In Silico Analysis Provides Insights for Patient-Specific Annuloplasty in Barlow´s Disease

Open AccessPublished:January 23, 2023DOI:
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      The objective of the present study was to predict the required mitral annular area reduction in Barlow patients to obtain a predefined leaflet area index by a novel in silico modeling method.


      Three-dimensional echocardiography was used to create patient-specific mitral valve models of eight patients diagnosed with Barlow’s disease and bileaflet prolapse pre-operatively. Six patients were also studied post-operatively in a finite element framework, to quantify the optimal coaptation area index. For the patient-specific finite element analyses, realistic papillary muscle and annular motion are incorporated, also for the in silico annuloplasty analyses. The annuloplasty ring size is reduced moderately until the optimal coaptation area index is achieved for each patient.


      The mean mitral annular area at end-diastole was reduced by 58 ± 7% post-operatively (p < 0.001), resulting in a post-operative coaptation area index of 20 ± 5%. To achieve the same coaptation area index with moderate annular reductions and no leaflet resection the annular reduction was 31 ± 6% (p < 0.001) .


      In silico analysis in selected Barlow’s patients demonstrates that annuloplasty with only moderate annular reduction may be sufficient to achieve optimal coaptation as compared to conventional surgical procedures.

      Graphical abstract


      Glossary of Abbreviations:

      BD (Barlow’s Disease), CAI (coaptation area index), ED (end diastole), FE (finite element), LS (late systole), MAA (mitral annular area), MAD (mitral annular disjunction), MR (mitral regurgitation), MRS (mitral regurgitation start), MVO (mitral valve opening), SAM (systolic anterior motion), SLA (segmented leaflet area)