arXiv subjects

Christian Herz

Publications and source records attributed to Christian Herz.

7 recordsLinked to original sources

arXiv2026

Biomechanically Informed Image Registration for Patient-Specific Aortic Valve Strain Analysis

Aortic valve (AV) biomechanics play a critical role in maintaining normal cardiac function. Pathological variations, particularly in bicuspid aortic valves, alter leaflet loading, increase strain, and accelerate disease progression. Accurate patient-specific characterization of valve geometry and deformation is therefore essential for predicting disease progression and guiding durable repair. Current imaging and computational methods often fail to capture rapid valve motion and complex patient-specific features, limiting precise biomechanical assessment. To address these limitations, we developed an image registration framework coupled with the finite element method (FEM) to improve AV tracking and biomechanical evaluation. The valve geometries derived from 4D echocardiography and CT were used to simulate AV closure and generate intermediate deformation states. These FEM-generated states facilitated leaflet tracking, while image registration corrected misalignment between simulations and imaging data. In 20 patients, FEM-augmented registration improved accuracy by 40% compared with direct registration. This improvement enabled more reliable strain estimation by measuring leaflet deformation directly from imaging and reducing uncertainties associated with boundary conditions and material assumptions. Areal, Green-Lagrange, and deviatoric strains were quantified in adult trileaflet/bicuspid valves, as well as pediatric patients, revealing distinct deformation patterns across valve groups. Convergence in mean deviatoric strain between adult trileaflet and pediatric valves suggests volumetric deformation underlies age- and size-related differences in AV mechanics. The FEM-augmented registration enhances tracking and biomechanical evaluation accuracy, providing clinically relevant insights into patient-specific AV deformation to support individualized medical and intervention planning.

q-bio.QM↗

arXiv2025

Integrated Open-Source Framework for Simulation of Transcatheter Pulmonary Valves in Native Right Ventricular Outflow Tracts

Background - Pulmonary insufficiency is a consequence of transannular patch repair in Tetralogy of Fallot (ToF), leading to late morbidity and mortality. Transcatheter native outflow tract pulmonary valve replacement (TPVR) has become common, but assessment of patient candidacy and selection of the optimal device remains challenging. We demonstrate an integrated open-source workflow for simulation of TPVR in image-derived models to inform device selection. Methods - Machine learning-based segmentation of CT scans was implemented to define the right ventricular outflow tract (RVOT). A custom workflow for device positioning and pre-compression was implemented in SlicerHeart. Resulting geometries were exported to FEBio for simulation. Visualization of results and quantification were performed using custom metrics implemented in SlicerHeart and FEBio. Results - RVOT model creation and device placement could be completed in under 1 minute. Virtual device placement using FE simulations visually mimicked actual device placement and allowed quantification of vessel strain, stress, and contact area. Regions of higher strain and stress were observed at the proximal and distal end locations of the TPVs where the devices impinge the RVOT wall. No other consistent trends were observed across simulations. The observed variability in mechanical metrics across RVOTS, stents, and locations in the RVOT highlights that no single device performs optimally in all anatomies, thereby reinforcing the need for simulation-based patient-specific assessment. Conclusions - This study demonstrates the feasibility of a novel open-source workflow for the rapid simulation of TPVR which with further refinement may inform assessment of patient candidacy and optimal device selection.

q-bio.TO↗

arXiv2025

Simulation of Repair on Dynamic Patient-Specific Left Atrioventricular Valve Models

Purpose: To develop and evaluate a dynamic, image-derived patient-specific physical simulation platform for the assessment of left atrioventricular valve (LAVV) repair strategies in pediatric patients with repaired atrioventricular canal defects. Methods: 3D transesophageal echocardiographic images of two patients with regurgitant LAVVs were identified from an institutional database. Custom code in SlicerHeart was used to segment leaflets, define the annulus, and generate patient-specific valve molds. Silicone valve models were fabricated and tested in a pulse duplicator under simulated physiological conditions. Five unrepaired valves were analyzed for manufacturing consistency, and multiple surgical repair techniques were compared for two patient-specific models. Results: Manufacturing variability was low in annular metrics (CV for annular circumference: 2.1; commissural distance: 4.1; annulus height: 14.7) but higher in leaflet closure metrics (billow height: 11.1%; billow volume: 18.9%; tenting height: 45.9%; tenting volume: 73.5%). In Patient 1, cleft closure and an Alfieri stitch both eliminated the regurgitant orifice area, but the Alfieri stitch resulted in elevated mean pressure gradient (17 mmHg vs. 4-9 mmHg for other repairs) and deteriorated with repeated loading. In Patient 2, no repair eliminated regurgitation entirely; however, combining an 11 mm patch augmentation with commissuroplasty reduced regurgitant area to 0.147 cm2, the smallest observed among tested strategies. Conclusion: This study demonstrates the feasibility of a dynamic physical simulation platform for preclinical LAVV repair evaluation. This proof-of-concept work highlights the platform potential for refining repair strategies before clinical application, which may be particularly relevant in small and heterogeneous populations with congenital heart disease.

physics.med-ph↗

arXiv2025

Simulation of Transcatheter Therapies for Atrioventricular Valve Regurgitation in an Open-Source Finite Element Simulation Framework

