Mitral valve function following ischemic cardiomyopathy: a biomechanical perspective.
Mitral valve function following ischemic cardiomyopathy: a biomechanical perspective.
复制标题
DOI：
10.3233/bme-130777
复制
发表时间：
2014
影响因子：
1
通讯作者：
Kim H
中科院分区：
文献类型：
--
作者：
Rim Y;McPherson DD;Kim H
缺血性二尖瓣（MV）是急慢性冠状动脉疾病引起的左心室病理重塑的常见并发症。它经常代表栓系力增加和 MV 小叶接合减少的病理后果。使用基于有限元的计算 MV 评估技术从生物力学角度研究了缺血 MV 功能。利用 MV 正常患者的 3D 超声心动图数据创建虚拟 3D MV 模型。通过改变正常乳头肌 (PM) 位置的配置，对两种类型的缺血性 MV 进行建模，其中包括不对称的内侧主导或对称的小叶隆起。使用动态有限元方法对 MV 功能进行计算模拟，并评估整个 MV 装置的生物力学信息。具有内侧为主的小叶隆起的缺血性 MV 在后内侧连合区域表现出明显的大应力分布，这是由于内侧 PM 向心尖内侧方向位移导致缺乏小叶接合。在具有平衡小叶隆起的缺血性二尖瓣中，在连合旁区域周围清楚地识别出二尖瓣功能不全和小叶接合不完全。这种计算 MV 评估策略有可能改善缺血性二尖瓣反流的诊断和缺血性 MV 的治疗。
Ischemic mitral valve (MV) is a common complication of pathologic remodeling of the left ventricle due to acute and chronic coronary artery diseases. It frequently represents the pathologic consequences of increased tethering forces and reduced coaptation of the MV leaflets. Ischemic MV function has been investigated from a biomechanical perspective using finite element-based computational MV evaluation techniques. A virtual 3D MV model was created utilizing 3D echocardiographic data in a patient with normal MV. Two types of ischemic MVs containing asymmetric medial-dominant or symmetric leaflet tenting were modeled by altering the configuration of the normal papillary muscle (PM) locations. Computational simulations of MV function were performed using dynamic finite element methods, and biomechanical information across the MV apparatus was evaluated. The ischemic MV with medial-dominant leaflet tenting demonstrated distinct large stress distributions in the posteromedial commissural region due to the medial PM displacement toward the apical-medial direction resulting in a lack of leaflet coaptation. In the ischemic MV with balanced leaflet tenting, mitral incompetency with incomplete leaflet coaptation was clearly identified all around the paracommissural regions. This computational MV evaluation strategy has the potential for improving diagnosis of ischemic mitral regurgitation and treatment of ischemic MVs.