Abstract
The strut chordae (SC) have a unique structure and play an important role in reinforcing the tunnel-shaped configuration of the mitral valve (MV) at the inflow and outflow tracts. We investigated the effect of varying the SC insertion location on normal MV function and dynamics to better understand the complex MV structures. A virtual parametric MV model was designed to replicate a normal human MV, and a total of nine MV modes were created from combinations of apical and lateral displacements of the SC insertion location. MV function throughout the full cardiac cycle was simulated using dynamic finite element analysis for all MV models. While the leaflet stress distribution and coaptation showed similar patterns in all nine MV models, the maximum leaflet stress values increased in proportion to the width of the SC insertion locations. A narrower SC insertion location resulted in a longer coaptation length and a smaller anterior coaptation angle. The top-narrow MV model demonstrated the shortest anterior leaflet bulging distance, lower stresses across the anterior leaflet, and the lowest maximum stresses. This biomechanical evaluation strategy can help us better understand the effect of the SC insertion locations on mechanism, function, and pathophysiology of the MV.
Highlights
An intricate tissue structure, the mitral valve (MV), regulates blood flow between the left atrium and the left ventricle (LV), and the components of the MV apparatus play complex roles to properly maintain normal MV function
The maximum stresses increased in accordance with the width of the strut chordae (SC) insertion location (Figure 5)
In all nine MV models, a similar stress distribution pattern was found in the anterior leaflet, demonstrating large stress values around the trigone region regardless of the differences in the SC insertion location
Summary
The mitral valve (MV), regulates blood flow between the left atrium and the left ventricle (LV), and the components of the MV apparatus play complex roles to properly maintain normal MV function. The MV apparatus is composed of the mitral annulus, two (anterior and posterior) leaflets, chordae tendineae, and papillary muscles. While LV pressure increases during systole, the circumferential size of the mitral annulus decreases. This facilitates leaflet contact and closes the mitral orifice. The papillary muscles contract and hold the chordae tendineae to prevent the leaflets from prolapsing towards the left atrium. It acts like a parachute cord that holds the leaflets at a high pressure to prevent blood from back-flowing towards the left atrium during systole. The chordae tendineae have been classified according to their site of insertion on the leaflets, yet their morphology and distribution on the leaflets result in a wide variety of distribution, form, and configuration for which there is no clear consensus on terminology [3]
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