Transection of anterior mitral basal stay chords alters left ventricular outflow dynamics and wall shear stress.

BACKGROUND AND AIM OF THE STUDY: Anterior mitral basal stay chords are relocated to correct prolapse of the anterior mitral leaflet (AML); it has also been suggested that their transection might be used to treat functional ischemic mitral regurgitation. The study aim was to clarify the effect of stay chord transection (SCT) on the hemodynamic aspects of left ventricular outflow. METHODS: Two three-dimensional left ventricular models including the left ventricular outflow tract and saddle-shaped mitral valve before and after SCT were constructed. After SCT, the AML was specified to be more concave and the aortomitral angle to be narrower than before SCT. Time-dependent turbulent flow in a flow range of 10 to 28 l/min during rapid ejection was simulated using the commercial software, FLUENT. RESULTS: Left ventricular outflow before SCT was streamlined along the AML throughout rapid ejection. After SCT, this flow was redirected in the vicinity of the AML, thereby creating a zone of persistent low-momentum recirculation associated with additional energy loss. Consequently, the axial forward flow delivered into the aorta after SCT was diminished. The high wall shear stress, which was concentrated at the fibrous trigones before SCT, was redistributed along the intertrigonal distance after SCT. CONCLUSION: The stay chords, which maintain the natural profile of the AML, are essential to streamline left ventricular outflow, facilitate flow delivery into the aorta, minimize dissipation of potential energy, and to create an optimum wall shear stress pattern that conforms to the fibrous trigones. Transection of the stay chords compromises local hemodynamics, resulting in greater energy loss and unfavorable wall shear stress distribution. The study results emphasize the importance of preserving stay chord function in mitral valve surgeries.

Finite element simulation of food transport through the esophageal body.

The peristaltic transport of swallowed material in the esophagus is a neuro-muscular function involving the nerve control, bolus-structure interaction, and structure-mechanics relationship of the tissue. In this study, a finite element model (FEM) was developed to simulate food transport through the esophagus. The FEM consists of three components, i.e., tissue, food bolus and peristaltic wave, as well as the interactions between them. The transport process was simulated as three stages, i.e., the filling of fluid, contraction of circular muscle and traveling of peristaltic wave. It was found that the maximal passive intraluminal pressure due to bolus expansion was in the range of 0.8-10 kPa and it increased with bolus volume and fluid viscosity. It was found that the highest normal and shear stresses were at the inner surface of muscle layer. In addition, the peak pressure required for the fluid flow was predicted to be 1-15 kPa at the bolus tail. The diseases of systemic sclerosis or osteogenesis imperfecta, with the remodeled microstructures and mechanical properties, might induce the malfunction of esophageal transport. In conclusion, the current simulation was demonstrated to be able to capture the main characteristics in the intraluminal pressure and bolus geometry as measured experimentally. Therefore, the finite element model established in this study could be used to further explore the mechanism of esophageal transport in various clinical applications.

Vascularization strategies for tissue engineers.

All tissue-engineered substitutes (with the exception of cornea and cartilage) require a vascular network to provide the nutrient and oxygen supply needed for their survival in vivo. Unfortunately the process of vascular ingrowth into an engineered tissue can take weeks to occur naturally and during this time the tissues become starved of essential nutrients, leading to tissue death. This review initially gives a brief overview of the processes and factors involved in the formation of new vasculature. It then summarizes the different approaches that are being applied or developed to overcome the issue of slow neovascularization in a range of tissue-engineered substitutes. Some potential future strategies are then discussed.

Finite element investigation of stentless pericardial aortic valves: relevance of leaflet geometry.

Recent developments in aortic valve replacement include the truly stentless pericardial bioprostheses with single point attached commissures (SPAC) implantation technique. The leaflet geometry available for the SPAC valves can either be a simple tubular or a complex three-dimensional structure molded using specially designed molds. Our main objective was to compare these two leaflet designs, the tubular vs. the molded, by dynamic finite element simulation. Time-varying physiological pressure loadings over a full cardiac cycle were simulated using ABAQUS. Dynamic leaflet behavior, leaflet coaptation parameters, and stress distribution were compared. The maximum effective valve orifice area during systole is 633.5 mm(2) in the molded valve vs. 400.6 mm(2) in the tubular valve, and the leaflet coaptation height during diastole is 4.5 mm in the former, in contrast to 1.6 mm in the latter. Computed compressive stress indicates high magnitudes at the commissures and inter-leaflet margins of the tubular valve, the highest being 3.83 MPa, more than twice greater than 1.80 MPa in the molded valve. The molded leaflet design which resembles the native valve exerts a positive influence on the mechanical performance of the SPAC pericardial valves compared with the simple tubular design. This may suggest enhanced valve efficacy and durability.