Abstract
Objectives: High leaflet and chordal stresses contribute to recurrent mitral regurgitation after repair procedures. We hypothesized that a saddle-shaped annuloplasty ring would reduce leaflet stress compared to a similarly sized flat annuloplasty ring. To test this hypothesis we used a novel 3D echocardiographically-based finite element modeling (FEM) technique for quantifying regional mitral valve stress. Methods: Real-time 3D echocardiography was performed in 8 sheep before and after placement of either a 30mm flat annuloplasty (n=4) or a 30mm saddle-shaped annuloplasty. Full-volume data sets of the MV were obtained using an IE33 platform(Philips Medical Systems, Andover, Massachusetts) and exported to Cardio-View (Tomtec Imaging Systems, Munich, Germany) for image analysis. Individual leaflet data were then interpolated using Matlab (The Mathworks, Natick, Massachusetts). Triangulated leaflet surfaces were extracted and the data imported into a commercial finite element program (ABAQUS/Explicit 6.3, HKS Inc. Pawtucket, RI) to quantify regional stress distributions in all segments (P1, P2, P3 and A1, A2, A3) of the MV. Results: Peak anterior and posterior leaflet stresses after flat annuloplasty placement were 0.20±0.001MPa and 21±0.02MPa. Peak anterior and posterior leaflet stress after saddle-shaped annuloplasty placement was 0.19±0.02MPa and 13±0.01MPa (p<0.05 for the posterior leaflet stresses) Conclusions: Saddle-shaped annuloplasty design results in greater stress reduction in the posterior leaflet than standard flat annuloplasty rings and may, therefore, result in more durable repairs. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
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