The effect of ventricular volume reduction surgery in the dilated, poorly contractile left ventricle: A simple finite element analysis Mark B. Ratcliffe,

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Presentation transcript:

The effect of ventricular volume reduction surgery in the dilated, poorly contractile left ventricle: A simple finite element analysis Mark B. Ratcliffe, MD, James Hong, MS, Ali Salahieh, BS, Stuart Ruch, MD, PhD, Arthur W. Wallace, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 116, Issue 4, Pages 566-577 (October 1998) DOI: 10.1016/S0022-5223(98)70162-X Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 1 Schematic of modeling process used in this study. Step 1: The unloaded diastolic LV is modeled as a thick-walled axisymmetric hemi-ellipsoid based on images of dilated human cardiomyopathic hearts. The unloaded systolic LV shape was derived from the diastolic shape. In this and subsequent steps only the right half of the axisymmetric shape is shown. Step 2: Material properties and boundary conditions are assigned. The base of the LV is fixed in both the x and y directions while the apex is fixed in the x direction only (hatched arrows). In this and the subsequent step the pre-resection shape is seen as the dashed line. Step 3: Apical VVRS: Apical resection is performed by reducing the long-axis radii, a1 and a2, while maintaining a constant wall thickness. The short-axis radii, b1 and b2, are unchanged. Step 4: Lateral VVRS: Lateral resection is performed by reducing the short-axis radii, b1 and b2, while maintaining a constant wall thickness. The long-axis radii, a1 and a2, are unchanged. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 566-577DOI: (10.1016/S0022-5223(98)70162-X) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 2 Schematic illustration of cardiac function parameters. Ea, Arterial elastance; Ees, end-systolic elastance; SW, stroke work (area ABCD); PVA, pressure-volume area (area ABCOD). The Journal of Thoracic and Cardiovascular Surgery 1998 116, 566-577DOI: (10.1016/S0022-5223(98)70162-X) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 3 Globally dilated, poorly contractile LV model. Systolic (A) and diastolic (B) finite element mesh before and after loading. In each panel the unloaded mesh is in green and the loaded mesh is in red. In each case only the right half of the axisymmetric mesh is shown. The diastolic model is loaded with 20 mm Hg of intracavitary LV pressure. The systolic model is loaded with 100 mm Hg of intracavitary LV pressure. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 566-577DOI: (10.1016/S0022-5223(98)70162-X) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 4 Apical VVRS: Systolic (A) and diastolic (B) finite element mesh before and after loading. In each panel the unloaded mesh is on the left and the loaded mesh is on the right. In each case only the right half of the axisymmetric mesh is shown. The diastolic model is loaded with 20 mm Hg of intracavitary LV pressure. The systolic model is loaded with 100 mm Hg of intracavitary LV pressure. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 566-577DOI: (10.1016/S0022-5223(98)70162-X) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 5 Lateral VVRS: Systolic (A) and diastolic (B) finite element mesh before and after loading. In each panel the unloaded mesh is on the left and the loaded mesh is on the right. In each case only the right half of the axisymmetric mesh is shown. The diastolic model is loaded with 20 mm Hg of intracavitary LV pressure. The systolic model is loaded with 100 mm Hg of intracavitary LV pressure. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 566-577DOI: (10.1016/S0022-5223(98)70162-X) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 6 Elastance and compliance before and after apical VVRS. Elastance curves are to the left and compliance curves are to the right. DCM, Dilated cardiomyopathy; AR, apical VVRS. Ten-percent AR (open triangles) and 20% AR (open circles) progressively shift preresection LV elastance and compliance (asterisks) to the left. In each case note that the compliance is shifted further to the left than the elastance. Symbols (asterisk, open triangle, and open circle) represent the actual values calculated by the finite element solver. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 566-577DOI: (10.1016/S0022-5223(98)70162-X) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 7 Elastance and compliance before and after lateral VVRS. Elastance curves are to the left and compliance curves are to the right. DCM, Dilated cardiomyopathy; LR, lateral VVRS. Ten-percent LR (closed triangles) and 20% LR (closed circles) progressively shift pre-resection LV elastance and compliance (asterisks) to the left. In each case note that the compliance is shifted further to the left than the elastance. Note that for each amount of resected LV mass, lateral VVRS shifts compliance and elastance further to the left than apical VVRS (Fig 5). Symbols (asterisk, closed triangle, and closed circle) represent the actual values calculated by the finite element solver. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 566-577DOI: (10.1016/S0022-5223(98)70162-X) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 8 The effect of VVRS on the stroke work/end-diastolic volume (A) and stroke work/end-diastolic pressure (B) (Starling's law) relationship. Ten-percent AR (dash-dash), 20% AR (dot-dot), 10% LR (dash-dot-dash), and 20% LR VVRS (dash-dot-dot-dash) progressively shift stroke work/end-diastolic volume relationship to the left (A). Note that VVRS not only shifts the VED intercept to the left but increases the slope of the relationship as well (DCM 0.006 J/mL; 20% lateral VVRS 0.009 J/mL). On the other hand, VVRS progressively decreases the slope of LV Starling relationship (B) above end-diastolic pressure = 5 mm Hg. Note that these effects are increased with a larger amount of resected LV mass and are greater in lateral VVRS than apical VVRS. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 566-577DOI: (10.1016/S0022-5223(98)70162-X) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 9 The effect of VVRS on the energy consumption per gram of myocardium. Note that 10% LV mass resection has an insignificant effect (1%) on myocardial energy expenditure. The 20% apical VVRS and 20% lateral VVRS reduce energy expenditure by 7% and 17%, respectively. PVA, Pressure-volume area. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 566-577DOI: (10.1016/S0022-5223(98)70162-X) Copyright © 1998 Mosby, Inc. Terms and Conditions