CE45 - Mathématiques et sciences du numérique pour la biologie et la santé

Simulation and Imaging for Mitral Regurgitation – SIMR

1- Tissue remodeling and ventricular flows will be measured using advanced magnetic resonance imaging techniques.
2- A new fluid-structure coupling algorithm will be developed to allow a complete numerical simulation of the mitral apparatus, and inverse problem techniques applied to a finite element model will be used to estimate cardiac contractility.

- The multi-modality imaging protocol has been designed based on the initial objectives.
- The infrastructure on H2P and the access procedure to process the native imaging data and the generated data have been set up and are open to partners.
- A specific H2P client has been shared to allow the download of results.
- Numerical study on the robustness (conservation of mass across the interface) of different low order dummy domain methods
- Implementation of a robust low-order dummy domain method
- Formulation and analysis of an explicit Robin-Robin coupling scheme (compatible compatible meshes)
- Geometric model of the mitral apparatus in normal or pathological conditions
- Implementation of fluid-structure-blood-myocardium interaction calculations on cardiac simulations with reduced valve models (resistive surface).
- Implementation and validation of a 3D shell model adapted to the physics of the mitral valve.
- An algorithm for the identification of global/regional kinematic anomalies is ready to be applied to the data that will be acquired on patients.

- The clinical study protocol is being modified
to evaluate the impact of preoperative fibrosis on left ventricular remodeling after mitral repair surgery.
- First patient enrolled in the study is scheduled for March 2002.
- Imaging data from the clinical study in the H2P database.
- First fluid-structure simulations with complete and reduced models of the mitral valve.

1. G. K. Rumindo, J. Ohayon, P. Croisille, and P. Clarysse, «In vivo
estimation of normal left ventricular stiffness and contractility
based on routine cine MR acquisition,« Medical Engineering &
Physics, vol. 85, pp. 16-26, 2020.
2. Daniel Grinberg, Rémi Buzzi, Matteo Pozzi, Rémi Schweizer,
Jean-Fabien Capsal, Bergamotte Thinot, Minh Quyen Le, Jean-
Francois Obadia, Pierre-Jean Cottinet, “Eco-audit of conventional
heart surgery procedures”, European Journal of Cardio-Thoracic
Surgery, 2021;, ezab320,

Submission summary

With 600 surgical operations per year, mitral insufficiency is the second cause of valvular surgery in France. Repair is preferred to replacement when it is possible. Cardiac ultrasound allows the quality of correction to be routinely assessed, but it does not measure the biomechanical impact of interventions on the mitral apparatus. A better understanding of this impact, based on objective physical quantities, would enable the optimization of the repair techniques.

The SIMR project aims at facing this major public health problem, with the following two objectives:

(1) Evaluate the physical consequences of mitral repair with new tools used in a clinical study involving 15 patients. Tissue remodeling and ventricular flow will be measured using advanced magnetic resonance imaging techniques, and chordae tension will be measured using an innovative device.

(2) Design numerical tools for the simulation of cardiac hemodynamics, blood/valve interaction and myocardial biomechanics, to provide the in silico counterpart of the in vivo measurements. In particular, a new fluid-structure coupling algorithm will be developed to allow a complete numerical simulation of the mitral apparatus, and inverse problem techniques applied to a finite element model will be used to estimate cardiac contractility.

The SIMR consortium gathers four complementary components: modeling and simulation (REO, M3DISIM, TIMC), clinical research (HCL), engineering (LGEF) and medical imaging (CREATIS). Active collaborations already exist between certain groups. The project will provide a unique opportunity to build new bridges between imaging, modeling, simulation and clinical research.

Several results with high scientific impact are expected. The device for measuring tensions in neo-cordages is a world first. At the end of the project, the impact of these tensions on the results of the repair and ventricular remodeling will be much better understood. The combination of magnetic resonance imaging velocimetry and numerical simulation is likely to be of great interest as intracavitary flows are currently a very active research field within in the imaging and simulation communities. Finally, a complete fluid-structure simulation of the mitral apparatus on a beating heart would be a major breakthrough in the field of cardiovascular simulation.

Project coordinator

Monsieur Miguel A. Fernández Varela (Centre de Recherche Inria de Paris)

The author of this summary is the project coordinator, who is responsible for the content of this summary. The ANR declines any responsibility as for its contents.


TIMC Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble
COMMEDIA Centre de Recherche Inria de Paris
M3DISIM Centre de Recherche Inria Saclay - Île-de-France

Help of the ANR 733,903 euros
Beginning and duration of the scientific project: January 2020 - 48 Months

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