Computed simulation of transcatheter edge-to-edge mitral valve repair
Introduction
A 73-year-old man stented on the circumflex artery 4 months ago during a ST-elevation myocardial infarction was admitted in the intensive care unit for heart failure. He initially required assisted ventilation but responded well to medical therapy.
Transthoracic and transoesophageal echocardiography showed a severe mitral regurgitation (MR) due to leaflet restrictive motion and prolapse of the medial segment of the posterior valve with a small rupture of chordae, limited inferior wall motion abnormalities with a 45% ejection fraction, and 60 mmHg systolic pulmonary pressure.
There was no need for revascularization and a Mitraclip XTL® (Abbott Vascular Inc., Santa-Clara, CA, USA) was implanted between A3 and P3 (red arrow) enabling to decrease the MR degree from severe to moderate. The patient markedly improved.
Observation
Using a finite element prototype software (PlanOp® Structural Heart, PrediSurge, France), we simulated the results of the intervention. First, a 3D model of the mitral valve was created reproducing the located medially MR before implantation (Panel A).
The clip implantation was simulated using the same clip size positioned at an identical location. The simulated model predicted a residual moderate MR lateral to the clip and a 0.20 cm2 regurgitant orifice (Panel B). We obtained a similar diastolic orifice shape (Panel C).
Result
We present a proof-of-concept case report of a computational simulation using the finite element of transcatheter edge-to-edge mitral valve intervention, closely mimicking procedural results.
With the expected increase in the number of centres and operators performing transcatheter interventions and as more devices become available, personalized medicine to help operators in procedural planning and in the clinical decision-making process will be critical.