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Development of a Dynamic Heart Phantom for Verification of Minimally Invasive Surgical Interventions Dennis Ceh ([email protected]) University of Windsor, Windsor, Ontario, Canada Medical Problem Design Decisions Mitral valve regurgitation (MVR) • Polyvinyl Alcohol cryogel (PVA-c) was used since it behaves similar to tissue, especially under ultrasound [2] • Is a disorder of the heart that occurs when the mitral valve does not properly close allowing blood to leak from the left ventricle back into the left atrium • Only needed to recreate elements that directly impact the motion of the mitral valve. That is the left ventricle, aortic valve and mitral valve. • Affects 2-6% of the population [1] • Trabeculae were added to both inside and outside of left ventricle to allow left ventricular twisting • Dangers include stroke and congestive heart failure (due to inadequate circulation) • Braided silk sutures were used to represent the chordae tendineae • Large number of cases (up to 49%) are inoperable with conventional surgical techniques due to co-morbidities Results Continued • Left ventricle was approximated as a hemi-ellipsoidal shape with volume of 135 ml (diastolic state). • An actuator system composed of pneumatic cylinders was used to compress the left ventricle Phantom setup with Philips ie33 US machine Overall Work Flow Design molds in CAD system Create molds with 3D printer Solidify PVA-c with freeze/thaw cycles www.heart-valve-surgery.com Inject molds with PVA-c Assemble phantom Use system with Neochord tool TEE Probe Resulting ultra sound image Further Work Medical Intervention The Neochord DS1000 is a minimally-invasive technology designed for mitral valve repair by adding new synthetic chordae tendineae. Procedure is performed with the aid of ultrasound (trans-esophageal echo or TEE). • Try other tissue mimicking materials (silicone, PVC) Results • Add 30◦ angle between mitral valve and aortic valve (which also impacts left ventricle design). • Improve upon the actuator system; allow different heart rates, manual control and computer interaction • Create different versions of the mitral valve to simulate various issues • Improve the general setup and assembly of the phantom In the images below: a) the neochord tool is navigated close to the mitral valve; b) the required leaflet is pierced; c) removal of the tool and fastening the new chordae; and d) the new chordae being used (a) References Mitral Valve Mold Aortic Valve Mold Left Ventricle Mold [1] Freed L, Levy D, Levine RA, et Al. Prevalence and clinical outcome of mitral-valve prolapse. New England Journal of Medicine, Jul 1 1999; 341(1):1-7 [2] Surry KJ, Austin HJ, Fenster A, Peters TM. Poly(vinyl alcohol) cryogel phantoms for use in ultrasound and MR imaging. Imaging Research Laboratories, Robarts Research Institute, London, Canada Acknowledgements (b) Special thanks for all the help to John Moore (Imaging Group, (c) (d) www.neochord.com Phantom side view Mitral and Aortic Valves With NeoChord Tool Robarts Research Institute) and Gerard Guiraudon (Canadian Surgical Technologies and Advanced Robotics, Lawson Health Research Institute, London Health Science Center, and the Imaging Group, Robarts Research Institute).