Effect of Congenital Anomalies of the Papillary Muscles on Mitral Valve Function

Parachute mitral valves (PMVs) and parachute-like asymmetric mitral valves (PLAMVs) are associated with congenital anomalies of the papillary muscles. Current imaging modalities cannot provide detailed biomechanical information. This study describes computational evaluation techniques based on three-dimensional (3D) echocardiographic data to determine the biomechanical and physiologic characteristics of PMVs and PLAMVs. The closing and opening mechanics of a normal mitral valve (MV), two types of PLAMV with different degrees of asymmetry, and a true PMV were investigated. MV geometric data in a patient with a normal MV was acquired from 3D echocardiography. The pathologic MVs were modeled by altering the configuration of the papillary muscles in the normal MV model. Dynamic finite element simulations of the normal MV, PLAMVs, and true PMV were performed. There was a strong correlation between the reduction of mitral orifice size and the degree of asymmetry of the papillary muscle location. The PLAMVs demonstrated decreased leaflet coaptation and tenting height. The true PMV revealed severely wrinkled leaflet deformation and narrowed interchordal spaces, leading to uneven leaflet coaptation. There were considerable decreases in leaflet coaptation and abnormal leaflet deformation corresponding to the anomalous location of the papillary muscle tips. This computational MV evaluation strategy provides a powerful tool to better understand biomechanical and pathophysiologic MV abnormalities.