RESUMEN
Annuloplasty ring choice and design are critical to the long-term efficacy of mitral valve (MV) repair. DynaRing is a selectively compliant annuloplasty ring composed of varying stiffness elastomer segments, a shape-set nitinol core, and a cross diameter filament. The ring provides sufficient stiffness to stabilize a diseased annulus while allowing physiological annular dynamics. Moreover, adjusting elastomer properties provides a mechanism for effectively tuning key MV metrics to specific patients. We evaluate the ring embedded in porcine valves with an ex-vivo left heart simulator and perform a 150 million cycle fatigue test via a custom oscillatory system. We present a patient-specific design approach for determining ring parameters using a finite element model optimization and patient MRI data. Ex-vivo experiment results demonstrate that motion of DynaRing closely matches literature values for healthy annuli. Findings from the patient-specific optimization establish DynaRing's ability to adjust the anterior-posterior and intercommissural diameters and saddle height by up to 8.8%, 5.6%, 19.8%, respectively, and match a wide range of patient data.
RESUMEN
Limited physical access to target organs of patients inside an MRI scanner is a major obstruction to real-time MRI-guided interventions. Traditional teleoperation technologies are incompatible with the MRI environment and although several solutions have been explored, a versatile system that provides high-fidelity haptic feedback and access deep inside the bore remains a challenge. We present a passive and nearly frictionless MRI-compatible hydraulic teleoperator designed for in-bore liver biopsies. We describe the design components, characterize the system transparency, and evaluate the performance with a user study in a laboratory and a clinical setting. The results demonstrate % difference between input and output forces during realistic manipulation. A user study with participants conducting mock needle biopsy tasks indicates that a remote operator performs equally well when using the device as when holding a biopsy needle directly in hand. Additionally, MRI compatibility tests show no reduction in signal-to-noise ratio in the presence of the device.