A High-Resolution Network with Strip Attention for Retinal Vessel Segmentation.

Accurate segmentation of retinal vessels is an essential prerequisite for the subsequent analysis of fundus images. Recently, a number of methods based on deep learning have been proposed and shown to demonstrate promising segmentation performance, especially U-Net and its variants. However, tiny vessels and low-contrast vessels are hard to detect due to the issues of a loss of spatial details caused by consecutive down-sample operations and inadequate fusion of multi-level features caused by vanilla skip connections. To address these issues and enhance the segmentation precision of retinal vessels, we propose a novel high-resolution network with strip attention. Instead of the U-Net-shaped architecture, the proposed network follows an HRNet-shaped architecture as the basic network, learning high-resolution representations throughout the training process. In addition, a strip attention module including a horizontal attention mechanism and a vertical attention mechanism is designed to obtain long-range dependencies in the horizontal and vertical directions by calculating the similarity between each pixel and all pixels in the same row and the same column, respectively. For effective multi-layer feature fusion, we incorporate the strip attention module into the basic network to dynamically guide adjacent hierarchical features. Experimental results on the DRIVE and STARE datasets show that the proposed method can extract more tiny vessels and low-contrast vessels compared with existing mainstream methods, achieving accuracies of 96.16% and 97.08% and sensitivities of 82.68% and 89.36%, respectively. The proposed method has the potential to aid in the analysis of fundus images.

[Numerical Analysis of Two-stage Axial Blood Pump Based on Blood Damage].

The implantable miniaturized axial blood pump works at a high rotational speed,which increases the risk of blood damage.In this article,we aimed to reduce the possibility of hemolysis and thrombosis by designing a twostage axial blood pump.Under the operation conditions of flow rate 5L/min and outlet pressure of 100 mm Hg,we carried out the numerical simulation on the two-stage and single-stage blood pumps to compare the hemolysis and platelet activation state.The results turned out that the hemolysis index of two-stage axial blood pump was better while the platelet activation state was worse than those of single stage design.On the index of hemolysis level and platelet activation state,the design of the two-stage pump with the low and high-head impeller combination was better than the two-stage pump with the equal heads,or the high and low-head impeller combination.In terms of reducing the risk of blood damage for implantable miniaturized axial blood pump,the research result can provide some theoretical basis and new design ideas.

[Research on Control of the Cardiovascular System Based on a Left Ventricular Assist Device].

We propose a control model of the cardiovascular system coupled with a rotary blood pump in the present paper.A new mathematical model of the rotary heart pump is presented considering the hydraulic characteristics and the similarity principle of pumps.A seven-order nonlinear spatial state equation adopting lumped parameter is used to describe the combined cardiovascular-pump model.Pump speed is used as the control variable.To achieve sufficient perfusion and to avoid suction,a feedback strategy based on minimum(diastolic)pump flow is used in the control model.The results showed that left ventricular assist device(LVAD)could improve hemodynamics of the cardiovascular system of the patient with heart failure in open loop.When rotation speed was 9,000r/min,cardiac output reached 82mL/s while the initial cardiac output was only 34mL/s without the LVAD support.When the rotation speed was above 12 800r/min,suction was found because the high rotating speed resulted in insufficient venous return volume.Suction was avoided by adopting the feedback control.The model reveals the interaction of LVAD and the cardiovascular system,which provides theoretical basis for the therapy of heart failure in the left ventricular and for the design of a physiological control strategy.

Attached indigenous microalgal-bacterial consortium with greater stress-resistance facilitated recovery of integrated fixed-film system after experiencing short-term stagnation inhibition.

