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Predicting the outcome of transcatheter mitral valve implantation using image-based computational models
- Source :
- Journal of cardiovascular computed tomography. 14(4)
- Publication Year :
- 2019
-
Abstract
- Background Th 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 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 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 Computational fluid dynamics simulation is a promising method to aid in pre-TMVI planning and understanding the factors underlying LVOT obstruction.
- Subjects :
- Male
Patient-Specific Modeling
medicine.medical_specialty
Cardiac Catheterization
Pilot Projects
030204 cardiovascular system & hematology
Prosthesis Design
Ventricular Function, Left
030218 nuclear medicine & medical imaging
Ventricular Outflow Obstruction
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Internal medicine
Mitral valve
Medicine
Ventricular outflow tract
Humans
Radiology, Nuclear Medicine and imaging
Systole
Pressure gradient
Aged
Retrospective Studies
Heart Valve Prosthesis Implantation
Mitral regurgitation
Ejection fraction
business.industry
Hemodynamics
Models, Cardiovascular
Mitral Valve Insufficiency
Blood flow
medicine.anatomical_structure
Treatment Outcome
Ventricle
Heart Valve Prosthesis
cardiovascular system
Cardiology
Mitral Valve
Female
Cardiology and Cardiovascular Medicine
business
Tomography, X-Ray Computed
Subjects
Details
- ISSN :
- 1876861X
- Volume :
- 14
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of cardiovascular computed tomography
- Accession number :
- edsair.doi.dedup.....0669bddc5719c28df82f71f02d9ac972