Transcatheter mitral valve replacement in mitral annulus calcification – “The art of computer simulation”

Júlia Karády; Ioannis Ntalas; Bernard Prendergast; Christopher Blauth; Steven Niederer; Pál Maurovich-Horvat; Ronak Rajani

doi:10.1016/j.jcct.2017.12.007

Transcatheter mitral valve replacement in mitral annulus calcification – “The art of computer simulation”

Júlia Karády, Ioannis Ntalas, Bernard Prendergast, Christopher Blauth, Steven Niederer, Pál Maurovich-Horvat, Ronak Rajani

Biomedical Engineering Department

Research output: Contribution to journal › Article › peer-review

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Abstract

There is considerable interest in transcatheter prosthetic valve treatment for mitral valve disease in high-risk individuals. Although the presence of mitral annular calcium (MAC) may provide an anchoring zone for such devices, results to date have been modest with reported technical failure rates approaching 30% in specialist centers. This in part relates to the risk of left ventricular outflow tract obstruction and device dislodgment but also to the lack of specific imaging guidelines to plan for such procedures. We present the use of finite element analysis and computer simulation based on cardiac CT in three patients with severe MAC in whom transcatheter devices were considered. In the first two cases, the computer simulations were performed after the clinical procedure and were concordant with the clinical outcome. For the third case, computer simulation was performed prior to the clinical procedure. This indicated unsuitability for transcatheter device deployment and a subsequent medical management was adopted. Overall, our initial results suggest that computer simulation may have the potential to improve patient selection for transcatheter mitral valve replacement in the presence of significant MAC.

Original language	English
Journal	Journal of Cardiovascular Computed Tomography
Early online date	4 Jan 2018
DOIs	https://doi.org/10.1016/j.jcct.2017.12.007
Publication status	E-pub ahead of print - 4 Jan 2018

Keywords

Mitral annulus calcification
Transcatheter mitral valve replacement
Cardiac computed tomography
Computer simulation
Finite element simulation

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10.1016/j.jcct.2017.12.007

Transcatheter mitral valve replacement_KARADY_Publishedonline4January2018_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 14.2 MBLicence: CC BY-NC-ND

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title = "Transcatheter mitral valve replacement in mitral annulus calcification – “The art of computer simulation”",

abstract = "There is considerable interest in transcatheter prosthetic valve treatment for mitral valve disease in high-risk individuals. Although the presence of mitral annular calcium (MAC) may provide an anchoring zone for such devices, results to date have been modest with reported technical failure rates approaching 30% in specialist centers. This in part relates to the risk of left ventricular outflow tract obstruction and device dislodgment but also to the lack of specific imaging guidelines to plan for such procedures. We present the use of finite element analysis and computer simulation based on cardiac CT in three patients with severe MAC in whom transcatheter devices were considered. In the first two cases, the computer simulations were performed after the clinical procedure and were concordant with the clinical outcome. For the third case, computer simulation was performed prior to the clinical procedure. This indicated unsuitability for transcatheter device deployment and a subsequent medical management was adopted. Overall, our initial results suggest that computer simulation may have the potential to improve patient selection for transcatheter mitral valve replacement in the presence of significant MAC.",

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T1 - Transcatheter mitral valve replacement in mitral annulus calcification – “The art of computer simulation”

AU - Karády, Júlia

AU - Ntalas, Ioannis

AU - Prendergast, Bernard

AU - Blauth, Christopher

AU - Niederer, Steven

AU - Maurovich-Horvat, Pál

AU - Rajani, Ronak

PY - 2018/1/4

Y1 - 2018/1/4

N2 - There is considerable interest in transcatheter prosthetic valve treatment for mitral valve disease in high-risk individuals. Although the presence of mitral annular calcium (MAC) may provide an anchoring zone for such devices, results to date have been modest with reported technical failure rates approaching 30% in specialist centers. This in part relates to the risk of left ventricular outflow tract obstruction and device dislodgment but also to the lack of specific imaging guidelines to plan for such procedures. We present the use of finite element analysis and computer simulation based on cardiac CT in three patients with severe MAC in whom transcatheter devices were considered. In the first two cases, the computer simulations were performed after the clinical procedure and were concordant with the clinical outcome. For the third case, computer simulation was performed prior to the clinical procedure. This indicated unsuitability for transcatheter device deployment and a subsequent medical management was adopted. Overall, our initial results suggest that computer simulation may have the potential to improve patient selection for transcatheter mitral valve replacement in the presence of significant MAC.

AB - There is considerable interest in transcatheter prosthetic valve treatment for mitral valve disease in high-risk individuals. Although the presence of mitral annular calcium (MAC) may provide an anchoring zone for such devices, results to date have been modest with reported technical failure rates approaching 30% in specialist centers. This in part relates to the risk of left ventricular outflow tract obstruction and device dislodgment but also to the lack of specific imaging guidelines to plan for such procedures. We present the use of finite element analysis and computer simulation based on cardiac CT in three patients with severe MAC in whom transcatheter devices were considered. In the first two cases, the computer simulations were performed after the clinical procedure and were concordant with the clinical outcome. For the third case, computer simulation was performed prior to the clinical procedure. This indicated unsuitability for transcatheter device deployment and a subsequent medical management was adopted. Overall, our initial results suggest that computer simulation may have the potential to improve patient selection for transcatheter mitral valve replacement in the presence of significant MAC.

KW - Mitral annulus calcification

KW - Transcatheter mitral valve replacement

KW - Cardiac computed tomography

KW - Computer simulation

KW - Finite element simulation

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DO - 10.1016/j.jcct.2017.12.007

M3 - Article

SN - 1934-5925

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

ER -

Transcatheter mitral valve replacement in mitral annulus calcification – “The art of computer simulation”

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Keywords

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