First Finite Element Model of the Left Ventricle With Mitral Valve: Insights Into Ischemic Mitral Regurgitation

摘要

Myocardial InfarctionEchocardiographyMagnetic Resonance ImagingImage AnalysisFinite Element ModelLoading ConditionsConstitutive ModelsResultsMitral Valve Deformation in the FE ModelEnd-Systolic Stress Computed in FE ModelThe Effect of Papillary Muscle Displacement on Simulated The Sheep Model of Ischemic MRThe Effect of Infarct StiffnessLeaflet StressLimitationsConclusions and Future DirectionsReferencesLeft ventricular remodeling after posterobasal myocardial infarction can lead to ischemic mitral regurgitation. This occurs as a consequence of leaflet tethering due to posterior papillary muscle displacement.MethodsA finite element model of the left ventricle, mitral apparatus, and chordae tendineae was created from magnetic resonance images from a sheep that developed moderate mitral regurgitation after posterobasal myocardial infarction. Each region of the model was characterized by a specific constitutive law that captured the material response when subjected to physiologic pressure loading.ResultsThe model simulation produced a gap between the posterior and anterior leaflets, just above the infarcted posterior papillary muscle, which is indicative of mitral regurgitation. When the stiffness of the infarct region was reduced, this caused the wall to distend and the gap area between the leaflets to increase by 33%. Additionally, the stress in the leaflets increased around the chordal connection points near the gap.ConclusionsThe methodology outlined in this work will allow a finite element model of both the left ventricle and mitral valve to be generated using noninvasive techniques.CTSNet classification:30Ischemic mitral regurgitation (MR) affects 1.2 to 2.1 million patients in the United States, with more than 400,000 patients having moderate-to-severe MR [