Srisook, Chirattikan
(2024)
Assessment of mitral valve geometry for personalised annuloplasty ring development.
PhD thesis, University of Nottingham.
Abstract
Heart valve disease can occur when one valve or a combination of the heart valves is not working properly. Heart valve disease is found in more than one million people in the UK (Malhotra, 2012) and more than five million people in the USA each year (Nkomo et al., 2006). In terms of all types of heart valve disease, mitral regurgitation is the most common (Malhotra, 2012; Moore et al., 2016). Mitral valve repair, the preferred method for treating mitral regurgitation, typically requires surgical intervention. While mitral valve replacement is available, mitral valve repair is claimed to have better outcomes (Magne et al., 2008; Fattouch et al., 2009). Previous papers have shown that valve repair with the use of an annuloplasty ring is able to restore the valve functions and overcome the mitral regurgitation by reducing the mitral valve size to completely coapt the mitral orifice area.
The aim of this study is to assess the geometry of the healthy mitral valve to determine the relationship between the mitral valve dimensions and to develop a method of isolating and 3D reconstructing the mitral valve in order to develop a personalised annuloplasty ring which is the ring that specifically designed and manufactured for an individual patient based on their unique cardiac anatomy.
This study makes a substantial contribution by improving the selection process for existing commercial rings, offering guidance on personalised ring considerations, evaluating opportunities for enhancing commercial ring designs, and providing a systematic approach to design personalised annuloplasty rings.
The research enhanced selection of current commercial rings through an examination of healthy mitral valve dimensions and their comparison with commercially available rings, the study identifies which existing rings closely align with the mitral valve's healthy dimensions. This information aids surgeons in making more informed choices during mitral valve repair surgeries. The research also emphasizes specific sizing strategies that better accommodate the anatomical variations observed in mitral valves.
The study emphasizes the considerable variability in individual mitral valve dimensions, highlighting the necessity of considering personalised annuloplasty rings. It provides a rationale for choosing personalised rings, especially in cases where standard-sized commercial rings may not precisely replicate a patient's unique mitral valve geometry. The insights gained into the limitations of commercial rings in accommodating diverse anatomies assist in deciding when to opt for personalised solutions.
The research also evaluates the accuracy of current commercial rings in mimicking healthy mitral valve dimensions, offering a foundation for assessing the efficacy of their designs. Identified areas for potential improvement in commercial ring designs provide valuable feedback for manufacturers. The study's findings may contribute to optimizing existing commercial ring designs to better align with the diverse anatomical characteristics of mitral valves.
For personalised ring design, the study outlines a comprehensive methodology for the design of bespoke annuloplasty rings tailored to individual patients. It emphasizes the importance of considering both shape and size in the design process, utilizing advanced tools and software such as ITK-SNAP and Blender for accurate 3D modelling and customization. The proposed workflow, including gap filling through statistical analysis in R Studio, provides a clear guide for researchers.
In conclusion, this study acts as a resource, refining the choice of existing commercial rings and advocating for thoughtful consideration of personalized and bespoke solutions. The gained insights have the potential to influence future improvements in the design of commercial annuloplasty rings.
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