Mechanics of the Tricuspid Valve—From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling
Abstract
:1. Introduction
2. Functional Tricuspid Regurgitation: Diagnosis and Treatment Options
2.1. Sub-Valvular Structures and Components of the TV
2.1.1. TV Annulus
2.1.2. TV Leaflets
2.1.3. TV Chordae Tendineae
2.2. Imaging Modalities for Assessing FTR
2.2.1. Echocardiography
Two-Dimensional Imaging Modalities
Standard Echocardiography Imaging Windows
Three-Dimensional Imaging Modalities
2.2.2. CMRI
2.2.3. Cardiac CT
2.3. Parameters for Grading TR Severity
2.3.1. Regurgitant Jet Area
2.3.2. VC Width
2.3.3. Proximal Isovelocity Surface Area (PISA)
2.3.4. TA Diameter
2.3.5. Proposed Revisions to The Current TR Severity’s Grading Recommendations
2.4. Surgical Interventions
2.4.1. Repair Methods for Surgical Treatment of FTR
2.4.2. Replacement Methods for Surgical Treatment of FTR
3. In-Vivo and In-Vitro Investigations
3.1. In-Vivo Dynamics and Strains of the TV Annulus
3.2. In-Vitro Flow and Pressure Systems
3.2.1. In-Vitro Flow Systems
3.2.2. In-Vitro Pressure Systems
3.3. Chordae Tendineae Force Measurements
3.4. Biomechanical Quantifications of the Subvalvlar Structures of the TV
3.4.1. Biaxial and Uniaxial Mechanical Properties of the TV Leaflets
3.4.2. Bending Properties of the TV Leaflets
3.4.3. Spatial Variations in Tissue Mechanics of TV Leaflets
3.4.4. Microstructural Constituent’s Contributions to Tissue Mechanics of the TV Leaflet
3.4.5. Mechanics of TV Chordae Tendineae
4. Computational Biomechanical Modeling of the TV
4.1. Disparity of Computational Models for the Left-Sided and Right-Sided Heart Valves
4.2. Geometrical Modeling of the TV
4.2.1. Modeling the TV Geometry
4.2.2. Parametric Design of Heart Valve Geometries
4.3. Constitutive Modeling of the TV Leaflets
4.4. Computational Models of the TV
4.4.1. Bio-Solid Models of the TV
4.4.2. FSI Model of the TV
5. Closing Remarks and Future Perspectives
Author Contributions
Funding
Conflicts of Interest
References
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Abbreviation | Description | |
---|---|---|
Anatomy | AP | Antero-posterior |
AV | Aortic valve | |
MV | Mitral valve | |
PV | Pulmonary valve | |
RA | Right atrium | |
RV | Right ventricle | |
SL | Septo-lateral | |
TA | Tricuspid valve annulus | |
TV | Tricuspid valve | |
TVAL | Tricuspid valve anterior leaflet | |
TVPL | Tricuspid valve posterior leaflet | |
TVSL | Tricuspid valve septal leaflet | |
VC | Vena contracta | |
Computational Modeling | CAD | Computer-aided design |
FE | Finite element | |
FSI | Fluid-structure interaction | |
IGA | Isogeometric analysis | |
SPH | Smooth particle hydrodynamics | |
Disease/Pathology | FTR | Functional tricuspid regurgitation |
HLHS | Hypoplastic left heart syndrome | |
ToF | Tetralogy of Fallot | |
TR | Tricuspid regurgitation | |
Imaging and Grading of the TR Severity | 2DE | Two-dimensional echocardiography |
3DE | Three-dimensional echocardiography | |
A4C | Apical four-chamber view | |
CT | Computed tomography | |
CMRI | Cardiac magnetic resonance imaging | |
EROA | Effective regurgitant orifice area | |
ME | Mid-esophageal | |
PISA | Proximal isovelocity surface area | |
PLAX | Parasternal long axis | |
PSAX | Parasternal short axis | |
RT3DE | Real-time three-dimensional echocardiography | |
RVEIO | Right ventricular early inflow-outflow | |
RVF | Right ventricular-focused | |
RVIF | Right ventricular inflow | |
R Vol | Regurgitant jet volume | |
TEE | Transesophageal echocardiography | |
TTE | Transthoracic echocardiography | |
Mechanics | C | Right Cauchy-Green tensor |
ECC | Green strain in the tissue’s circumferential direction | |
ERR | Green strain in the tissue’s radial direction | |
Fx | Force in the x-direction | |
Fy | Force in the y-direction | |
I1 | First invariant of the right Cauchy-Green tensor C | |
I4 | Fourth invariant of the right Cauchy-Green tensor C | |
λ | Stretch ratio | |
Tcirc | Membrane tension in the circumferential direction | |
Trad | Membrane tension in the radial direction | |
Microstructure | A | Atrialis layer |
ECM | Extracellular matrix | |
F | Fibrosa layer | |
GAGs | Glycosaminoglycans | |
PGs | Proteoglycans | |
S | Spongiosa layer | |
SMC | Smooth muscle cell | |
V | Ventricularis layer | |
VIC | Valvular interstitial cell | |
Specimen Labels | -C | Control specimen |
-T | Treated specimen | |
A/S | Atrialis/spongiosa layer | |
F/V | Fibrosa/ventricularis layer | |
LG | Left chordae group | |
RG | Right chordae group |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Lee, C.-H.; Laurence, D.W.; Ross, C.J.; Kramer, K.E.; Babu, A.R.; Johnson, E.L.; Hsu, M.-C.; Aggarwal, A.; Mir, A.; Burkhart, H.M.; et al. Mechanics of the Tricuspid Valve—From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling. Bioengineering 2019, 6, 47. https://doi.org/10.3390/bioengineering6020047
Lee C-H, Laurence DW, Ross CJ, Kramer KE, Babu AR, Johnson EL, Hsu M-C, Aggarwal A, Mir A, Burkhart HM, et al. Mechanics of the Tricuspid Valve—From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling. Bioengineering. 2019; 6(2):47. https://doi.org/10.3390/bioengineering6020047
Chicago/Turabian StyleLee, Chung-Hao, Devin W. Laurence, Colton J. Ross, Katherine E. Kramer, Anju R. Babu, Emily L. Johnson, Ming-Chen Hsu, Ankush Aggarwal, Arshid Mir, Harold M. Burkhart, and et al. 2019. "Mechanics of the Tricuspid Valve—From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling" Bioengineering 6, no. 2: 47. https://doi.org/10.3390/bioengineering6020047