New insights into mitral heart valve prolapse after chordae rupture through fluid-structure interaction computational modeling.
New insights into mitral heart valve prolapse after chordae rupture through fluid-structure interaction computational modeling.
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DOI：
10.1038/s41598-018-35555-5
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发表时间：
2018-11-23
影响因子：
4.6
通讯作者：
Sun W
中科院分区：
文献类型：
--
作者：
Caballero A;Mao W;McKay R;Primiano C;Hashim S;Sun W
二尖瓣（MV）动力学取决于二尖瓣小叶、腱索、二尖瓣环、乳头肌和相邻心室壁之间的力平衡。腱索断裂破坏MV和左心室（LV）之间的连接，导致二尖瓣返流（MR），这是最常见的瓣膜疾病。在这项研究中，流体-结构相互作用（FSI）建模框架的实施，以调查腱索断裂对左心脏（LH）的动力学和严重程度的MR的影响。一个控制和七个腱索断裂LH模型的开发，以模拟病理过程中，最小的腱索断裂之前更广泛的腱索断裂。不同的非偏心性和偏心性反流束被确定在收缩期。心脏效率以每搏输出功的比值来评价。二尖瓣结构结果显示，基底/支柱腱索是主要的承重腱索。腱索断裂数量增加导致基础/支柱张力降低，但边缘/中间载荷增加。特定扇贝的腱索断裂不一定会增加整个脱垂瓣叶的应力。这项工作代表了对病理性LH动力学的患者特异性建模的进一步进展，并有可能提高我们对原发性MR的生物力学机制和治疗的理解。
Mitral valve (MV) dynamics depends on a force balance across the mitral leaflets, the chordae tendineae, the mitral annulus, the papillary muscles and the adjacent ventricular wall. Chordae rupture disrupts the link between the MV and the left ventricle (LV), causing mitral regurgitation (MR), the most common valvular disease. In this study, a fluid-structure interaction (FSI) modeling framework is implemented to investigate the impact of chordae rupture on the left heart (LH) dynamics and severity of MR. A control and seven chordae rupture LH models were developed to simulate a pathological process in which minimal chordae rupture precedes more extensive chordae rupture. Different non-eccentric and eccentric regurgitant jets were identified during systole. Cardiac efficiency was evaluated by the ratio of external stroke work. MV structural results showed that basal/strut chordae were the major load-bearing chordae. An increased number of ruptured chordae resulted in reduced basal/strut tension, but increased marginal/intermediate load. Chordae rupture in a specific scallop did not necessarily involve an increase in the stress of the entire prolapsed leaflet. This work represents a further step towards patient-specific modeling of pathological LH dynamics, and has the potential to improve our understanding of the biomechanical mechanisms and treatment of primary MR.
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