The effect of mitral annuloplasty shape in ischemic mitral regurgitation: A finite element simulation

Vincent M. Wong, Jonathan F. Wenk, Zhihong Zhang, Guangming Cheng, Gabriel Acevedo-Bolton, Mike Burger, David A. Saloner, Arthur W. Wallace, Julius M. Guccione, Mark B. Ratcliffe, Liang Ge

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Background: Undersized mitral annuloplasty (MA) is the preferred surgical treatment for chronic ischemic mitral regurgitation. However, the preferred shape of undersized MA is unclear. Methods: A previously described finite element model of the left ventricle with mitral valve based on magnetic resonance images of a sheep with chronic ischemic mitral regurgitation after posterolateral myocardial infarction was used. Saddle-shape (Edwards Physio II) and asymmetric (IMR ETlogix) MA rings were digitized and meshed. Virtual annuloplasty was performed using virtual sutures to attach the MA ring. Left ventricular diastole and systole were performed before and after virtual MA of each type. Results: Both types of MA reduced the septolateral dimension of the mitral annulus and abolished mitral regurgitation. The asymmetric MA was associated with lower virtual suture force in the P2 region but higher force in P1 and P3 regions. Although both types of MA reduced fiber stress at the left ventricular base, fiber stress reduction after asymmetric MA was slightly greater. Neither type of MA affected fiber stress at the left ventricular equator or apex. Although both types of MA increased leaflet curvature and reduced leaflet stress, stress reduction with saddle-shape MA was slightly greater. Both MA types reduced stress on the mitral chordae. Conclusions: The effects of saddle-shape and asymmetric MA rings are similar. Finite element simulations are a powerful tool that may reduce the need for animal and clinical trials.

Original languageEnglish
Pages (from-to)776-782
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number3
StatePublished - Mar 2012

Bibliographical note

Funding Information:
We thank Edwards Lifesciences for providing samples of the annuloplasty rings used in this work. This study was supported by NIH grants R01-HL-084431 (M.B.R.) and R01-HL-077921 and 86400 (J.M.G.).

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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