High Resolution Imaging of the Mitral Valve in the Natural State with 7 Tesla MRI

Imaging techniques of the mitral valve have improved tremendously during the last decade, but challenges persist. The delicate changes in annulus shape and papillary muscle position throughout the cardiac cycle have significant impact on the stress distribution in the leaflets and chords, thus preservation of anatomically accurate positioning is critical. The aim of this study was to develop an in vitro method and apparatus for obtaining high-resolution 3D MRI images of porcine mitral valves in both the diastolic and systolic configurations with physiologically appropriate annular shape, papillary muscle positions and orientations, specific to the heart from which the valve was harvested. Positioning and mounting was achieved through novel, customized mounting hardware consisting of papillary muscle and annulus holders with geometries determined via pre-mortem ultrasonic intra-valve measurements. A semi-automatic process was developed and employed to tailor Computer Aided Design models of the holders used to mount the valve. All valve mounting hardware was 3D printed using a stereolithographic printer, and the material of all fasteners used were brass for MRI compatibility. The mounted valves were placed within a clear acrylic case, capable of holding a zero-pressure and pressurized liquid bath of a MRI-compatible fluid. Obtaining images from the valve submerged in liquid fluid mimics the natural environment surrounding the valve, avoiding artefacts due to tissue surface tension mismatch and gravitational impact on tissue shape when not neutrally buoyant. Fluid pressure was supplied by reservoirs held at differing elevations and monitored and controlled to within ±1mmHg to ensure that the valves remained steady. The valves were scanned in a 7 Tesla MRI system providing a voxel resolution of at least 80μm. The systematic approach produced 3D datasets of high quality which, when combined with physiologically accurate positioning by the apparatus, can serve as an important input for validated computational models

Simultaneous determination of regional left ventricular wall stresses in intact canine hearts

Von Hans Walte

Rigid, Complete Annuloplasty Rings Increase Anterior Mitral Leaflet Strains in the Normal Beating Ovine Heart

Background-Annuloplasty ring or band implantation during surgical mitral valve repair perturbs mitral annular dimensions, dynamics, and shape, which have been associated with changes in anterior mitral leaflet (AML) strain patterns and suboptimal long-term repair durability. We hypothesized that rigid rings with nonphysiological three-dimensional shapes, but not saddle-shaped rigid rings or flexible bands, increase AML strains

The effect of pure mitral regurgitation on mitral annular geometry and three-dimensional saddle shape

ObjectiveChronic ischemic mitral regurgitation is associated with mitral annular dilatation in the septal-lateral dimension and flattening of the annular 3-dimensional saddle shape. To examine whether these perturbations are caused by the ischemic insult, mitral regurgitation, or both, we investigated the effects of pure mitral regurgitation (low pressure volume overload) on annular geometry and shape.MethodsEight radiopaque markers were sutured evenly around the mitral annulus in sheep randomized to control (CTRL, n = 8) or experimental (HOLE, n = 12) groups. In HOLE, a 3.5- to 4.8-mm hole was punched in the posterior leaflet to generate pure mitral regurgitation. Four-dimensional marker coordinates were obtained radiographically 1 and 12 weeks postoperatively. Mitral annular area, annular septal-lateral and commissure–commissure dimensions, and annular height were calculated every 16.7 ms.ResultsMitral regurgitation grade was 0.4 ± 0.4 in CTRL and 3.0 ± 0.8 in HOLE (P < .001) at 12 weeks. End-diastolic left ventricular volume index was greater in HOLE at both 1 and 12 weeks; end-systolic volume index was larger in HOLE at 12 weeks. Mitral annular area increased in HOLE predominantly in the commissure–commissure dimension, with no difference in annular height between HOLE versus CTRL at 1 or 12 weeks, respectively.ConclusionIn contrast with annular septal-lateral dilatation and flattening of the annular saddle shape observed with chronic ischemic mitral regurgitation, pure mitral regurgitation was associated with commissure–commissure dimension annular dilatation and no change in annular shape. Thus, infarction is a more important determinant of septal-lateral dilatation and annular shape than mitral regurgitation, which reinforces the need for disease-specific designs of annuloplasty rings

Chapter 12 Mitral LV Relationship

Figures 12.1-12.6 show the geometric relationships between the left ventricle and the mitral valve components for hearts H1-H6. The view is from the right fibrous trigone towards the left fibrous trigone, i.e., from the posterior wall of the LV towards the anterior wall. The best fit anterior leaflet plane is clamped to the X-Y axis for both the top frame (maximum LV inflow) and the bottom frame (maximum left ventricular pressure). LV markers #1-4 and # 8-13 are subepicardial; septal markers #5-7 are endocardial. The outflow tract is at lower right in each figure

Chapter 06 Anterior Leaflet Curvatures

Anterior leaflet circumferential and radial curvatures were quantified in the six hearts as described in Appendix C. In brief, for each frame a best-fit plane was fit to all the anterior leaflet markers, including the trigonal hinge markers. Coordinate X-Y basis vectors were established in this plane and radial curvature was defined from the radius of a circle passing through the X-Z coordinates of radial marker triplets in this coordinate system (roughly perpendicular to the line connecting the LFT-RFT markers) and circumferential curvature defined from the radius of the circle passing through the Y-Z coordinates of circumferential marker triplets (roughly parallel to the line connecting the LFT-RFT markers). As defined in this fashion, positive curvature was concave to the LV, negative curvature was convex to the LV