Computational fluid dynamics as a novel method to predict haemodynamic changes and guide transcatheter edge-to-edge repair.

Abstract

A 78-year-old female with severe mitral regurgitation (MR) presented with heart failure. Due to the high risk of surgery, transcatheter mitral valve edge-to-edge repair (TEER) was introduced. Computational fluid dynamics (CFD) has been widely used for cardiac function assessment. Here, we investigated the haemodynamic changes by using CFD and its predictive values in TEER. The left heart system (LHS) was constructed from computed tomography and transoesophageal echocardiographic (TEE) images (Mimics 19.0, Leuven, Belgium; 3D Slicer software). The haemodynamics of LHS was calculated and visualized by 3D streamlines using the finite volume method and the combination of pressure-Implicit with splitting of operators and semi-Implicit method for pressure linked equations (PIMPLE) algorithm (OpenFOAM software) before the procedure, indicating perfect matching with the TEE view (Panel A). The reverse flow could be observed in the left atrium, and the MR fraction (MRF) calculated by CFD was 52%, similar to the echocardiographic diagnosis (MR 4+). The CFD-simulated mean mitral valve pressure gradient (MVPG) was 1.77 mmHg, consistent with echocardiography (2 mmHg).