Background: Computational simulation using numerical analysis methods can help\nto assess the complex biomechanical and functional characteristics of the mitral\nvalve (MV) apparatus. It is important to correctly determine physical contact\ninteraction between the MV apparatus components during computational MV\nevaluation. We hypothesize that leaflet-to-chordae contact interaction plays an\nimportant role in computational MV evaluation, specifically in quantitating the\ndegree of leaflet coaptation directly related to the severity of mitral regurgitation\n(MR). In this study, we have performed dynamic finite element simulations of MV\nfunction with and without leaflet-to-chordae contact interaction, and determined the\neffect of leaflet-to-chordae contact interaction on the computational MV evaluation.\nMethods: Computational virtual MV models were created using the MV geometric\ndata in a patient with normal MV without MR and another with pathologic MV with\nMR obtained from 3D echocardiography. Computational MV simulation with full\ncontact interaction was specified to incorporate entire physically available contact\ninteractions between the leaflets and chordae tendineae. Computational MV\nsimulation without leaflet-to-chordae contact interaction was specified by defining\nthe anterior and posterior leaflets as the only contact inclusion.\nResults: Without leaflet-to-chordae contact interaction, the computational MV\nsimulations demonstrated physically unrealistic contact interactions between the\nleaflets and chordae. With leaflet-to-chordae contact interaction, the anterior\nmarginal chordae retained the proper contact with the posterior leaflet during the\nentire systole. The size of the non-contact region in the simulation with leaflet-tochordae\ncontact interaction was much larger than for the simulation with only\nleaflet-to-leaflet contact.\nConclusions: We have successfully demonstrated the effect of leaflet-to-chordae\ncontact interaction on determining leaflet coaptation in computational dynamic MV\nevaluation. We found that physically realistic contact interactions between the leaflets\nand chordae should be considered to accurately quantitate leaflet coaptation for MV\nsimulation. Computational evaluation of MV function that allows precise quantitation\nof leaflet coaptation has great potential to better quantitate the severity of MR.
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