Interactive editing of virtual chordae tendineae for the simulation of the mitral valve in a decision support system
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ORIGINAL ARTICLE
Interactive editing of virtual chordae tendineae for the simulation of the mitral valve in a decision support system Lars Walczak1,2 · Lennart Tautz1,2 · Mathias Neugebauer1 · Joachim Georgii1 · Isaac Wamala3 · Simon Sündermann2,3,4 · Volkmar Falk2,3,4,5 · Anja Hennemuth1,2,4 Received: 11 January 2020 / Accepted: 6 July 2020 © The Author(s) 2020
Abstract Purpose Decision support systems for mitral valve disease are an important step toward personalized surgery planning. A simulation of the mitral valve apparatus is required for decision support. Building a model of the chordae tendineae is an essential component of a mitral valve simulation. Due to image quality and artifacts, the chordae tendineae cannot be reliably detected in medical imaging. Methods Using the position-based dynamics framework, we are able to realistically simulate the opening and closing of the mitral valve. Here, we present a heuristic method for building an initial chordae model needed for a successful simulation. In addition to the heuristic, we present an interactive editor to refine the chordae model and to further improve pathology reproduction as well as geometric approximation of the closed valve. Results For evaluation, five mitral valves were reconstructed based on image sequences of patients scheduled for mitral valve surgery. We evaluated the approximation of the closed valves using either just the heuristic chordae model or a manually refined model. Using the manually refined models, prolapse was correctly reproduced in four of the five cases compared to two of the five cases when using the heuristic. In addition, using the editor improved the approximation in four cases. Conclusions Our approach is suitable to create realistically parameterized mitral valve apparatus reconstructions for the simulation of normally and abnormally closing valves in a decision support system. Keywords Decision support · Mitral valve · Position-based dynamics
Introduction Mitral valve (MV) regurgitation (MR) is the second most common heart valve disease with an increasing incidence [6]. Roughly 12,300 MV procedures were performed in Germany in 2017 [1]. Patients with MR exhibit defects in the leaflets, annulus, or chordae tendineae (CT, tendinous cords), but other pathological alterations are possible as well. The result is an incomplete closure or a prolapsing of the leaflets
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Lars Walczak [email protected]
1
Fraunhofer MEVIS, Bremen, Germany
2
Charité—Universitätsmedizin Berlin, Berlin, Germany
3
German Heart Institute Berlin—DHZB, Berlin, Germany
4
German Centre for Cardiovascular Research—DZHK, Berlin, Germany
5
Swiss Federal Institute of Technology, Zürich, Switzerland
into the left atrium (LA), which, in turn, leads to blood flow back into the LA during heart contraction. Heart function is impaired and volume load on the LA as well as the lungs is increased. The gold standard therapy for MR is surgical reconstruction [13,14]. To further improve the planning process prior to an intervention and to f
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