, valve replacement, or transcatheter edge-to-edge (E-2-E) repair all provide valid options depending on anatomy and clinical circumstances. These interventions alter the MV morphology, impacting LV filling dynamics. We used fluid-structure interactions (FSI) to evaluate LV filling dynamics after MV interventions, taking into consideration full left-heart (LH) dynamics. Methods: 3-D MV model of a patient suffering from severe MR was reconstructed from echocardiographic data. A LH wall motion algorithm was developed and applied to CT-derived LA and LV walls to realistically represent LH dynamics. LH wall motion, MV dynamics and blood flow in LA and LV during MV function was simulated using a strongly coupled fluid structure interaction approach. Virtual interventions using a surgical 33mm bioprosthetic valve (BPV) and transcatheter E-2-E repair were performed and evaluated. Results: Our FSI model predicted a physiological vortex ring developing in the LV for the pre-op MV during early diastole. BPV produced complex asymmetrical vortices. Due to its double orifice, the E-2-E clip produced two separate vortex rings with the largest velocity magnitude. Of all the three treatments, BPV had the greatest leaflet deformation rate. Conclusion: This model provides realistic quantitative insights into post-op filling dynamics that can be used to personalize and optimize valve intervention. These methodologies may help clinicians to realistically predict and evaluate patient-specific LV filling dynamics to tailor MV interventions.