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Isolation of Mouse Interstitial Valve Cells to Study the Calcification of the Aortic Valve In Vitro
Published on: May 10, 2021
Progressive aortic valve calcification: three-dimensional visualization and biomechanical analysis
Rotem Halevi1, Ashraf Hamdan2, Gil Marom3
1Faculty of Engineering, Tel-Aviv University, Tel-Aviv 69978, Israel.
Insights
A new Reverse Calcification Technique (RCT) reconstructs early calcific aortic valve disease (CAVD) stages using CT scans. This method aids in understanding disease progression and mechanical valve performance.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Medical Imaging Analysis
Background:
- Calcific aortic valve disease (CAVD) involves progressive calcification of the aortic valve (AV), altering hemodynamics and mechanical function.
- Understanding CAVD initiation and progression is crucial for effective patient management.
Purpose of the Study:
- To introduce and validate the Reverse Calcification Technique (RCT) for recreating early stages of CAVD.
- To analyze the mechanical implications of different calcification patterns using patient-specific data.
Main Methods:
- RCT utilizes 3D CT scan data to progressively subtract low-density calcification voxels, reconstructing earlier disease stages.
- Finite Element (FE) analysis compared healthy AV mechanics with simulated CAVD configurations.
Main Results:
- Four distinct calcification geometries and growth patterns were identified using RCT.
- Simulated moderate stenosis reduced orifice area from 2.9cm² to 1.4cm².
- Strain magnitude increased significantly (0.24 vs. 0.17) at calcification edges, indicating mechanical stress concentration.
Conclusions:
- RCT offers a novel method to visualize and study early CAVD stages and identify potential disease initiation sites.
- The technique enables realistic FE mechanical simulations of calcified AVs, aiding in predicting disease progression.
Abstract:
Calcific aortic valve disease (CAVD) is a progressive pathology characterized by calcification mainly within the cusps of the aortic valve (AV). As CAVD advances, the blood flow and associated hemodynamics are severely altered, thus influencing the mechanical performance of the AV. This study proposes a new method, termed reverse calcification technique (RCT) capable of re-creating the different calcification growth stages. The RCT is based on three-dimensional (3D) spatial computed tomography (CT) distributions of the calcification density from patient-specific scans. By repeatedly subtracting the calcification voxels with the lowest Hounsfield unit (HU), only high calcification density volume is presented. RCT posits that this volume re-creation represents earlier calcification stages and may help identify CAVD initiation sites. The technique has been applied to scans from 12 patients (36 cusps) with severe aortic stenosis who underwent CT before transcatheter aortic valve implantation (TAVI). Four typical calcification geometries and growth patterns were identified. Finite elements (FE) analysis was applied to compare healthy AV structural response with two selected CAVD-RCT configurations. The orifice area decreased from 2.9cm(2) for the healthy valve to 1.4cm(2) for the moderate stenosis case. Local maximum strain magnitude of 0.24 was found on the edges of the calcification compared to 0.17 in the healthy AV, suggesting a direct relation between strain concentration and calcification geometries. The RCT may help predict CAVD progression in patients at early stages of the disease. The RCT allows a realistic FE mechanical simulation and performance of calcified AVs.