Stability of integrated fixed-film indigenous microalgal-bacterial consortium (IF-IMBC) requires further investigation. This study focused on the influence of short-term stagnation (STS), caused by influent variations or equipment maintenance, on IF-IMBC. Results showed that the IF-IMBC system experienced initial inhibition followed by subsequent recovery during STS treatment. Enhanced organics utilization was believed to contribute to system recovery. It is proposed that the attached IMBC possessed greater stress resistance. On the one hand, a higher increase in bacteria potentially participating in organic degradation was observed. Moreover, the dominant eukaryotic species significantly decreased in suspended IMBC while its abundance remained stable in the attached state. On the other hand, increased abundance for most functional enzymes was primarily observed in the attached bacteria. This fundamental research aims to bridge the knowledge gap regarding the response of IMBC to variations in operational conditions.

PEDV-spike-protein-expressing mRNA vaccine protects piglets against PEDV challenge.

Porcine epidemic diarrhea virus (PEDV), a swine enteropathogenic coronavirus, causes severe diarrhea in neonatal piglets, which is associated with a high mortality rate. Thus, developing effective and safe vaccines remains a top priority for controlling PEDV infection. Here, we designed two lipid nanoparticle (LNP)-encapsulated mRNA (mRNA-LNP) vaccines encoding either the full-length PEDV spike (S) protein or a multiepitope chimeric spike (Sm) protein. We found that the S mRNA-LNP vaccine was superior to the Sm mRNA-LNP vaccine at inducing antibody and cellular immune responses in mice. Evaluation of the immunogenicity and efficacy of the S mRNA vaccine in piglets confirmed that it induced robust PEDV-specific humoral and cellular immune responses in vivo. Importantly, the S mRNA-LNP vaccine not only protected actively immunized piglets against PEDV but also equipped neonatal piglets with effective passive anti-PEDV immunity in the form of colostrum-derived antibodies after the immunization of sows. Our findings suggest that the PEDV-S mRNA-LNP vaccine is a promising candidate for combating PEDV infection.IMPORTANCEPorcine epidemic diarrhea virus (PEDV) continues to harm the global swine industry. It is important to develop a highly effective vaccine to control PEDV infection. Here, we report a PEDV spike (S) mRNA vaccine that primes a potent antibody response and antigen-specific T-cell responses in immunized piglets. Active and passive immunization can protect piglets against PED following the virus challenge. This study highlights the efficiency of the PEDV-S mRNA vaccine and represents a viable approach for developing an efficient PEDV vaccine.

Classification of Children's Heart Sounds With Noise Reduction Based on Variational Modal Decomposition.

Purpose: Children's heart sounds were denoised to improve the performance of the intelligent diagnosis. Methods: A combined noise reduction method based on variational modal decomposition (VMD) and wavelet soft threshold algorithm (WST) was proposed, and used to denoise 103 phonocardiogram samples. Features were extracted after denoising and employed for an intelligent diagnosis model to verify the effect of the denoising method. Results: The noise in children's phonocardiograms, especially crying noise, was suppressed. The signal-to-noise ratio obtained by the method for normal heart sounds was 14.69 dB at 5 dB Gaussian noise, which was higher than that obtained by WST only and the other VMD denoising method. Intelligent classification showed that the accuracy, sensitivity and specificity of the classification system for congenital heart diseases were 92.23, 92.42, and 91.89%, respectively and better than those with WST only. Conclusion: The proposed noise reduction method effectively eliminates noise in children's phonocardiograms and improves the performance of intelligent screening for the children with congenital heart diseases.

A Single-opening&closing Valve Tester for Direct Measurement of Closing Volume of the Heart Valve.

