Patient-specific subvalvular apparatuses consisting of chordae tendineae and papillary muscles to complete mitral valve replicas

Mitral valve regurgitation is one of the most common heart valve diseases and mitral valve repair is the favored but challenging therapy. To improve preoperative understanding of mitral valve anatomy and enable preoperative simulation of mitral valve repair, patient-specific mitral valve replicas have been developed. However, most of these replicas are missing the subvalvular apparatus consisting of cords, the chordae tendineae, and papillary muscles. Hence, as they only represent incomplete anatomy, it is impossible to simulate the repair technique implantation of artificial chordae tendineae on them. To solve this problem, we developed patient-specific subvalvular apparatus replicas completing the mitral valve replicas. From 3D ultrasound images of hearts, the chordae tendineae were segmented and used to realize the subvalvular apparatus replicas which were 3D printed from soft material and integrated into the existing mitral valve replicas. The mitral valve replicas with subvalvular apparatus were assessed by an expert heart surgeon who rated them as realistic and successfully simulated mitral valve repair by implanting artificial chordae tendineae into them.