The hemodynamic effects of double-orifice valve repair for mitral regurgitation: A 3D computational model

Objectives: A 3D computational model has been implemented for the evaluation of the hemodynamics of the double orifice repair. Critical issues for surgical decision making and echo-Doppler evaluation of the results of the procedure are investigated. Methods: A parametric 3D computational model of the double-orifice mitral valve based on the finite elements model has been constructed from clinical data. Nine different geometries were investigated, corresponding to three total inflow areas (1.5, 2.25 and 3 cm²) and to three orifice configurations (two equal orifices, two orifices of different areas, i.e. one twice as much the other one, and a single orifice). The simulations were performed in transit; the fluid was initially quiescent and was accelerated to the maximum flow rate with a cubic function. For each case, some characteristic values of velocity and pressure were determined: velocities were calculated downstream of each orifice, at the centre of it (V(cen1), V(cen2)). The maximum velocity was also determined for each orifice (V(max1), V(max2)). Maximum pressure drops (Δp(max)) across the valve were compared with the estimations (Δp(Bernoulli) based on the Bernoulli formula (4 V²). Results; In each simulation, no notable difference was observed between V(cen1) and V(cen2), and between V(max1) and V(max2), regardless of the valve configuration. Maximum velocity and Δp(max) were related to the total orifice area and were not influenced by the orifice configuration. ΔP(Bernoulli) calculated with V(max) was well correlated with the Δp(max) obtained throughout the simulations (y = 0.9126x + 0.3464, r = 0.996); on the contrary the pressure drops estimated using V(cen) underestimated (y = 0.6757x + 0.3073, r = 0.999) the actual pressure drops. Conclusions: The hemodynamic behaviour of a double orifice mitral valve does not differ from that of a physiological valve of same total area: pressure drops and flow velocity across the valve are not influenced by the configuration of the valve. Echo Doppler estimation of the maximum velocities is a reliable method for the calculation of pressure gradients across the repaired valve.