Mitral Valve Regurgitation Murmurs—Insights from Hemoacoustic Computational Modeling

Abstract

Mitral regurgitation (MR) is the leakage of blood from the left ventricle into the left atrium during systole through a mitral valve that does not close fully. A systolic murmur is produced by MR and can be used to diagnose this disease. In the current study, we use hemoacoustic simulations to characterize the features of murmurs for a range of severities relevant to chronic MR. The incompressible Navier–Stokes equations are solved using an immersed boundary method to simulate the blood flow. The resultant pressure fluctuations on the lumen wall serve as the source for the murmur, and the murmur propagation through the thorax is modeled as a 3D elastic wave in a linear viscoelastic material. The resulting acceleration on the surface of the thorax is used as a surrogate for the measurement from a stethoscope, and these characteristics of the acceleration signal are examined in detail. We found that the intensity of the MR murmur is lower at the mitral point on the precordium, as compared with the aortic and pulmonic areas. This is somewhat counterintuitive but is supported by other studies in the past. We also found that the intensity of the murmur, as well as the break frequency, are well correlated with the severity of MR, and this information can be useful for automated auscultation and phonocardiographic applications.

Keywords

• computational hemodynamics
• heart sound
• systolic murmur
• elastic wave
• auscultation