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Ann Thorac Surg 2010;89:1546-1553. doi:10.1016/j.athoracsur.2010.02.036
© 2010 The Society of Thoracic Surgeons
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Guangming Cheng
Arthur W. Wallace
Mark B. Ratcliffe
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Original Articles: Adult Cardiac

First Finite Element Model of the Left Ventricle With Mitral Valve: Insights Into Ischemic Mitral Regurgitation

Jonathan F. Wenk, PhDa,b,e, Zhihong Zhang, MSa,e, Guangming Cheng, MD, PhDa,e, Deepak Malhotra, MDa,e, Gabriel Acevedo-Bolton, PhDd,e, Mike Burger, MSf, Takamaro Suzuki, MDa,e, David A. Saloner, PhDd,e, Arthur W. Wallace, MD, PhDc,e, Julius M. Guccione, PhDa,b,e, Mark B. Ratcliffe, MDa,b,e,*

a Department of Surgery, University of California, San Francisco, California
b Department of Bioengineering, University of California, San Francisco, California
c Department of Anesthesia, University of California, San Francisco, California
d Department of Radiology, University of California, San Francisco, California
e Veterans Affairs Medical Center, San Francisco, California
f Livermore Software Technology Corporation, Livermore, California

Accepted for publication February 12, 2010.

* Address correspondence to Dr Ratcliffe, Surgical Service (112), San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121 (Email: mark.ratcliffe{at}va.gov).

Background: Left ventricular remodeling after posterobasal myocardial infarction can lead to ischemic mitral regurgitation. This occurs as a consequence of leaflet tethering due to posterior papillary muscle displacement.

Methods: A finite element model of the left ventricle, mitral apparatus, and chordae tendineae was created from magnetic resonance images from a sheep that developed moderate mitral regurgitation after posterobasal myocardial infarction. Each region of the model was characterized by a specific constitutive law that captured the material response when subjected to physiologic pressure loading.

Results: The model simulation produced a gap between the posterior and anterior leaflets, just above the infarcted posterior papillary muscle, which is indicative of mitral regurgitation. When the stiffness of the infarct region was reduced, this caused the wall to distend and the gap area between the leaflets to increase by 33%. Additionally, the stress in the leaflets increased around the chordal connection points near the gap.

Conclusions: The methodology outlined in this work will allow a finite element model of both the left ventricle and mitral valve to be generated using noninvasive techniques.


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Invited Commentary
Jerry Braun
Ann. Thorac. Surg. 2010 89: 1554. [Extract] [Full Text] [PDF]



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J. Braun
Invited Commentary
Ann. Thorac. Surg., May 1, 2010; 89(5): 1554 - 1554.
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