Heart surgery: Annuloplasty

Software module for planning annular rings in individual patients. | © dkfz.de

The mitral valve regulates the blood flow from the left atrium into the left ventricle of the heart by opening or closing the valvular cusps. One of the most common functional disorders of the mitral valve is mitral valve insufficiency in which the heart valve no longer closes completely. This results in a regurgitation of the blood from the ventricle into the atrium with symptoms of mild exhaustion and dyspnea.
If the indication for surgery is given, the heart valve either can be reconstructed or replaced. Because of better life expectancies and fewer risks over the long term, reconstructive procedures are usually preferred today. During this procedure, the original heart valve is essentially preserved. However, various surgical techniques are used to adapt the shape of the heart valve in such a way that the valvular cusps once again close correctly.
A component of nearly all reconstructive procedures is annuloplasty which involves the implantation of a ring on the mitral annulus, a fibrous, ring-shaped tissue which surrounds and stabilizes the valvular cusps. By implanting this artificial ring, the pathologically altered mitral valve is once again stabilized and through reshaping is brought into an anatomically more favorable shape.
To adapt the shape of the ring to the individual anatomy of the patient and thus optimally restore the function of the heart valve, we are working on a computer-assisted procedure which facilitates and optimizes an individualized preoperative planning of the intervention.

Project team

Congenital heart defects

Simulation and planning result of a tunnel-like patch for surgical correction of a complex heart defect. | © dkfz.de

In Germany approximately 6,000 children are born each year with a congenital heart defect. At an annual birth rate of approx. 650,000, this corresponds to more than 1% of all neonates, or one out of every 100 children. Thus, congenital heart defects are the among most common congenital malformations overall.
However, congenital heart defects are characterized by a high degree of variability. Up to 70 different types of pathology belong to the category of congenital heart defects; these can occur both in isolated form as well as in combination with other pathologies. Therefore, each congenital heart defect must be regarded as an individual case with an individual anatomy.
The anatomy of severe congenital heart defects is frequently very complex and varies greatly from the anatomy of a healthy heart. The estimation of three-dimensional diagnostic measures for quantification such as volume measurements, length measurements or the positional relationship between different structures is solely limited by the sectional imaging modalities such as MRI.
In the surgical correction of severe, congenital heart defects which - for example - is often performed by implanting a patch material to close erroneous shunts or to reconstruct cardiac structures, the fact that the heart is still growing must also be calculated.
To simplify the diagnosis and treatment planning the congenital heart defects project therefore will develop computer-assisted applications to optimize spatial visualization and thus facilitate precise estimates of the spatial dimensions and positional relationships. This is the prerequisite for an adequate diagnosis and treatment planning. Another area of application is the development of computer-based software with which patch implantation surgery can be planned beforehand. By means of individualized operation planning based on quantified data, it is possible to save time intraoperatively and to optimize the shape of the patch and thus minimize the risks of surgery over the long term and improve the patients' quality of life.

Project team