PURPOSE: The objective of this study was to develop a novel single opening&closing pulsatile flow in-vitro valve tester for direct measurement of closing volume of the heart valve. METHODS: A single opening&closing valve tester was composed of a piston pump, valve mounting chamber, reservoir, measurement and control system. The piston pump was used to drive a valve to open and close with dictated flow which comprised three phases of accelerated, constant, and decelerated flow with six slopes. A high speed camera was used to record valve opening and closing images. Two pressure transducers across the tested valve were used to capture the ending time of valve closing which was verified by the high-speed photography. The closing time was measured and closing volume was calculated with a piston displacement volume during valve closing. A tilting disc valve and porcine mitral valve were tested. RESULTS: There was a big difference in flowrate between the Transonic flowmeter and piston pump. The heart valve opened and closed under the dictated flow driven by the piston pump. The transvalvular pressure was minor during valve opening and then increased sharply during valve closing. The closing time varied approximately linearly with the slope of the decelerated flow and was comparable between the two methods by the transvalvular pressure and high-speed photography. The closing volumes did not change much with the slope of the decelerated flow and were 7.0 ± 1.0 and 14.0 ± 1.5 mL for the tilting disc valve and mitral valve, respectively. CONCLUSION: Pulsatile flow is challenging to the flowmeter. A novel single opening&closing pulsatile flow in-vitro valve tester for the heart valve has successfully been developed and can be used to simulate and evaluate the opening and closing hemodynamics of the heart valve. The tester can be used to measure valve closing volume and time accurately with a standardized testing protocol free from effect of other components such as the resistance, compliance units and auxiliary valve in the continuous pulsatile flow valve tester.

Mitral valve annulus tension and the mechanism of annular dilation: an in-vitro study.

BACKGROUND AND AIM OF THE STUDY: The mitral annulus mechanics associated with annular dilation in pathologies such as mitral valve (MV) prolapse, ischemic and dilative heart diseases remain unknown. The study aim was to investigate annulus tension (AT) in the dilated annulus and in the displaced papillary muscles due to these pathological conditions. METHODS: Ten porcine MVs were harvested and mounted on a MV closure test rig with the papillary muscles held in the slack, normal, and taut positions. The MV annulus tissue rested on top of a plastic ring on which it could slide freely. The annulus was held by strings in the periphery during valve closure under hydrostatic trans-mitral pressure. The string tensions were measured, and further divided by string spacing to obtain the AT. Three annuli of normal, 25% dilated and 50% dilated annulus sizes were used. RESULTS: The AT was lowest at the commissural segment of the annulus, but increased towards the anterior and posterior segments, with a greater increase towards the anterior segment than towards the posterior. The AT increased with the increase of the apical PM displacement from the slack to normal, and then taut position in the commissural segment of the annulus. Although the AT increased with annulus area, the increase was less pronounced in the commissural segment than in the anterior and posterior segments. CONCLUSION: There is a significant difference in AT values between a normal and prolapsed MV, and between a normal MV and a MV with displaced papillary muscles. This difference suggests that annular dilation is a consequence and MV counteraction of imbalanced annular mechanics between the AT and myocardial force.

Mechanics of the mitral valve strut chordae insertion region.

Interest in developing durable mitral valve repair methods is growing, underscoring the need to better understand the native mitral valve mechanics. In this study, the authors investigate the dynamic deformation of the mitral valve strut chordae-to-anterior leaflet transition zone using a novel stretch mapping method and report the complex mechanics of this region for the first time. Eight structurally normal porcine mitral valves were studied in a pulsatile left heart simulator under physiological hemodynamic conditions -120 mm peak transvalvular pressure, 5 l/min cardiac output at 70 bpm. The chordal insertion region was marked with a structured array of 31 miniature markers, and their motions throughout the cardiac cycle were tracked using two high speed cameras. 3D marker coordinates were calculated using direct linear transformation, and a second order continuous surface was fit to the marker cloud at each time frame. Average areal stretch, principal stretch magnitudes and directions, and stretch rates were computed, and temporal changes in each parameter were mapped over the insertion region. Stretch distribution was heterogeneous over the entire strut chordae insertion region, with the highest magnitudes along the edges of the chordal insertion region and the least along the axis of the strut chordae. At early systole, radial stretch was predominant, but by mid systole, significant stretch was observed in both radial and circumferential directions. The compressive stretches measured during systole indicate a strong coupling between the two principal directions, explaining the small magnitude of the systolic areal stretch. This study for the first time provides the dynamic kinematics of the strut chordae insertion region in the functioning mitral valve. A heterogeneous stretch pattern was measured, with the mechanics of this region governed by the complex underlying collagen architecture. The insertion region seemed to be under stretch during both systole and diastole, indicating a transfer of forces from the leaflets to the chordae and vice versa throughout the cardiac cycle, and demonstrating its role in optimal valve function.

