1. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 Schematic of the UCD Dublin left heart simulator: 1—porcine mitral valve, 2—papillary muscle locator, 3—mechanical prosthetic aortic valve, 4—mitral valve chamber, 5—pressure sensor LV, 6—pressure sensor LV, 7—pressure sensor aortic, 8—pressure sensor left atrium, 9—compliance chamber, 10—characteristic aortic resistance, 11—peripheral resistance, 12—electromagnetic flow meter, 13—piston, 14—brushless AC servomotor, 15—FlexDrive II Motion Controller, 16—PC with MintDrive II Motion Control Software, 17—aortic head tank (vented), 18—left atrial head tank (vented), 19—temperature controlled reservoir, 20—cartridge filter, 21—sump pump, and 22—air bleed valve Figure Legend:

2. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 A sample mitral valve mounted within the mitral chamber showing the annulus plate and papillary muscle force rods. The valve was sown to both the plate and the papillary muscle force rods. The location of the papillary muscles relative to the annulus plate was adjusted by moving the force rods. Figure Legend:

3. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 The coaptation measurement device was used to measure the coaptation force between the valve leaflets. (a) Exploded assembly: 1—sensor body upper, 2—load cell A, 3—ground stainless steel axle, 4—ground stainless steel lever arm A, 5—ground stainless steel lever arm B, 6—load cell B, 7—alignment pins, and 8—sensor body lower; (b) assembled device; and (c) schematic of a lever arm of the device showing the dynamic loading on the arm. Figure Legend:

4. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 Coordinate system adapted for determination of papillary muscle position relative to the mitral valve. The origin is taken at the point of intersection of the annular, septolateral, and APP. Positions A1–P1, A2–P2, and A3–P3 indicated the points of coaptation where the coaptation force was measured. Figure Legend:

5. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 Measured static coaptation force against transmitral pressure for coaptation positions: (a) A1–P1, (b) A2–P2, and (c) A3–P3. The coaptation force is averaged across all ten hearts used in the sample, the error bars are indicative of the maximum and minimum values within the sample. Figure Legend:

6. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 The cardiac cycle was used in the left heart simulation as measured during testing on heart valve 4. Traces include the atrial pressure and the LV pressure within the mitral valve chamber. The volume flow rate through the mitral valve is also shown, flow into the ventricle is considered − ve. The flow in the return line to the pump is also shown, this was used to synchronize all the measurements made during testing. Figure Legend:

7. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 Normal mitral valve test results averaged over the four hearts tested. Results are shown for the transmitral pressure and mean coaptation force against time (left) and mean coaptation force against transmitral pressure (right). Error bars are indicative of the maximum and minimum values within the sample. (a) A1–P1, (b) A2–P2, and (c) A3–P3. Figure Legend:

8. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 Functional regurgitant mitral valve test results averaged over the four hearts tested. Results are shown for the transmitral pressure and mean coaptation force against time (left) and mean coaptation force against transmitral pressure (right). Coaptation force is observed to decrease at position A1–P1 and to increase at positions A2–P2 and A3–P3. Error bars are indicative of the maximum and minimum values within the sample. (a) A1–P1, (b) A2–P2, and (c) A3–P3. Figure Legend:

9. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 A regression analysis prediction of the coaptation force at a transmitral pressure of 100mmHg for normal and functional regurgitant mitral heart valve. The error bars are the standard error of the regression fit. A marked decrease in the coaptation force at position A1–P1 is observed whereas a marked increase in coaptation force at A2–P2 and A3–P3 is observed. Figure Legend:

10. Date of download: 6/22/2016 Copyright © ASME. All rights reserved. From: In Vitro Measurement of the Coaptation Force Distribution in Normal and Functional Regurgitant Porcine Mitral Valves J Biomech Eng. 2015;137(7):071008-071008-11. doi:10.1115/1.4029746 Correlation of the change in coaptation force as a function of the change in papillary muscle position. The most significant correlations are selected at each position. (a) A1–P1, (b) A2–P2, and (c) A3–P3. Figure Legend: