Valvular heart disease affects millions of patients in the United States--many of which have severe disease associated with decreased survival. The GCRG has had a long-standing interest in understanding the normal and pathologic processes that contributed to valve function or dysfunction, respectively. With particular attention towards ischemic mitral regurgitation, we utilize a multi-modality approach to define the biomechanical factors that influence disease progression post-infarct. Following the advent of 3D echocardiography and sonomicrometry array localization, our group first described distortions of the normal saddle-shaped mitral annulus following ischemic insult (3rd Gorman et al. 1997; Gorman et al. 1995). Using finite element modelling , we have since been able to describe in great detail the leaflet stress distribution in both normal and pathologic conditions. Of particular importance, our work has shown a biomechanical advantage to maintaining leaflet curvature and annular saddle shape (Annular Height to Commisural Width Ratio - AHCWR - ~15%) by reducing peak leaflet stress (Salgo et al. , 2002).
3D echocardiographic reconstruction of a patient's mitral valve with ischemic mitral regurgitation
Our work has since been successfully translated into the clinical realm--as evidenced by multiple commerically available annuloplasty devices designed to restore normal saddle-shaped annular geometry. Further, widespread availability of 3D echocardiography has led to multiple human studies directed towards understanding valvular pathology and guiding novel repair techniques (Padala et al. 2009; Robb et al. 2011; Vergnat et al. 2011). Because repair is not always feasible and reoperative surgeries can be technically challenging, our group is also actively involved in the design and development of percutaneous valve replacement therapies.