Intelligent Diagnosis of Heart Murmurs in Children with Congenital Heart Disease.

Heart auscultation is a convenient tool for early diagnosis of heart diseases and is being developed to be an intelligent tool used in online medicine. Currently, there are few studies on intelligent diagnosis of pediatric murmurs due to congenital heart disease (CHD). The purpose of the study was to develop a method of intelligent diagnosis of pediatric CHD murmurs. Phonocardiogram (PCG) signals of 86 children were recorded with 24 children having normal heart sounds and 62 children having CHD murmurs. A segmentation method based on the discrete wavelet transform combined with Hadamard product was implemented to locate the first and the second heart sounds from the PCG signal. Ten features specific to CHD murmurs were extracted as the input of classifier after segmentation. Eighty-six artificial neural network classifiers were composed into a classification system to identify CHD murmurs. The accuracy, sensitivity, and specificity of diagnosis for heart murmurs were 93%, 93.5%, and 91.7%, respectively. In conclusion, a method of intelligent diagnosis of pediatric CHD murmurs is developed successfully and can be used for online screening of CHD in children.

Role of annulus tension in annular dilatation.

BACKGROUND AND AIM OF THE STUDY: Mitral annulus mechanics are related to annular dilatation, and are not well understood. The study aim was to develop a method to measure regional annulus tension (AT) during valve closure, and to understand its role in annular dilatation. METHODS: A porcine mitral valve was harvested and mounted on a mitral valve closure test rig with the papillary muscles held in the normal position. The mitral valve annulus tissue rested on a plastic ring on which it was able to slide freely, there being no restriction in the interface between the annulus and the ring. The annulus was pulled by strings in the periphery during valve closure under a hydrostatic trans-mitral pressure. The string tensions were measured and further divided by string spacing to obtain the AT. A total of 10 mitral valves was tested. RESULTS: The AT distribution along the anterolateral annulus exhibited a concave curve. The anterior, commissural and posterior ATs were 40.0, 17.8, and 30.6 N/m, respectively, and the trans-mitral pressure 120 mmHg. The ATs in the three sections of the annulus were significantly different. CONCLUSION: A novel method to measure AT has been developed successfully. The AT was lower in the commissural section of the annulus than in the anterior or posterior sections. This finding may suggest that the potential for annular dilatation in the commissural section is high.

Effects of papillary muscle position on anterior leaflet stretches under mitral valve edge-to-edge repair.

BACKGROUND AND AIM OF THE STUDY: The mitral valve edge-to-edge repair (ETER) procedure inevitably alters mitral valve leaflet mechanics. The study aim was to quantify the effects of papillary muscle (PM) position on stretches in the central area of the anterior leaflet after mitral valve ETER. METHODS: Sixteen markers of a 4x4 array were attached onto the central area of the mitral valve anterior leaflet. The free edges of the mitral valve leaflets were sutured together with a single stitch to mimic the ETER. The mitral valve was then mounted in an in-vitro flow loop that was capable of simulating physiological loading conditions. The PM of the mitral valve was set in slack, normal, and taut positions. Displacements of the markers were obtained from the images of the markers, in order to calculate the stretches and stretch rates. RESULTS: The major principal stretch during systole was significantly greater than that during diastole in the three PM positions. The major principal (radial) stretch was significantly greater in the taut PM position than in the normal and slack PM positions during diastole. However, there was no significant difference in the minor principal (circumferential) stretch during diastole in the three PM positions. The loading and unloading stretch rates were not affected by the PM position, except for the major principal stretch rate during loading. CONCLUSION: With regards to the central region of the mitral valve anterior leaflet, the radial stretch during diastole was significantly less than that during systole. Therefore, the load on the anterior leaflet during systole, rather than that during diastole, should be considered when evaluating ETER durability, especially in the taut PM position. The circumferential stretch during diastole was not influenced by the PM positions.

