Fig 1.
Representative FE mesh of the LV with Mitral Valve and MitraClip modeled as virtual sutures.
Views include (A) LV showing postero-lateral MI, (B) en face view of the mitral valve with MitraClip and (C) close up of MitraClip as virtual sutures. The leaflet elements used for stress calculation are marked in orange. BZ–infarct borderzone; RZ–remote myocardium; AL–anterior leaflet; P1,2,3 –posterior leaflet sections; Ao–capped region of aortic outflow and MClp–MitraClip.
Fig 2.
The simulation timelines.
Fig 3.
Representative Von Mises stress color maps of the mitral valve before (A and D) and after (B and E) virtual MitraClip and after MitraClip in an enlarged LV (C and F). Effects are seen at end- diastole (A—C) and end systole (D—F). Note that these color maps are not dimensionally exact. AL–anterior leaflet; P1,2,3 –posterior leaflet sections; MClip–MitraClip.
Fig 4.
Stress in the peri-MitraClip region in the anterior and posterior leaflets at end-diastole (A and B) and end-systole (C and D).
Fig 5.
Septo-lateral annular dimension at end-diastole (A) and end-systole (B) at baseline and after simulated partial and complete grasp MitraClip.
Fig 6.
Color map of Δ in myocardial radial strain, Err, at end-diastole after simulated complete grasp MitraClip in the baseline LV (A) and in a dilated LV (B). Ao–left ventricular outflow/ aorta region. PA–posterior mitral annulus. MI–myocardial infarction.
Fig 7.
Radial strain, 𝐸_𝑟𝑟, after simulated partial and complete grasp MitraClip in the P2 sub-valvular myocardium at end-diastole (A), P2 sub-valvular endocardium at end-diastole (B) and P2 sub-valvular myocardium at end-systole (C) respectively. Err before and after MitraClip is relative to the pre-procedure unloaded state.
Fig 8.
Diagram of the proposed mechanical effects of MitraClip application.
The black arrows represent displacement of the posterior leaflet, lateral annulus and lateral sub-valvular LV wall caused by MitraClip application. The effects are to increase leaflet stress, decrease the septo-lateral annular dimension and stretch the sub-valvular myocardium. LV–left ventricle, LA–left atrium, MC–MitraClip.