3

SB C2015
Summer Biomechanics, Bioengineering and BIotransport Conference
June 29 July 2, National Harbor, MD, USA

DETERMINATION OF THE TENSILE MECHANICAL PROPERTIES OF THE SEGMENTED

TRICUSPID VALVE ANNULUS

Fatima Al-Quaiti (1), Evelia Salinas (1), Lori Boies (1), Edward Sako (2), Shamik Bhattacharya (1)

(1) School of Science, Engineering and

Technology
St. Marys University
San Antonio, Texas, United States

INTRODUCTION
The tricuspid valve apparatus consists of the tricuspid annulus,
leaflets, and chordae. The valve is located between the right atrium
and right ventricle of the heart and prevents the back flow
(regurgitation) of blood into the right atrium. The tricuspid annulus
(TA), identified in Figure 1, is defined as the hinge point of the
leaflets; surgically it is identified as the apparent transition between
the right atrial tissue and the tricuspid leaflet.

Tricuspid
annulus

(2) Cardiothoracic Surgery

University of Texas Health Science Center at San
Antonio
San Antonio, Texas, United States

Functional tricuspid regurgitation (FTR) is increasingly recognized as

a source of morbidity in patients, particularly those with chronic mitral
valve regurgitation [1]. Asymmetric tricuspid annulus dilation is a
major feature in FTR. The mechanism of this asymmetric dilation is
not understood clearly. Tricuspid ring annuloplasty (TRA) is the most
preferred surgical therapy to repair FTR. In TRA, a partial ring is
sutured to the annulus, which cinches the dilated annulus and restores
the native shape. However, the ring only partially covers the annulus,
keeping the septal segment untouched due to the presence of the AV
node. After TRA, instances of recurrent regurgitation, septal dilation,
and ring separation have occurred [2]. Differing strengths between the
free and septal annulus segments can contribute to the asymmetrical
annulus dilation or to the septal dilation after TRA. The hypothesis is
that the annulus segments may not have same mechanical properties.
To date, there has been no quantification of the mechanical properties
of the tricuspid valve annulus. This study aims to quantify the tensile
mechanical properties of the segmented tricuspid annulus. The data
collected will be used to identify the differences in the tensile
mechanical properties between the septal and free wall regions across
species. The findings of this study may potentially enhance our
understanding of asymmetrical tricuspid annulus dilation and may
contribute to the durability of the TRA technique.

METHODS

FIGURE 1 THE TRICUSPID VALVE ANNULUS

This method was modeled after a previous tensile test study of the
mitral valve annulus [3]. Ovine and porcine hearts were collected from
local slaughterhouses and transported in coolers. Hearts were
cryopreserved until the day of the experiment upon which hearts were
thawed in a saline bath at 37.5C. To carry out the experiment, we
used the UStretch Tissue Tensile Test system (Cellscale). The TA was

cut into a free wall segment and a septal wall segment. The free wall
segment consisted of the anterior and posterior sections. The tissues
were then isolated and trimmed to an approximate length of 30.0 mm,
width of 6.0 mm, and thickness of 1.2 mm. The tissues were then
marked with 4 graphite markers placed in a square at the center of the
tissue. We secured 6.0 to 7.0 mm of the tissue on both sides between
two grips (Figure 2).

FIGURE 5 STRETCH TO FAILURE CURVES FOR OVINE

AND PORCINE TRICUSPID ANNULUS SEGMENTS
FIGURE 2 TENSILE TEST SET-UP OF TRICUSPID
ANNULUS SEGMENTS
The experiment was carried out at 37.5C. Samples first
underwent a preconditioning phase in which the tissues were stretched
by 7.5 mm at a speed of 2.0 mm/min and then recovered to their
original length. After the completion of the preconditioning phase, the
tissues were stretched at a speed of 2.0 mm/min until they presented
the first sign of failure, which was indicated by a drop in the
magnitude of force required to stretch the tissue.
To calculate stress, the force was divided by the product of the
thickness and width of the tissue. Stress was analyzed through a
calculation of force divided by the product of tissue thickness and
width. The percent strain was quantified using UStretch image
analysis. As shown in Figure 3, the trackers were placed at the center
of each marker, and the percent strain was measured for each
movement between images as a 4-point average.

FIGURE 3 CALCULATED PERCENT STRAIN USING

POSITIONED TRACKERS

RESULTS
The results are based on two ovine hearts and two porcine hearts.
In the preconditioning (Figure 4) and stretch to failure curves (Figure
5), we found that as the tissues were stretched, the stress and strain
also both increased. Variation of mechanical properties between the
septal and free wall regions was greater for the porcine hearts
compared to the ovine hearts.

The porcine septal wall tissue samples had an average stress and
strain of 0.983 MPa and 64.4%, respectively. The porcine free wall
tissue samples experienced an average stress of 0.868 MPa and an
average strain of 108.1% at the first sign of failure. The ovine septal
wall tissue samples had an average stress and strain of 0.854 MPa and
64.2%, respectively. The ovine free wall tissue samples experienced
an average stress of 0.771 MPa and an average strain of 78.4% at the
first sign of failure.

DISCUSSION
The mechanical properties of the TA have not been investigated.
The purpose of this study is to build a database for the mechanical
properties of the TA. In both species, it appears that the septal wall can
withstand a larger stress, but lower strain than the free wall before
failing. We found that the septal walls of the porcine hearts could
withstand a greater amount of stress and lower amount of strain than
the ovine hearts before exhibiting the first sign of failure. The free wall
tissues of the porcine hearts experienced lower stress and lower strain
than the free wall tissues of the sheep hearts.
Although the stress increases with strain and strain and vice
versa, their values at the first sign of failure for the porcine septal wall
tissue were lower than the values shown at the first sign of failure for
the septal tissue in the ovine hearts, indicating that the two species do
not exhibit the same stress and strain over the same amount of tissue.
The preliminary experiment showed a difference in the
mechanical properties between the septal and free wall regions of
porcine and ovine TA. More experiments need to be done to validate
these findings. The variation in mechanical properties across different
segments of the TA and across the species may help us understand the
mechanics of asymmetrical tricuspid annulus dilation. The results can
also enhance our understanding of the cause of septal dilation
following TRA. This can lead to a better ring design, increase the
durability of TRA, or the development of a percutaneous TRA
technique.

ACKNOWLEDGEMENTS
The work is supported by St. Marys Research grant, IIMS-CTSA
grant (UTHSCA), and MARC fellow training aid. We thank Daniel
Gerdin for his help in this work and appreciate all the support given by
Dr. Tim Raabe.

REFERENCES

FIGURE 4 PRE-CONDITIONING CURVES FOR OVINE AND

PORCINE TRICUSPID ANNULUS SEGMENTS

[1] Izumi, C., K. Iga, and T. Konishi, Progression of isolated

tricuspid regurgitation late after mitral valve surgery for
rheumatic mitral valve disease. J Heart Valve Dis, 2002. 11(3): p.
353-6.
[2] Isomura, T., et al., Tricuspid annuloplasty with the MC3 ring and
septal plication technique. Asian Cardiovasc Thorac Ann, 2015.
23(1): p. 5-10.
[3] Gunning, G.M. and B.P. Murphy, Determination of the tensile
mechanical properties of the segmented mitral valve annulus. J
Biomech, 2014. 47(2): p. 334-40.