Numerical simulation study on systolic anterior motion of the mitral valve in hypertrophic obstructive cardiomyopathy. (1st September 2018)

• Record Type: Journal Article
• Authors: Deng, Long; Huang, Xueying; Yang, Chun; Lyu, Bin; Duan, Fujian; Tang, Dalin; Song, Yunhu
• Is Part Of: International journal of cardiology. Volume 266(2018)
• Page Start: 167
• Page End: 173
• Publication Date: 2018-09-01
• Subjects: CT computed tomography -- ECG electrocardiography -- FSI fluid–structure interaction -- HOCM hypertrophic obstructive cardiomyopathy -- LV left ventricle -- LVOT left ventricular outflow tract -- LVOTG left ventricular outflow tract gradient -- MV mitral valve -- MVL mitral valve leaflets -- SAM systolic anterior motion -- VFM vector flow mapping; Systolic anterior motion -- Hypertrophic obstructive cardiomyopathy -- Septal myectomy -- Computational model -- Numerical simulation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.01.062
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The hydrodynamic mechanisms of systolic anterior motion (SAM) of the mitral valve in hypertrophic obstructive cardiomyopathy (HOCM) remain unclear. Methods: Based on computed tomography (CT) images and clinical data, pre- and post-operative computational models of the left ventricle were constructed for 6 HOCM patients receiving septal myectomy. SAM was abolished in 5 patients and persisted in one after septal myectomy surgery. The obtained simulation results including flow field of the left ventricle and mechanical behaviors of the mitral valve (MV) between pre- and post-operative FSI models were compared. Results: The pressure difference and shear stress on the mitral valve leaflets (MVL) were relatively high pre-operatively, and decreased significantly after satisfactory surgery, but remained high following failed surgery. The significant increase in coaptation-to-septal distance was found when SAM was abolished. Conclusions: Our results indicated that high pressure difference and shear stress on the MVL might directly initiate SAM in HOCM. Successful septal myectomy enlarged the coaptation-to-septal distance sufficiently to keep the MVL away from the ejection flow, thereby eliminating SAM. Highlights: CT-based patient-specific computational models of LV in HOCM patients Simulation results between pre- and post-op models were compared. High pressure difference and shear stress on MVL might directly initiate SAM in HOCM.