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MIVAL3D: A MULTIDISPLINARY PROJECT OF SEHRC ON MITRAL VALVE
SURGERY E-LEARNING.
M. Gonzalez, S. Grau, D. Tost, R. Aguilar, R. Rodriguez-Lecoq, J. C. Castro, J. Garrigos, J.
M. Colomé, J. Escudero
SEHRC (Southern Europe eHealth Research and Innovation Centre), Barcelona, Spain
The mitral valve insufficiency is the second heart valve disease in the first world, which
frequently requires surgical treatment. Since the 50s, this pathology has been settled by the
replacement of mitral valve by different types of prosthesis with good results, albeit with
some important limitations: need for anticoagulation when using mechanical prosthesis,
hemodynamic behavior acceptable but not optimal or some others. Therefore, whenever it is
possible, valve repair is preferable to prosthesis replacement. It consists either of an
annuloplasty, i.e. inserting a cloth-covered ring around the valve to bring the leaflets into
contact with each other, or partial resection of the leaflets or re-suspension with artificial
cords. These surgery procedures require a high level of expertise and a pre-surgery thorough
evaluation of different strategies for the intervention. Although modern heart imaging such
3D echocardiography provides a good insight of the heart structures, there is a lack of specific
tools for surgeons to visually analyze the heart structures, simulate different surgical
approaches and predict function changes after the intervention.
The aim of our project is to create a set of tools based on medical imaging that will allow
surgeons to visually analyze and interactively manipulate a 3D model of the patient's heart,
simulate a surgical intervention procedure and predict functional changes after the
intervention. We will create a scalable line of work, in phases, which will allow to obtain
different modular programs.
The purpose of Phase I of our project is to develop a virtual recreation tool that will: (i)
reconstruct a 3D graphic model of the heart from two- and three-dimensional
echocardiographic images, (ii) segment its different structures and extract a polygonal model
of the left ventricle and the mitral valve, (iii) perform a quantitative analysis of the mitral
valve motion in normal physiological conditions and (iv) construct a synthetic reference
virtual model of the heart that will be used as a reference atlas model. Using the application,
surgeons will be able to select a dataset of a particular patient or a reference model, analyze it
on the basis of illustrative visualizations that will clearly distinguish the segmented structures,
and, at the same time, provide enough realism. Moreover, they will be able to query for a
blood flow simulation that will take into account the topological and geometrical model of the
mitral valve and the left ventricle, the blood pressures and the mechanical properties of the
heart tissues. The results of this simulation will be shown as an animation on top of the heart
model. Finally, they will be able to graphically define a surgery approach and query for the
modified model animation. At later stages of the project, we will focus on generating tools to
better understand how different types of disturbance determine the occurrence of defects
closure valve cooptation, ultimately responsible for the severity of regurgitation (insufficiency
valve) of different sizes, geometry and different locations.
Keyword: Cardiac Surgery training, 3D echo-cardiographic imaging, Illustrative multimodal