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Euler’s Elastica-Based Biomechanics of the Papillary Muscle Approximation in Ischemic Mitral Valve Regurgitation: A Simple 2D Analytical Model

Ischemic mitral regurgitation (IMR) occurs as an adverse consequence of left ventricle remodeling post-myocardial infarction. A change in mitral valve configuration with an imbalance between closing and tethering forces underlie this pathological condition. These abnormalities lead to impaired leafl...

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Autores principales: Nappi, Francesco, Carotenuto, Angelo Rosario, Avtaar Singh, Sanjeet Singh, Mihos, Christos, Fraldi, Massimiliano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539350/
https://www.ncbi.nlm.nih.gov/pubmed/31075914
http://dx.doi.org/10.3390/ma12091518
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author Nappi, Francesco
Carotenuto, Angelo Rosario
Avtaar Singh, Sanjeet Singh
Mihos, Christos
Fraldi, Massimiliano
author_facet Nappi, Francesco
Carotenuto, Angelo Rosario
Avtaar Singh, Sanjeet Singh
Mihos, Christos
Fraldi, Massimiliano
author_sort Nappi, Francesco
collection PubMed
description Ischemic mitral regurgitation (IMR) occurs as an adverse consequence of left ventricle remodeling post-myocardial infarction. A change in mitral valve configuration with an imbalance between closing and tethering forces underlie this pathological condition. These abnormalities lead to impaired leaflet coaptation and a variable degree of mitral regurgitation, which can in turn influence the ventricular filling status, the heart rhythm and the afterload regardless of the residual ischemic insult. The IMR correction can be pursued through under-sizing mitral annuloplasty and papillary muscle approximation to restore the mitral valve and left ventricle physiological geometry to, consequently, achieve normalization of the engaged physical forces. Because the structures involved undergo extremely large deformations, a biomechanics model based on the Euler’s Elastica –the mitral leaflet– interlaced with nonlinear chordae tendineae anchored on papillary muscles has been constructed to elucidate the interactions between closing and tethering forces. The model takes into account the actual updated geometrical and mechanical features of the valvular and subvalvular apparatuses in physiological and IMR conditions, as well as in case of papillary muscle approximation, finally furnishing ad hoc geometry-based mathematical relations that could be utilised to support—and optimize—the relevant choices in cardiac surgery.
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spelling pubmed-65393502019-06-05 Euler’s Elastica-Based Biomechanics of the Papillary Muscle Approximation in Ischemic Mitral Valve Regurgitation: A Simple 2D Analytical Model Nappi, Francesco Carotenuto, Angelo Rosario Avtaar Singh, Sanjeet Singh Mihos, Christos Fraldi, Massimiliano Materials (Basel) Article Ischemic mitral regurgitation (IMR) occurs as an adverse consequence of left ventricle remodeling post-myocardial infarction. A change in mitral valve configuration with an imbalance between closing and tethering forces underlie this pathological condition. These abnormalities lead to impaired leaflet coaptation and a variable degree of mitral regurgitation, which can in turn influence the ventricular filling status, the heart rhythm and the afterload regardless of the residual ischemic insult. The IMR correction can be pursued through under-sizing mitral annuloplasty and papillary muscle approximation to restore the mitral valve and left ventricle physiological geometry to, consequently, achieve normalization of the engaged physical forces. Because the structures involved undergo extremely large deformations, a biomechanics model based on the Euler’s Elastica –the mitral leaflet– interlaced with nonlinear chordae tendineae anchored on papillary muscles has been constructed to elucidate the interactions between closing and tethering forces. The model takes into account the actual updated geometrical and mechanical features of the valvular and subvalvular apparatuses in physiological and IMR conditions, as well as in case of papillary muscle approximation, finally furnishing ad hoc geometry-based mathematical relations that could be utilised to support—and optimize—the relevant choices in cardiac surgery. MDPI 2019-05-09 /pmc/articles/PMC6539350/ /pubmed/31075914 http://dx.doi.org/10.3390/ma12091518 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nappi, Francesco
Carotenuto, Angelo Rosario
Avtaar Singh, Sanjeet Singh
Mihos, Christos
Fraldi, Massimiliano
Euler’s Elastica-Based Biomechanics of the Papillary Muscle Approximation in Ischemic Mitral Valve Regurgitation: A Simple 2D Analytical Model
title Euler’s Elastica-Based Biomechanics of the Papillary Muscle Approximation in Ischemic Mitral Valve Regurgitation: A Simple 2D Analytical Model
title_full Euler’s Elastica-Based Biomechanics of the Papillary Muscle Approximation in Ischemic Mitral Valve Regurgitation: A Simple 2D Analytical Model
title_fullStr Euler’s Elastica-Based Biomechanics of the Papillary Muscle Approximation in Ischemic Mitral Valve Regurgitation: A Simple 2D Analytical Model
title_full_unstemmed Euler’s Elastica-Based Biomechanics of the Papillary Muscle Approximation in Ischemic Mitral Valve Regurgitation: A Simple 2D Analytical Model
title_short Euler’s Elastica-Based Biomechanics of the Papillary Muscle Approximation in Ischemic Mitral Valve Regurgitation: A Simple 2D Analytical Model
title_sort euler’s elastica-based biomechanics of the papillary muscle approximation in ischemic mitral valve regurgitation: a simple 2d analytical model
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539350/
https://www.ncbi.nlm.nih.gov/pubmed/31075914
http://dx.doi.org/10.3390/ma12091518
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