FEBio FINESSE: An Open-Source Finite Element Simulation Approach to Estimate In Vivo Heart Valve Strains Using Shape Enforcement: FEBio FINESSE: An Open-Source Finite Element Simulation

Purpose Finite element simulations are an enticing tool to evaluate heart valve function; however, patient-specific simulations derived from 3D echocardiography are hampered by several technical challenges. The objective of this work is to develop an open-source method to enforce matching between finite element simulations and in vivo image-derived heart valve geometry in the absence of patient-specific material properties, leaflet thickness, and chordae tendineae structures. Methods We evaluate FEBio Finite Element Simulations with Shape Enforcement (FINESSE) using three synthetic test cases considering a range of model complexity. FINESSE is then used to estimate the in vivo valve behavior and leaflet strains for three pediatric patients. Results Our results suggest that FINESSE can be used to enforce finite element simulations to match an image-derived surface and estimate the first principal leaflet strains within ± 0.03 strain. Key considerations include: (i) defining the user-defined penalty, (ii) omitting the leaflet commissures to improve simulation convergence, and (iii) emulating the chordae tendineae behavior via prescribed leaflet free edge motion or a chordae emulating force. In all patient-specific cases, FINESSE matched the target surface with median errors of approximately the smallest voxel dimension. Further analysis revealed valve-specific findings, such as the tricuspid valve leaflet strains of a 2-day old patient with HLHS being larger than those of two 13-year old patients. Conclusions FEBio FINESSE can be used to estimate patient-specific in vivo heart valve leaflet strains. The development of this open-source pipeline will enable future studies to begin linking in vivo leaflet mechanics with patient outcomes.