Numerical Aspects of Hypertrophic Cardiomyopathy Treatment

Hypertrophic Cardiomyopathy (HCM) is an inherited disease considered to be the leading cause of sudden cardiac death (SCD) in athletes and is found in 1 of 200 people of the general population. Current recommended treatment is medication to control symptoms, however, still affecting the patient`s quality of life, limiting their daily activities. Hypertrophic Obstructive Cardiomyopathy (HOCM) is a common complication of HCM characterized by obstructive motion of the anterior mitral leaflet causing mitral regurgitation, compromising systolic left ventricular (LV) reduced ejection fraction, and significant outflow pressure gradients (>30mmHg) . Some patients who are unresponsive to medication are prone to highly invasive surgery, including myectomy or ablation, with relatively high mortality and morbidity rates. We propose an improvement of both the flow regimes and pressure gradients by placing a percutaneous device in the LV using a minimally invasive procedure, making surgery redundant. Utilizing computational fluid dynamics (CFD) methods, we intend to present the modeling procedure of a LV, implementation of boundary conditions (BC) and assumptions, leading to a numerical model which represents the case at hand, while simplifying it. Three 3D models will be used to display the different aspects of the modeling procedure including transient time-dependent FSI analyses of the flow in the healthy LV, the pathologic HOCM LV and the treated LV. In addition, a contact analysis of the structural model of LV myocardium will be used to construct the LV geometry after device implantation in the HOMC LV. The results will then be used to compare the effects of a percutaneous device on the position of the mitral valve leaflets and the hemodynamics of the different LV cases.