Tricuspid valve regurgitation decreases after mitraclip implantation: Fluid structure interaction simulation
Tricuspid valve regurgitation decreases after mitraclip implantation: Fluid structure interaction simulation
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DOI：
10.1016/j.mechrescom.2019.04.009
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发表时间：
2019-04-01
影响因子：
2.4
通讯作者：
Guccione, Julius M.
中科院分区：
文献类型：
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作者：
Dabiri, Yaghoub;Yao, Jiang;Guccione, Julius M.
未经治疗的三尖瓣返流（TR）与死亡率、发病率和住院率增加有关。目前的药物和手术治疗选择是有限的。MitraClip （MC）是一种边缘到边缘的经皮介入治疗，据报道对治疗TR有效。本研究的目的是通过多物理场流固相互作用（FSI）分析来检查MC位置对TR的影响。计算装置包括三尖瓣（TV）、腱索、血液颗粒和包围小叶和血液颗粒的管。小叶和弦被建模为超弹性材料，血液被建模为光滑粒子流体力学。FSI分析了通过关闭的瓣膜的血流，并进行了多个模拟，包括正常、病变和治疗状态的电视。为了模拟病变电视，从正常电视上移除间隔和肺小叶之间的一组索，这导致反流增加。考虑了四种MC处理情况：i)一个MC靠近环，ii)一个MC大约在环和小叶尖端之间，iii)一个MC靠近小叶尖端，iv)两个MC：一个大约在环和小叶尖端之间，一个靠近小叶尖端。与正常电视（2.5%）相比，病变电视的TR增高（7.5%）。所有MC处理的情况下TR均下降。位于环和小叶尖端之间中点附近的MC导致TR下降幅度最大（与未处理的情况相比为75.2%）。位于小叶尖端附近的MC与最低的TR降低相关（与未治疗的情况相比为2.2%）。当使用两种MC时，TR降低率相对较高（68.7%），但与最优的单一MC相比，TR没有提高。在所有条件下，MC都会导致夹断区域附近的高应力；在叶尖附近的MC值最高。使用定量计算方法，我们证实了之前关于MC治疗TR疗效的临床报告。本研究的结果可能会导致设计更有效的TR MC干预措施。版权所有。
Untreated tricuspid valve regurgitation (TR) is associated with increased rates of mortality, morbidity, and hospitalization. Current pharmacological and surgical treatment options for TR are limited. MitraClip (MC), an edge-to-edge percutaneous intervention, has been reported to be effective for treatment of TR. The goal of this study was to examine the effects of MC position on TR, using a multiphysics fluid-structure-interaction (FSI) analysis.The computational set up included the tricuspid valve (TV), the chordae tendineae, the blood particles, and a tube that surrounded the leaflets and blood particles. The leaflets and chordae were modeled as hyperelastic materials, and blood was modeled using smoothed particle hydrodynamics. FSI analysis was conducted for blood flow through the closed valve for multiple simulations that account for normal, diseased, and treated conditions of the TV. To simulate the diseased TV, a group of chordae between septal and pulmonary leaflets were removed from the normal TV, which produced increased regurgitation. Four MC treated scenarios were considered: i) one MC near the annulus, ii) one MC approximately midway between the annulus and leaflet tip, iii) one MC near the leaflet tip, iv) two MCs: one approximately midway between the annulus and leaflet tip, and one close to the leaflet tip.The TR increased in diseased TV (7.5%) compared to normal TV (2.5%). All MC treated scenarios decreased TR. The MC located near the midway point between the annulus and leaflet tip led to the largest decrease in TR (75.2% compared to the untreated condition). The MC located near the leaflet tip was associated with the lowest reduction in TR (2.2% compared to the untreated condition). When two MCs were used, reduction in TR was relatively high (68.7%), but TR was not improved compared to the optimal single MC. MC caused high stresses in the vicinity of the clipping area in all conditions; the highest occurred when the MC was near the leaflet tips.Using a quantitative computational approach, we confirm previous clinical reports on the efficacy of MC for treatment of TR. The results of this study could lead to the design of more efficient MC interventions for TR. (C) 2019 Elsevier Ltd. All rights reserved.