Modelling of Lesions Associated with Functional Mitral Regurgitation in an Ex Vivo Platform
Modelling of Lesions Associated with Functional Mitral Regurgitation in an Ex Vivo Platform
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DOI：
10.1007/s10439-017-1885-6
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发表时间：
2017-10-01
影响因子：
3.8
通讯作者：
Vismara, Riccardo
中科院分区：
文献类型：
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作者：
Jaworek, Michal;Lucherini, Federico;Vismara, Riccardo
功能性二尖瓣反流（FMR）是一种复杂的病理，涉及瓣膜和瓣下结构重构，其治疗被认为是具有挑战性的。目前缺乏实验模型，无法在现实环境中对FMR治疗进行可靠的临床前评估。提出了一种新的模拟FMR的方法，并将其应用于离体被动跳动心脏平台。FMR是通过主要在前后方向扩张二尖瓣环（MA），并通过特别设计和3D打印的扩张和移位装置在顶部和外侧置换乳头肌（pm）来获得的。它引起血流动力学和瓣膜形态的改变。孤立性二尖瓣扩张（MAD）导致二尖瓣前后距离（A-P）明显增加，合拢高度（CH）、支包面积（TA）和收缩期小叶成角降低，类似于临床上公认的ⅰ型二尖瓣反流，小叶运动正常。而伴随的MAD与PM移位引起A-P， TA， CH的增加。这种几何构型复制了典型的IIIb型病变的决定因素，小叶运动受限。所提出的方法提供了一个现实的和可重复的离体FMR模型，具有临床病理相关的两个病变。它有望成功地用于临床前研究、临床培训和医学教育。
Functional mitral regurgitation (FMR) is a complex pathology involving valvular and subvalvular structures reconfiguration, and its treatment is considered challenging. There is a lack of experimental models allowing for reliable preclinical FMR treatments' evaluation in a realistic setting. A novel approach to simulate FMR was developed and incorporated into an ex vivo passive beating heart platform. FMR was obtained by dilating the mitral annulus (MA) mainly in the antero-posterior direction and displacing the papillary muscles (PMs) apically and laterally by ad hoc designed and 3D printed dilation and displacing devices. It caused hemodynamic and valve morphology alterations. Isolated MA dilation (MAD) led to significantly increased antero-posterior distance (A-P) and decreased coaptation height (CH), tenting area (TA) and systolic leaflets angulation, resembling clinically recognized type I of mitral regurgitation with normal leaflet motion. Whereas concomitant MAD with PM displacement caused an increase in A-P, TA, CH. This geometrical configuration replicated typical determinants of type IIIb lesion with restricted leaflet motion. The proposed methods provided a realistic and repeatable ex vivo FMR model featuring two lesions clinically associated with the pathology. It bears a promise to be successfully utilized in preclinical studies, clinical training and medical education.