In vitro stretches of the mitral valve anterior leaflet under edge-to-edge repair condition.

Mitral valve edge-to-edge repair (ETER) alters valve mechanics, which may impact efficacy and durability of the repair. The objective of this paper was to quantify stretches in the central region of the anterior leaflet of the mitral valve after ETER with a single suture and 6 mm suture. Sixteen markers, forming a 4x4 array, were attached onto the central region of the mitral valve anterior leaflet. The mitral valve was subjected to ETER with a single suture and 6 mm suture, and mounted in an in vitro flow loop simulating physiological conditions. Images of the marker array were used to calculate marker displacement and stretch. A total of 9 mitral valves were tested. Two peak stretches were observed during a cardiac cycle, one in systole and the other in diastole under mitral valve edge-to-edge repair condition. The major principal (radial) stretch during systole was significantly greater than that during diastole. However, there was no significant difference between the minor principal (circumferential) stretch during diastole and that during systole. In addition, there were no significant differences in the radial and circumferential, or areal stretches and stretch rates during diastole between the single suture and 6 mm suture. The ETER subjects the mitral valve leaflets to double frequency of loading and unloading. Minor change in suture length may not result in a significant load difference in the central region of the anterior leaflet during diastole.

Papillary muscle and annulus size effect on anterior and posterior annulus tension of the mitral valve: an insight into annulus dilatation.

Mitral valve (MV) annulus mechanics and its effect on annulus dilatation are not well understood. The objective of the current study was to understand annulus tension (AT) during valve closure. A porcine MV rested on top of annulus rings with papillary muscles (PMs) held at slack, normal and taut conditions. The annulus was held by strings in the periphery during valve closure under static trans-mitral pressures. String tensions were measured and further used to calculate the anterior and posterior ATs. Three rings of different sizes were used to simulate normal and dilatated annuli. Fourteen MVs were tested. The anterior ATs were 37.21+/-11.03, 53.86+/-14.98 and 58.87+/-15.72N/m, respectively, at the slack, normal and taut PM positions in the normal annulus at the trans-mitral pressure of 16.3kPa (122mmHg). The posterior ATs were 24.52+/-5.68, 36.29+/-8.89 and 42.32+/-11.82N/m, respectively, at the slack, normal and taut PM positions in the normal annulus at the trans-mitral pressure of 16.3kPa (122mmHg). AT increased as the PM changed from slack to normal, then to taut PM positions. The AT increases with the increase of annulus area and linearly with the increase of trans-mitral pressure. The AT increases with the increases of apical PM displacement and dilatated annulus area, and reduces the potential of annulus dilatation. Low trans-mitral pressure due to existent mitral regurgitation, and MV prolapse increase the potential of annulus dilatation.

Effect of mitral valve strut chord cutting on marginal chord tension.

BACKGROUND AND AIM OF THE STUDY: The technique of strut chordaesc (SC) cutting, which was proposed for the correction of ischemic mitral regurgitation, has been shown to be an effective short-term procedure. However, the effects of SC cutting on other chordal tensions are unknown. The study aim was to assess anterior leaflet marginal chord tensions after SC cutting. METHODS: Tensions of anterior leaflet marginal chordae were measured before and after the cutting of each strut chord independently, or of both SC together, in an intact porcine mitral valve. The cutting positions were chosen between intermediate and marginal chord branching positions. Transmitral pressures were 120 and 160 mmHg. A total of 12 mitral valves was tested. RESULTS: At a transmitral pressure of 120 mmHg, anterolateral SC cutting increased the tension of the marginal chord from the anterolateral papillary muscle (from 0.10 +/- 0.02 to 0.29 +/- 0.11 N; p = 0.02), but not from the posteromedial papillary muscle. At a transmitral pressure of 120 mmHg, posteromedial SC cutting significantly increased the tension of the marginal chord from the posteromedial papillary muscle (from 0.08 +/- 0.03 to 0.34 +/- 0.20 N; p = 0.029), but not from the anterolateral papillary muscle. Cutting both SC at a transmitral pressure of 120 mmHg increased the tension of the marginal chord from both the posteromedial papillary muscle (from 0.09 +/- 0.04 to 0.40 +/- 0.26 N; p = 0.001) and from the anterolateral papillary muscle (from 0.11 +/- 0.03 to 0.48 +/- 0.13 N; p <0.000001). CONCLUSION: Cutting either of the SC significantly increases the tension of the anterior leaflet marginal chord from the same papillary muscle, but not from the other papillary muscle. Cutting both SCs significantly increases the anterior leaflet marginal chord tensions from both papillary muscles by approximately four-fold.

