Toward Precision in Simulation of Pediatric Mitral Valve Repair Using Patient-Specific Fluid-Structure Interaction Modeling

Abstract Background Assessment of mitral valve (MV) function and hemodynamics is essential for optimizing surgical repair in children with mitral regurgitation. Patient-specific fluid-structure interaction (FSI) modeling can capture the complex interplay between valvular mechanics and blood flow. In this study, we apply a patient-specific FSI framework to evaluate MV function and hemodynamics in pediatric patients before and after surgery. Methods Seven pediatric patients with mitral regurgitation were analyzed (age range: 2–17 years; median: 6 years; 57% female). Patient-specific MV apparatus geometries were segmented from pre- and post-operative 3D echocardiograms. Flow boundary conditions were derived from left ventricular volume measurements. Valve dynamics and hemodynamics were simulated using the FSI framework. Model performance was evaluated against echocardiographic data, pre- and post-operatively. Results The FSI model reproduced the angle of the regurgitant jet. Pre-operatively, the regurgitation grade matched echocardiographic assessment in 6 of 7 patients, and post-operatively in 4 of 7. The site of regurgitation was correctly identified in 6 of 7 patients, pre- and post-operatively. The model reproduced the observed intraventricular flow patterns in most patients, and the simulated transvalvular pressure gradients agreed with Doppler measurements (mean difference: 0.38 ± 1.57 mmHg pre-operatively, –0.42 ± 3.26 mmHg post-operatively). Conclusions The proposed FSI framework captured MV function, hemodynamics, and disease-specific features in pediatric patients pre- and post-operatively, based on evaluation in one of the largest cohorts for the field. This computational framework has the potential to enable predictive simulations that could support surgical planning in the future and improve repair outcomes in children.