Mitral Valve Dynamic Analysis And Potential Clinical Applications

说明(申请人提供)：二尖瓣修补术是二尖瓣关闭不全患者的首选治疗方法。在MV修复手术中，尚未解决的问题是预测哪种修复方式对每个患者来说是最好的。很大的困难在于不能准确地理解MV的生理学，而MV生理学使其容易出现功能障碍和功能不全。如果影像技术可以与适当的计算MV评估方法相结合，那么MV修复的改进诊断和治疗方法就可以被开发出来。目前的临床三维(3-D)超声心动图可以显示MV装置良好的体积形态。我们开发了新的计算技术，用于结构和流体动力学评估，以确定心脏瓣膜的病理生理学。三维超声心动图和我们的计算模拟技术相结合，可以提供一个强大的工具来评估MV装置的复杂结构和功能信息。拟议项目的团队已经在瓣膜动力学的计算建模和临床超声心动图研究中展示了成功完成该项目的能力。我们的主要目的是开发一种新的计算技术，结合三维超声心动图、有限元(FE)和流体-结构相互作用(FSI)分析来评估MV形态(正常与病变瓣膜，修复前与修复后)对MV功能的影响。为此，我们将：1)开发一个集成的建模平台，从三维经食道超声心动图创建一个虚拟的MV模型，用于计算模拟和分析；2)通过对正常、病变和修复的MV进行比较动态有限元评估，确定MV复合体几何变化的后果；以及3)使用一个全面的、最先进的3D FSI模型来分析正常的MV功能和MV疾病和修复引起的左心室流体动力学的变化。我们的长期目标是开发一种将成像技术与计算结构和流体动力学分析方法相结合的诊断方法，以提供针对患者的精确3D MV几何形状以及正常MV功能和瓣膜疾病变化的详细信息。通过将我们的研究集中在这个方向上，我们将能够将我们的技术和策略转化到临床环境中，使研究人员能够量化MV修复后与疾病相关的功能改变的程度和恢复到正常瓣膜功能的程度。

DESCRIPTION (provided by applicant): Mitral valve (MV) repair is the preferred treatment in patients with MV insufficiency. The unsolved problem in MV repair surgery is predicting which repair is optimal for each patient. Much of the difficulty lies in not precisely understanding MV physiology which predisposes it to dysfunction and insufficiency. If imaging techniques can be combined with appropriate computational MV evaluation methods, then improved diagnosis and therapeutic approaches to MV repair can be developed. Current clinical three-dimensional (3-D) echocardiography can demonstrate excellent volumetric morphology of the MV apparatus. We have developed novel computational techniques for structural and fluid dynamic evaluation to determine cardiac valve pathophysiology. The combination of 3-D echocardiography and our computational simulation techniques can provide a powerful tool to evaluate complex structural and functional information of the MV apparatus. The team for the proposed project has demonstrated capability in computational modeling of valve dynamics and in clinical echocardiographic studies to successfully complete the project. Our principal aim is to develop a novel computational technique combining 3-D echocardiography with finite element (FE) and fluid-structure interaction (FSI) analyses to evaluate the effects of MV morphology (normal vs. diseased valves, and pre- vs. post-repair) on MV function. To this end, we will; 1) develop an integrated modeling platform to create a virtual MV model from 3-D transesophageal echocardiography for computational simulation and analysis; 2) determine the consequences of geometric alterations of the MV complex by comparative dynamic FE evaluations on normal, diseased, and repaired MVs; and 3) employ a comprehensive, state-of-the-art 3-D FSI model to analyze both normal MV function and alterations in left ventricle fluid dynamics resulting from MV disease and repair. Our long term goals are to develop a diagnostic methodology combining imaging techniques and computational structural and fluid dynamic analyses methods that will provide precise patient-specific 3-D MV geometry as well as detailed information of normal MV function and alterations with valvular disease. Through focusing our studies in this direction, we will be able to transition our techniques and strategies into the clinical setting to allow investigators to quantitate the extent of disease-related functional alterations and restoration towards normal valvular function following MV repair.