Mechanical Properties and Composition of the Basal Leaflet-Annulus Region of the Tricuspid Valve.

The Tricuspid valve (TV) annulus is a transition structure from the leaflets to the myocardium, with 3 different annulus segments corresponding to the TV leaflets, which includes both basal leaflets and bordering myocardium. The objective of this study was to understand TV annulus mechanical properties and correlate it to the biological composition. The uniaxial testing of the annulus segments from ten porcine TVs was performed to measure Young's modulus (E) and extensibility (εT). Western blotting and histology were executed. The septal annulus E value (208.7 ± 67.2 kPa) was statistically greater (p < 0.01) than that of the anterior (92.0 ± 66.8 kPa) and the posterior annulus segment (136.8 ± 56.9 kPa) (p < 0.05), respectively. εT among the 3 segments were equivalent (p values < 0.05). Western blotting and histology indicated that collagen was greatest along the septal annulus segment, which is correlated to E values. Collagen fibers from the leaflets inserted into the myocardium and faded out. Collagen content explains greater E and suture strength in the surgical annulus repair and larger resistance to annulus dilation in the septal annulus as compared with other segments. This study elucidates new knowledge of mechanical properties of the basal leaflet-annulus region of the TV annulus, which can be useful for future TV repair techniques.

Transapical Coaptation Plate for Functional Mitral Regurgitation: An In Vitro Study.

A novel transapical coaptation plate (TCP) device was developed and anchored by sutures in the mitral valve to treat functional mitral regurgitation. The objective of this study was to test efficacy of the TCP in an in vitro model. Eight fresh porcine mitral valves were mounted in a left heart simulator to simulate functional mitral regurgitation by means of annular dilatation and asymmetrical or symmetrical papillary muscle (PM) displacement. Six polyurethane TCPs in thickness of 6.4(#1), 4.8(#2), 3.2(#3) mm and hardness of durometer 30 A (H) and 30 OO(S),were fabricated and labeled as H1, H2, H3 and S1, S2, S3, respectively. These TCPs were anchored by the sutures in the mitral annulus and left ventricle apex, and tested. Steady backward flow leakage in a hydrostatic condition and regurgitant volume in a pulsatile flow were measured before and after implantation of the TCPs. Mean regurgitant volume fractions in the asymmetric PM displacement were reduced significantly from 59.1 to 37.2% for H1, 43.2% for H2, 35.9% for S1 and 34.2% for S2 (p < 0.021), after implantation of the TCPs. No significant reduction in mitral regurgitation was seen for H3 and S3 (p > 0.067). Mitral regurgitation was mild in the symmetric PM displacement, and was not significantly reduced after implantation of the TCPs. In conclusion, the TCP anchored by the sutures in the mitral annulus and left ventricle apex functions successfully as a plug in the mitral valve leaflet gap. The TCP with thickness equal to or greater than 4.8 mm is effective to reduce functional mitral regurgitation. The TCP hardness has no effect on difference in reduction of functional mitral regurgitation.

The material properties of the native porcine mitral valve chordae tendineae: an in vitro investigation.