Purpose: Transcatheter edge-to-edge repair (TEER) and annuloplasty devices are increasingly used to treat mitral valve regurgitation, yet their mechanical effects and interactions remain poorly understood. This study aimed to establish an open-source finite element modeling (FEM) framework for simulating patient-specific mitral valve repairs and to evaluate how TEER, annuloplasty, and combined strategies influence leaflet coaptation and valve mechanics. Methods: Four G4 MitraClip geometries were modeled and deployed in FEBio to capture leaflet grasp and subsequent clip-leaflet motion under physiologic pressurization. CardioBand annuloplasty was simulated by reducing annular circumference via displacement-controlled boundary conditions, and Mitralign suture annuloplasty was modeled using discrete nodal constraints. Simulations were performed for prolapse and dilated annulus cases. Valve competence (regurgitant orifice area, ROA), coaptation/contact area (CA), and leaflet stress and strain distributions were quantified. Results: In prolapse, TEER restored coaptation but increased leaflet stresses, whereas band and suture annuloplasty produced distinct valve morphologies with lower stress distributions. In dilation, TEER alone left residual regurgitation, while annuloplasty improved closure. Combined TEER & band annuloplasty minimized ROA, maximized CA, and reduced stresses relative to TEER alone, though stresses remained higher than annuloplasty alone. Conclusion: This study establishes a reproducible, open-source FEM framework for simulating transcatheter TEER and annuloplasty repairs, with the potential to be extended beyond the mitral valve. By quantifying the mechanical trade-offs of TEER, suture annuloplasty, band annuloplasty, and their combinations, this methodology highlights the potential of virtual repair to guide patient selection and optimize surgical planning.

physics.med-ph↗

arXiv2025

ADEPT: A Noninvasive Method for Determining Elastic Parameters of Valve Tissue

Computer simulation of "virtual interventions" may inform optimal valve repair for a given patient prior to intervention. However, the paucity of noninvasive methods to determine in vivo mechanical parameters of valves limits the accuracy of computer prediction and their clinical application. To address this, we propose ADEPT: A noninvasive method for Determining Elastic Parameters of valve Tissue. In this work, we demonstrated its application to the tricuspid valve of a child. We first tracked valve displacements from open to closed frames within a 3D echocardiogram time sequence using image registration. Physics-informed neural networks were subsequently applied to estimate the nonlinear mechanical properties from first principles and reference displacements. The simulated model using these patient-specific parameters closely aligned with the reference image segmentation, achieving a mean symmetric distance of less than 1 mm. Our approach doubled the accuracy of the simulated model compared to the generic parameters reported in the literature.

q-bio.QM↗

arXiv2024

Effect of Parametric Variation of Chordae Tendineae Structure on Simulated Atrioventricular Valve Closure

Many approaches have been used to model chordae tendineae geometries in finite element simulations of atrioventricular heart valves. Unfortunately, current "functional" chordae tendineae geometries lack fidelity that would be helpful when informing clinical decisions. The objectives of this work are (i) to improve synthetic chordae tendineae geometry fidelity to consider branching and (ii) to define how the chordae tendineae geometry affects finite element simulations of valve closure. In this work, we develop an open-source method to construct synthetic chordae tendineae geometries in the SlicerHeart Extension of 3D Slicer. The generated geometries are then used in FEBio finite element simulations of atrioventricular valve function to evaluate how variations in chordae tendineae geometry influence valve behavior. Effects are evaluated using functional and mechanical metrics. Our findings demonstrated that altering the chordae tendineae geometry of a stereotypical mitral valve led to changes in clinically relevant valve metrics and valve mechanics. Specifically, cross sectional area had the most influence over valve closure metrics, followed by chordae tendineae density, length, radius and branches. We then used this information to showcase the flexibility of our new workflow by altering the chordae tendineae geometry of two additional geometries (mitral valve with annular dilation and tricuspid valve) to improve finite element predictions. This study presents a flexible, open-source method for generating synthetic chordae tendineae with realistic branching structures. Further, we establish relationships between the chordae tendineae geometry and valve functional/mechanical metrics. This research contribution helps enrich our open-source workflow and brings the finite element simulations closer to use in a patient-specific clinical setting.

physics.med-ph↗

arXiv2019

Interactive-Automatic Segmentation and Modelling of the Mitral Valve

Mitral valve regurgitation is the most common valvular disease, affecting 10% of the population over 75 years old. Left untreated, patients with mitral valve regurgitation can suffer declining cardiac health until cardiac failure and death. Mitral valve repair is generally preferred over valve replacement. However, there is a direct correlation between the volume of cases performed and surgical outcomes, therefore there is a demand for the ability of surgeons to practice repairs on patient specific models in advance of surgery. This work demonstrates a semi-automated segmentation method to enable fast and accurate modelling of the mitral valve that captures patient-specific valve geometry. This modelling approach utilizes 3D active contours in a user-in-the-loop system which segments first the atrial blood pool, then the mitral leaflets. In a group of 15 mitral valve repair patients, valve segmentation and modelling attains an overall accuracy (mean absolute surface distance) of 1.40+-0.26 mm, and an accuracy of 1.01+-0.13 mm when only comparing the extracted leaflet surface proximal to the ultrasound probe. Thus this image-based segmentation tool has the potential to improve the workflow for extracting patient-specific mitral valve geometry for 3D modelling of the valve.

eess.IV↗