Image-Based Computational Fluid Dynamics to Compare Two Repair Techniques for Mitral Valve Prolapse.

IF 3 2区 医学 Q3 ENGINEERING, BIOMEDICAL Annals of Biomedical Engineering Pub Date : 2024-08-09 DOI:10.1007/s10439-024-03597-8
Lorenzo Bennati, Giovanni Puppini, Vincenzo Giambruno, Giovanni Battista Luciani, Christian Vergara
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Abstract

OBJECTIVE : The treatment of mitral valve prolapse involves two distinct repair techniques: chordal replacement (Neochordae technique) and leaflet resection (Resection technique). However, there is still a debate in the literature about which is the optimal one. In this context, we performed an image-based computational fluid dynamic study to evaluate blood dynamics in the two surgical techniques. METHODS : We considered a healthy subject (H) and two patients (N and R) who underwent surgery for prolapse of the posterior leaflet and were operated with the Neochordae and Resection technique, respectively. Computational Fluid Dynamics (CFD) was employed with prescribed motion of the entire left heart coming from cine-MRI images, with a Large Eddy Simulation model to describe the transition to turbulence and a resistive method for managing valve dynamics. We created three different virtual scenarios where the operated mitral valves were inserted in the same left heart geometry of the healthy subject to study the differences attributed only to the two techniques. RESULTS : We compared the three scenarios by quantitatively analyzing ventricular velocity patterns and pressures, transition to turbulence, and the ventricle ability to prevent thrombi formation. From these results, we found that the operative techniques affected the ventricular blood dynamics in different ways, with variations attributed to the reduced mobility of the Resection posterior leaflet. Specifically, the Resection technique resulted in turbulent forces, related with the risk of hemolysis formation, up to 640 Pa, while the other two scenarios exhibited a maximum of 240 Pa. Moreover, in correspondence of the ventricular apex, the Resection technique reduced the areas with low velocity to 15%, whereas the healthy case and the Neochordae case maintained these areas at 30 and 48%, respectively. Our findings suggest that the Neochordae technique developed a more physiological flow with respect to the Resection technique. CONCLUSION: Resection technique gives rise to a different direction of the mitral jet during diastole increasing the ability to washout the ventricular apex preventing from thrombi formation, but at the same time it promotes turbulence formation that is associated with ventricular effort and risk of hemolysis.

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基于图像的计算流体力学比较二尖瓣脱垂的两种修复技术
目的:二尖瓣脱垂的治疗涉及两种不同的修复技术:腱膜置换术(Neochordae 技术)和瓣叶切除术(Resection 技术)。然而,关于哪种方法最佳,文献中仍存在争议。在此背景下,我们进行了一项基于图像的计算流体力学研究,以评估两种手术技术的血液动力学。方法 :我们考虑了一名健康受试者(H)和两名因后瓣叶脱垂而接受手术的患者(N 和 R),他们分别采用了新腱索技术和切除技术。我们采用了计算流体动力学(CFD)技术,利用 cine-MRI 图像对整个左心的运动进行了规定,并使用大涡流模拟模型来描述向湍流的过渡,同时使用阻力法来管理瓣膜的动态。我们创建了三种不同的虚拟场景,在与健康受试者相同的左心几何形状中植入已手术的二尖瓣,以研究两种技术的差异。结果 :我们通过定量分析心室速度模式和压力、向湍流的过渡以及心室防止血栓形成的能力,对三种情况进行了比较。从这些结果中,我们发现手术技术以不同的方式影响心室血液动力学,而这些变化可归因于切除后叶的流动性降低。具体来说,Resection 技术产生的湍流力高达 640 Pa,与溶血形成的风险有关,而其他两种情况下的湍流力最大为 240 Pa。此外,与心室顶相对应,Resection 技术将低速区域减少到 15%,而健康情况和 Neochordae 情况下这些区域分别保持在 30% 和 48%。我们的研究结果表明,与切除技术相比,Neochordae 技术能形成更符合生理的血流。结论:二尖瓣切除术使二尖瓣射流在舒张期的方向不同,增强了冲刷心室顶的能力,防止血栓形成,但同时也促进了湍流的形成,而湍流的形成与心室用力和溶血风险有关。
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来源期刊
Annals of Biomedical Engineering
Annals of Biomedical Engineering 工程技术-工程:生物医学
CiteScore
7.50
自引率
15.80%
发文量
212
审稿时长
3 months
期刊介绍: Annals of Biomedical Engineering is an official journal of the Biomedical Engineering Society, publishing original articles in the major fields of bioengineering and biomedical engineering. The Annals is an interdisciplinary and international journal with the aim to highlight integrated approaches to the solutions of biological and biomedical problems.
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