The material properties of the mitral valve chordae tendineae are important for the understanding of leaflet coaptation configuration and chordal pathology. There is limited information about the mechanical properties of the chordae during physiologic loading. Dual camera stereo photogrammetry was used to measure strains of the chordae in vitro under physiologic loading conditions. Two high-speed, high-resolution cameras captured the movement of graphite markers attached to the central section of the chordae. A uniaxial test simulating the same loading conditions was conducted on the same chordae using the same markers. The maximum strain experienced during the cardiac cycle was 4.29% +/- 3.43%. The loading rate was higher at 75.3% +/- 48.6% strain per second than the unloading rate at -54.8% +/- -56.6% strain per second. The anterior lateral strut chordae had a higher maximum strain (5.7% +/- 3.8%) and loading rate (80.5% +/- 51.9% strain per second) than the posterior medial strut chordae (5.5% +/- 2.3% strain and 68.1% +/- 48.3% strain per second). The posterior medial strut chordae had a higher unloading rate (-68.5% +/- -59.1% strain per second) than the anterior lateral strut chordae (-44.9% +/- -57.2% strain per second). Although the anterior lateral and posterior medial strut chordae have a significantly different diameter and length, they experience a similar strain, strain rate, and tension. In conclusion, a non-destructive technique was developed to measure in vitro chordal strain in the mitral valve. This technique allows the investigation of the behavior of biological tissues under physiologic loading conditions.

Annulus Tension on the Tricuspid Valve: An In-Vitro Study.

Annulus tension (AT) is defined as leaflet tension per unit length of the annulus circumference. AT was investigated to understand tricuspid valve (TV) annulus mechanics. Ten porcine TVs were mounted on a right ventricle rig with an annulus plate to simulate TV closure. The TVs were mounted on the annulus plate in a normal and dilated TV annulus sizes, and closed under transvalvular pressure of 40 mmHg with the annulus held peripherally by wires. Anterior papillary muscle (PM) and septal PM were displaced in the dilated annulus. Wire forces were measured, and ATs (N/m) were calculated. Clover repair was performed in the dilated TV state subsequently, and AT was calculated again. A one-way ANOVA and Tukey's HSD test were used to test significances between the different TV states along each annulus segment with p < 0.05. Average ATs for the normal annulus, dilated annulus, and clover repair were 10.75 ± 1.87, 28.81 ± 10.51, and 26.93 ± 11.44 N/m, respectively. Septal annulus segments had the highest ATs when compared to the other segments. For the clover repair, there were no significant changes in AT values. ATs and leaflet forces increased roughly 3-4 times with annulus dilation. AT decelerates annulus dilation as previously shown in the mitral valve. Clover repair does not prevent further annulus dilation by AT change and should be accompanied by annuloplasty. AT improves annulus contraction during a cardiac cycle and should be considered when designing annuloplasty in the future.

Characterization of biomechanical properties of aged human and ovine mitral valve chordae tendineae.

The mitral valve (MV) is a highly complex cardiac valve consisting of an annulus, anterior and posterior leaflets, chordae tendineae (chords) and two papillary muscles. The chordae tendineae mechanics play a pivotal role in proper MV function: the chords help maintain proper leaflet coaptation and rupture of the chordae tendineae due to disease or aging can lead to mitral valve insufficiency. Therefore, the aim of this study was to characterize the mechanical properties of aged human and ovine mitral chordae tendineae. The human and ovine chordal specimens were categorized by insertion location (i.e., marginal, basal and strut) and leaflet type (i.e., anterior and posterior). The results show that human and ovine chords of differing types vary largely in size but do not have significantly different elastic and failure properties. The excess fibrous tissue layers surrounding the central core of human chords added thickness to the chords but did not contribute to the overall strength of the chords. In general, the thinner marginal chords were stiffer than the thicker basal and strut chords, and the anterior chords were stiffer and weaker than the posterior chords. The human chords of all types were significantly stiffer than the corresponding ovine chords and exhibited much lower failure strains. These findings can be explained by the diminished crimp pattern of collagen fibers of the human mitral chords observed histologically. Moreover, the mechanical testing data was modeled with the nonlinear hyperelastic Ogden strain energy function to facilitate accurate computational modeling of the human MV.