Mitral Valve Annuloplasty
- 25 October 2011
- journal article
- research article
- Published by Springer Science and Business Media LLC in Annals of Biomedical Engineering
- Vol. 40 (3), 750-761
- https://doi.org/10.1007/s10439-011-0442-y
Abstract
Mitral valve annuloplasty is a common surgical technique used in the repair of a leaking valve by implanting an annuloplasty device. To enhance repair durability, these devices are designed to increase leaflet coaptation, while preserving the native annular shape and motion; however, the precise impact of device implantation on annular deformation, strain, and curvature is unknown. In this article, we quantify how three frequently used devices significantly impair native annular dynamics. In controlled in vivo experiments, we surgically implanted 11 flexible-incomplete, 11 semi-rigid-complete, and 12 rigid-complete devices around the mitral annuli of 34 sheep, each tagged with 16 equally spaced tantalum markers. We recorded four-dimensional marker coordinates using biplane videofluoroscopy, first with device and then without, which were used to create mathematical models using piecewise cubic splines. Clinical metrics (characteristic anatomical distances) revealed significant global reduction in annular dynamics upon device implantation. Mechanical metrics (strain and curvature fields) explained this reduction via a local loss of anterior dilation and posterior contraction. Overall, all three devices unfavorably caused reduction in annular dynamics. The flexible-incomplete device, however, preserved native annular dynamics to a larger extent than the complete devices. Heterogeneous strain and curvature profiles suggest the need for heterogeneous support, which may spawn more rational design of annuloplasty devices using design concepts of functionally graded materials.Keywords
This publication has 48 references indexed in Scilit:
- Rigid, Complete Annuloplasty Rings Increase Anterior Mitral Leaflet Strains in the Normal Beating Ovine HeartCirculation, 2011
- In vivo dynamic strains of the ovine anterior mitral valve leafletJournal of Biomechanics, 2011
- Anterior Mitral Leaflet Curvature During the Cardiac Cycle in the Normal Ovine HeartCirculation, 2010
- How do annuloplasty rings affect mitral leaflet dynamic motion?☆☆☆European Journal of Cardio-Thoracic Surgery, 2010
- Regional stiffening of the mitral valve anterior leaflet in the beating ovine heartJournal of Biomechanics, 2009
- Saddle Shape of the Mitral Annulus Reduces Systolic Strains on the P2 Segment of the Posterior Mitral LeafletThe Annals of Thoracic Surgery, 2009
- Releasable annuloplasty ring insertion — a novel experimental implantation model☆European Journal of Cardio-Thoracic Surgery, 2009
- In Vivo Dynamic Deformation of the Mitral Valve AnnulusAnnals of Biomedical Engineering, 2009
- Stress–strain behavior of mitral valve leaflets in the beating ovine heartJournal of Biomechanics, 2009
- Material properties of the ovine mitral valve anterior leaflet in vivo from inverse finite element analysisAmerican Journal of Physiology-Heart and Circulatory Physiology, 2008