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Its gold standard treatment is mitral annuloplasty, the surgical reduction in mitral annular area through the implantation of annuloplasty rings. Recurrent regurgitation rates may, however, be as high as 30% and more. While the degree of annular downsizing has been linked to improved long\u2010term outcomes, too aggressive downsizing increases the risk of ring dehiscences and significantly impairs repair durability. Here, we prototype a virtual sizing tool to quantify changes in annular dimensions, surgically induced tissue strains, mitral annular stretches, and suture forces in response to mitral annuloplasty. We create a computational model of dilated cardiomyopathy onto which we virtually implant annuloplasty rings of different sizes. Our simulations confirm the common intuition that smaller rings are more invasive to the surrounding tissue, induce higher strains, and require larger suture forces than larger rings: The total suture force was 2.2\u00a0N for a 24\u2010mm ring, 1.9\u00a0N for a 28\u2010mm ring, and 0.8\u00a0N for a 32\u2010mm ring. Our model predicts the highest risk of dehiscence in the septal and postero\u2013lateral annulus where suture forces are maximal. These regions co\u2010localize with regional peaks in myocardial strain and annular stretch. Our study illustrates the potential of realistic predictive simulations in cardiac surgery to identify areas at risk for dehiscence, guide the selection of ring size and shape, rationalize the design of smart annuloplasty rings and, ultimately, improve long\u2010term outcomes after surgical mitral annuloplasty. Copyright \u00a9 2016 John Wiley &amp; Sons, Ltd.<\/jats:p>","DOI":"10.1002\/cnm.2788","type":"journal-article","created":{"date-parts":[[2016,3,30]],"date-time":"2016-03-30T23:32:51Z","timestamp":1459380771000},"source":"Crossref","is-referenced-by-count":39,"title":["A virtual sizing tool for mitral valve annuloplasty"],"prefix":"10.1002","volume":"33","author":[{"given":"Manuel K.","family":"Rausch","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering Yale University  New Haven 06511 CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander M.","family":"Z\u00f6llner","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering Stanford University  Stanford 94305 CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Genet","sequence":"additional","affiliation":[{"name":"Laboratoire de M\u00e9canique des Solides CNRS\u2010UMR 7649 Ecole Polytechnique  Palaiseau 91128 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Baillargeon","sequence":"additional","affiliation":[{"name":"Dassault Syst\u00e8mes Simulia Corporation  Fremont 94538 CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Bothe","sequence":"additional","affiliation":[{"name":"University Heart Center Freiburg  Freiburg 79106 Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Kuhl","sequence":"additional","affiliation":[{"name":"Departments of Mechanical Engineering, Bioengineering and Cardiothoracic Surgery Stanford University  Stanford 94305 CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,4,20]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000053558.55471.2D"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.6.1999"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-013-0813-7"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(81)90534-8"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(92)90455-V"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-002-0024-6"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-001-0029-6"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2004.07.037"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2013.07.013"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.10.023"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-011-0442-y"},{"issue":"1","key":"e_1_2_6_13_1","first-page":"11","article-title":"Outcome after mitral valve repair for functional ischemic mitral regurgitation","volume":"11","author":"Tahta SA","year":"2002","journal-title":"Journal of Heart Valve Disease"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.796151"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2011.11.021"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2013.03.018"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-015-1351-2"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13239-015-0216-z"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.011163"},{"key":"e_1_2_6_20_1","first-page":"416424","article-title":"A high\u2010fidelity and micro\u2010anatomically accurate 3D finite element model for simulations of functional mitral valve","author":"Lee CH","year":"2013","journal-title":"Lecture Notes in Computer Science"},{"key":"e_1_2_6_21_1","unstructured":"Zygote Media Group Inc. 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