In vitro and in vivo models were proposed to evaluate the effects of ischemic mitral regurgitation and surgical repair on the function and mechanics of the heart’s mitral valve. In specific aim 1, a novel transducer was developed to measure the radially directed forces that may act on devices implanted to the mitral annulus. In an ovine model, radial forces were found to statistically increase with left ventricular pressure and were reduced in the setting of ischemic mitral regurgitation. In specific aim 2, the suture forces required to constrain true-sized and undersized annuloplasty rings to the mitral annulus of ovine animals was evaluated. Suture forces were observed to be larger on the anterior aspect of the rings and were elevated with annular undersizing. In specific aim 3, an in vitro simulator’s ability to mimic healthy and ischemic mitral regurgitation ovine mitral valve function was evaluated. After understanding the accuracy of the model, the in vitro ischemic mitral regurgitation model was used to evaluate the progressive effects of annuloplasty on strut and intermediary chordal tethering. The generated data and knowledge will contribute to the development of more durable devices and techniques to assess the significant clinical burden known as ischemic mitral regurgitation.

Mitral valve disease is widely prevalent among pediatric and adult population across the world, and it encompasses a spectrum of lesions which include congenital valve defects, degenerative valve lesions, and valve dysfunction due to secondary pathologies. Though replacement of the diseased mitral valves with artificial heart valves has been the standard of care until early 1990's, current trends have veered towards complete surgical repair. These trends are encouraging, but current repair techniques are plagued with lack of durability and high rates of failure within 10 years after repair. With increasing number of patients receiving mitral valve repair, there is now an immediate need to understand the mechanisms of repair failure, and assess the role of several clinical risk factors on valve repair. In this thesis, an in vitro pulsatile left heart simulator was developed to mimic the congenital and adult mitral valve pathological morphologies in normal porcine valves, and simulate the pathological valve hemodynamics and mechanics. Different surgical repair techniques were used to correct the valve lesions, and the post repair valve hemodynamics, mechanics and geometry were assessed using quantitative measurement techniques. The extent to which each repair restores physiological valve function and mechanics was assessed, and the impact of different pathological risk factors on repair failure mechanisms was investigated. It is expected that the knowledge from this thesis would play an important role in the evolution of mitral valve surgical repair, and guide the development of more effective and long-lasting heart valve repair technologies.