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Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

Author

Listed:
  • Yue Zhang
  • Vicky Y Wang
  • Ashley E Morgan
  • Jiwon Kim
  • Mark D Handschumacher
  • Chaya S Moskowitz
  • Robert A Levine
  • Liang Ge
  • Julius M Guccione
  • Jonathan W Weinsaft
  • Mark B Ratcliffe

Abstract

Purpose: MitraClip is the sole percutaneous device approved for functional mitral regurgitation (MR; FMR) but MR recurs in over one third of patients. As device-induced mechanical effects are a potential cause for MR recurrence, we tested the hypothesis that MitraClip increases leaflet stress and procedure-related strain in sub-valvular left ventricular (LV) myocardium in FMR associated with coronary disease (FMR-CAD). Methods: Simulations were performed using finite element models of the LV + mitral valve based on MRI of 5 sheep with FMR-CAD. Models were modified to have a 20% increase in LV volume (↑LV_VOLUME) and MitraClip was simulated with contracting beam elements (virtual sutures) placed between nodes in the center edge of the anterior (AL) and posterior (PL) mitral leaflets. Effects of MitraClip on leaflet stress in the peri-MitraClip region of AL and PL, septo-lateral annular diameter (SLAD), and procedure-related radial strain (Err) in the sub-valvular myocardium were calculated. Results: MitraClip increased peri-MitraClip leaflet stress at end-diastole (ED) by 22.3±7.1 kPa (p

Suggested Citation

  • Yue Zhang & Vicky Y Wang & Ashley E Morgan & Jiwon Kim & Mark D Handschumacher & Chaya S Moskowitz & Robert A Levine & Liang Ge & Julius M Guccione & Jonathan W Weinsaft & Mark B Ratcliffe, 2019. "Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-16, October.
    • Handle: RePEc:plo:pone00:0223472
    DOI: 10.1371/journal.pone.0223472
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