Predicting the outcome of transcatheter mitral valve implantation using image-based computational models.
Aged
Cardiac Catheterization
/ adverse effects
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
/ adverse effects
Hemodynamics
Humans
Male
Mitral Valve
/ diagnostic imaging
Mitral Valve Insufficiency
/ diagnostic imaging
Models, Cardiovascular
Patient-Specific Modeling
Pilot Projects
Predictive Value of Tests
Prosthesis Design
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
Treatment Outcome
Ventricular Function, Left
Ventricular Outflow Obstruction
/ etiology
Computational fluid dynamics
LVOT obstruction
Mitral prosthetic valve
Mitral regurgitation
Patient-specific simulation
Pressure gradients
Journal
Journal of cardiovascular computed tomography
ISSN: 1876-861X
Titre abrégé: J Cardiovasc Comput Tomogr
Pays: United States
ID NLM: 101308347
Informations de publication
Date de publication:
Historique:
received:
18
06
2019
revised:
06
09
2019
accepted:
27
11
2019
pubmed:
22
12
2019
medline:
30
9
2020
entrez:
22
12
2019
Statut:
ppublish
Résumé
The appropriate placement and size selection of mitral prostheses in transcatheter mitral valve implantation (TMVI) is critical, as encroachment on the left ventricular outflow tract (LVOT) may lead to flow obstruction. Recent advances in computed tomography (CT) can be employed for pre-procedural planning of mitral prosthetic valve placement. This study aims to develop patient-specific computational fluid dynamics models of the left ventricle (LV) in the presence of a mitral valve prosthesis to investigate blood flow and LVOT pressure gradient during systole. Patient-specific computational fluid dynamics simulations of TMVI with varied cardiac anatomy and insertion angles were performed (n = 30). Wide-volume full cycle cardiovascular CT images prior to TMVI were used as source anatomical data (n = 6 patients). Blood movement was governed by Navier-Stokes equations and the LV endocardial wall deformation was derived from each patient's CT images. The computed pressure gradients in the presence of the mitral prosthesis compared well with clinically measured gradients. Analysis of the effects of prosthetic valve angulation, aorto-mitral annular angle, ejection fraction, LV size and new LVOT area (neo-LVOT) after TMVI in silico revealed that the neo-LVOT area (p < 0.001) was the most significant factor affecting LVOT pressure gradient. Angulation of the mitral valve can substantially mitigate LVOT gradient. Computational fluid dynamics simulation is a promising method to aid in pre-TMVI planning and understanding the factors underlying LVOT obstruction.
Sections du résumé
BACKGROUND
BACKGROUND
The appropriate placement and size selection of mitral prostheses in transcatheter mitral valve implantation (TMVI) is critical, as encroachment on the left ventricular outflow tract (LVOT) may lead to flow obstruction. Recent advances in computed tomography (CT) can be employed for pre-procedural planning of mitral prosthetic valve placement. This study aims to develop patient-specific computational fluid dynamics models of the left ventricle (LV) in the presence of a mitral valve prosthesis to investigate blood flow and LVOT pressure gradient during systole.
METHODS
METHODS
Patient-specific computational fluid dynamics simulations of TMVI with varied cardiac anatomy and insertion angles were performed (n = 30). Wide-volume full cycle cardiovascular CT images prior to TMVI were used as source anatomical data (n = 6 patients). Blood movement was governed by Navier-Stokes equations and the LV endocardial wall deformation was derived from each patient's CT images.
RESULTS
RESULTS
The computed pressure gradients in the presence of the mitral prosthesis compared well with clinically measured gradients. Analysis of the effects of prosthetic valve angulation, aorto-mitral annular angle, ejection fraction, LV size and new LVOT area (neo-LVOT) after TMVI in silico revealed that the neo-LVOT area (p < 0.001) was the most significant factor affecting LVOT pressure gradient. Angulation of the mitral valve can substantially mitigate LVOT gradient.
CONCLUSIONS
CONCLUSIONS
Computational fluid dynamics simulation is a promising method to aid in pre-TMVI planning and understanding the factors underlying LVOT obstruction.
Identifiants
pubmed: 31862348
pii: S1934-5925(19)30339-9
doi: 10.1016/j.jcct.2019.11.016
pii:
doi:
Types de publication
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
335-342Informations de copyright
Copyright © 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.