{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:23:48Z","timestamp":1790789028150,"version":"4.1.0"},"reference-count":83,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T00:00:00Z","timestamp":1583971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["16SDG27760143"],"award-info":[{"award-number":["16SDG27760143"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001298","name":"Presbyterian Health Foundation","doi-asserted-by":"publisher","award":["C5122401"],"award-info":[{"award-number":["C5122401"]}],"id":[{"id":"10.13039\/100001298","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>The atrioventricular heart valves (AHVs) are responsible for directing unidirectional blood flow through the heart by properly opening and closing the valve leaflets, which are supported in their function by the chordae tendineae and the papillary muscles. Specifically, the chordae tendineae are critical to distributing forces during systolic closure from the leaflets to the papillary muscles, preventing leaflet prolapse and consequent regurgitation. Current therapies for chordae failure have issues of disease recurrence or suboptimal treatment outcomes. To improve those therapies, researchers have sought to better understand the mechanics and microstructure of the chordae tendineae of the AHVs. The intricate structures of the chordae tendineae have become of increasing interest in recent literature, and there are several key findings that have not been comprehensively summarized in one review. Therefore, in this review paper, we will provide a summary of the current state of biomechanical and microstructural characterizations of the chordae tendineae, and also discuss perspectives for future studies that will aid in a better understanding of the tissue mechanics\u2013microstructure linking of the AHVs\u2019 chordae tendineae, and thereby improve the therapeutics for heart valve diseases caused by chordae failures.<\/jats:p>","DOI":"10.3390\/bioengineering7010025","type":"journal-article","created":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T12:22:51Z","timestamp":1584015771000},"page":"25","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Mechanics and Microstructure of the Atrioventricular Heart Valve Chordae Tendineae: A Review"],"prefix":"10.3390","volume":"7","author":[{"given":"Colton J.","family":"Ross","sequence":"first","affiliation":[{"name":"Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK 73019, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junnan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou 310058, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou 310058, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wu","sequence":"additional","affiliation":[{"name":"Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK 73019, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8019-3329","authenticated-orcid":false,"given":"Chung-Hao","family":"Lee","sequence":"additional","affiliation":[{"name":"Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK 73019, USA"},{"name":"Institute for Biomedical Engineering, Science and Technology (IBEST), The University of Oklahoma, Norman, OK 73019, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1002\/clc.4960170611","article-title":"Pathology of mitral valve stenosis and pure mitral regurgitation\u2014Part I","volume":"17","author":"Waller","year":"1994","journal-title":"Clin. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/clc.4960180212","article-title":"Pathology of tricuspid valve stenosis and pure tricuspid regurgitation\u2014Part I","volume":"18","author":"Waller","year":"1995","journal-title":"Clin. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1056\/NEJM196704272761702","article-title":"Diagnosis and surgical treatment of mitral regurgitation secondary to ruptured chordae tendineae","volume":"276","author":"Sanders","year":"1967","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/S0022-5223(19)38752-5","article-title":"Mitral regurgitation due to ruptured chordae tendineae: Early and late results of valve repair","volume":"89","author":"Orszulak","year":"1985","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/0002-9149(85)90315-7","article-title":"Mitral valve prolapse and ruptured chordae tendineae","volume":"55","author":"Jeresaty","year":"1985","journal-title":"Am. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Khoiy, K.A., Asgarian, K.T., Loth, F., and Amini, R. (2018). Dilation of tricuspid valve annulus immediately after rupture of chordae tendineae in ex-vivo porcine hearts. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0206744"},{"key":"ref_7","first-page":"375","article-title":"Mitral valve repair: An in-vitro comparison of the effect of surgical repair on the pressure required to cause mitral valve regurgitation","volume":"15","author":"Espino","year":"2006","journal-title":"J. Heart. Valve Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Carpentier, A., Adams, D.H., and Filsoufi, F. (2011). Carpentier\u2019s Reconstructive Valve Surgery From Valve Analysis to Valve Reconstruction, Saunders Elsevier Health Sciences.","DOI":"10.1016\/B978-0-7216-9168-8.50043-5"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/S0022-5223(96)70251-9","article-title":"Repair of anterior leaflet prolapse: Chordal transfer is superior to chordal shortening","volume":"112","author":"Smedira","year":"1996","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/S0003-4975(99)01313-2","article-title":"Repair of anterior leaflet mitral valve prolapse: Chordal replacement versus chordal shortening","volume":"69","author":"Phillips","year":"2000","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","first-page":"II35","article-title":"Transposition of chordae in mitral valve repair. Mid-term results","volume":"88","author":"Sousa","year":"1993","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/S0022-5223(19)35132-3","article-title":"Generation of chordae tendineae with polytetrafluoroethylene stents: Results of mitral valve chordal replacement in sheep","volume":"97","author":"Revuelta","year":"1989","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1016\/j.jtcvs.2014.03.045","article-title":"Long-term outcomes of artificial chordal replacement with tourniquet technique in mitral valve repair: A single-center experience of 700 cases","volume":"148","author":"Tabata","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1111\/j.1540-8191.1991.tb00352.x","article-title":"Comparison of viscoelastic properties of suture versus porcine mitral valve chordae tendineae","volume":"6","author":"Cochran","year":"1991","journal-title":"J. Card. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1093\/icvts\/ivv014","article-title":"Acute safety and efficacy of the NeoChord procedure","volume":"20","author":"Colli","year":"2015","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/S1054-8807(04)00006-7","article-title":"Ruptured synthetic expanded polytetrafluoroethylene chordae tendinae","volume":"13","author":"Butany","year":"2004","journal-title":"Cardiovasc. Pathol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/1995-705X.152994","article-title":"Morphological study of chordae tendinae in human cadaveric hearts","volume":"16","author":"Gunnal","year":"2015","journal-title":"Heart Views"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1161\/01.CIR.41.3.449","article-title":"Morphology of the human mitral valve: I. Chordae tendineae: A new classification","volume":"41","author":"Lam","year":"1970","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1161\/01.CIR.43.3.333","article-title":"Morphology of the human tricuspid valve","volume":"43","author":"Silver","year":"1971","journal-title":"Circulation"},{"key":"ref_20","first-page":"337","article-title":"Differential tension between secondary and primary mitral chordae in an acute in-vivo porcine model","volume":"11","author":"Lomholt","year":"2002","journal-title":"J. Heart. Valve Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.jmbbm.2016.05.034","article-title":"Characterization of biomechanical properties of aged human and ovine mitral valve chordae tendineae","volume":"62","author":"Zuo","year":"2016","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1046\/j.1469-7580.1998.19240573.x","article-title":"Structure of chordae tendineae in the left ventricle of the human heart","volume":"192","author":"Meir","year":"1998","journal-title":"J. Anat."},{"key":"ref_23","first-page":"17","article-title":"Morphological study on mitral valve chordae tendineae in the hearts of human fetuses","volume":"12","author":"Aragao","year":"2019","journal-title":"Int. J. Anat. Var."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jmbbm.2018.07.024","article-title":"An investigation of the anisotropic mechanical properties and anatomical structure of porcine atrioventricular heart valves","volume":"87","author":"Jett","year":"2018","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1161\/01.RES.31.3.417","article-title":"Canine mitral complex: Ultrastructure and electromechanical properties","volume":"31","author":"Fenoglio","year":"1972","journal-title":"Circul. Res."},{"key":"ref_26","first-page":"236","article-title":"Scanning electron microscopical study of human mitral valve chordae tendineae","volume":"101","author":"Lim","year":"1977","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"455","DOI":"10.2170\/jjphysiol.30.455","article-title":"Mechanical properties and ultrastructure of normal human tricuspid valve chordae tendineae","volume":"30","author":"Lim","year":"1980","journal-title":"Jpn. J. Physiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0735-1097(03)00626-0","article-title":"Glycosaminoglycan profiles of myxomatous mitral leaflets and chordae parallel the severity of mechanical alterations","volume":"42","author":"Griffin","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0046-8177(88)80195-3","article-title":"Floppy mitral valve chordae tendineae: Histopathologic alterations","volume":"19","author":"Baker","year":"1988","journal-title":"Hum. Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/0014-4800(76)90021-6","article-title":"Unified concept on the role of acid mucopolysaccharides and connective tissue proteins in the accumulation of lipids, lipoproteins, and calcium in the atherosclerotic plaque","volume":"25","author":"Hollander","year":"1976","journal-title":"Exp. Mol. Pathol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S1054-8807(98)00021-0","article-title":"Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: A histomorphometric study of 130 excised segments","volume":"8","author":"Fornes","year":"1999","journal-title":"Cardiovasc. Pathol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/0002-8703(95)90397-6","article-title":"Abnormalities in elastic fibers and other connective-tissue components of floppy mitral valve","volume":"129","author":"Tamura","year":"1995","journal-title":"Am. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1042\/bj2440597","article-title":"Biochemical characterization of individual normal, floppy and rheumatic human mitral valves","volume":"244","author":"Lis","year":"1987","journal-title":"Biochem. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/j.ijcard.2012.04.092","article-title":"Structural analysis of chordae tendineae in degenerative disease of the mitral valve","volume":"167","author":"Icardo","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/01.mot.0000126087.48709.13","article-title":"Physiologic barriers to xenotransplantation","volume":"9","author":"Thein","year":"2004","journal-title":"Curr. Opin. Organ. Transplant."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1046\/j.1469-7580.1998.19310105.x","article-title":"Anatomy of the pig heart: Comparisons with normal human cardiac structure","volume":"193","author":"Crick","year":"1998","journal-title":"J. Anat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.athoracsur.2005.02.011","article-title":"Structural characterization of the chordae tendineae in native porcine mitral valves","volume":"80","author":"Ritchie","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1093\/cvr\/2.3.290","article-title":"The vascularization of the heart valves: A comparative study","volume":"2","author":"Duran","year":"1968","journal-title":"Cardiovasc. Res."},{"key":"ref_39","first-page":"292","article-title":"Ultrastructure of porcine mitral valve chordae tendineae","volume":"18","author":"Liao","year":"2009","journal-title":"J. Heart. Valve Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/S0021-9290(03)00109-X","article-title":"A structural basis for the size-related mechanical properties of mitral valve chordae tendineae","volume":"36","author":"Liao","year":"2003","journal-title":"J. Biomech."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1023\/B:ABME.0000032460.97278.e9","article-title":"Relationship between collagen fibrils, glycosaminoglycans, and stress relaxation in mitral valve chordae tendineae","volume":"32","author":"Liao","year":"2004","journal-title":"Ann. Biomed. Eng."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1115\/1.1695569","article-title":"The structure and mechanical properties of the mitral valve leaflet-strut chordae transition zone","volume":"126","author":"Chen","year":"2004","journal-title":"J. Biomech. Eng."},{"key":"ref_43","first-page":"267","article-title":"Chordae tendineae architecture in the papillary muscle insertion","volume":"22","author":"Gusukuma","year":"2004","journal-title":"Int. J. Morphol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.jtcvs.2007.12.026","article-title":"A 20-year experience with mitral valve repair with artificial chordae in 608 patients","volume":"135","author":"Salvador","year":"2008","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_45","first-page":"139","article-title":"Long-term pathological changes of expanded polytetrafluoroethylene (ePTFE) suture in the human heart","volume":"10","author":"Minatoya","year":"2001","journal-title":"J. Heart. Valve Dis."},{"key":"ref_46","first-page":"278","article-title":"Acute mitral regurgitation due to ruptured ePTFE neo-chordae","volume":"16","author":"Coutinho","year":"2007","journal-title":"J. Heart Valve Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1139\/y75-048","article-title":"Mechanical properties of human mitral valve chordae tendineae: Variation with size and strain rate","volume":"53","author":"Lim","year":"1975","journal-title":"Can. J. Physiol. Pharmacol."},{"key":"ref_48","unstructured":"Yamada, H., and Evans, F.G. (1970). Strength of Biological Materials, Williams & Wilkins."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1161\/01.RES.39.4.580","article-title":"Morphology and relationship to extensibility curves of human mitral valve chordae tendineae","volume":"39","author":"Lim","year":"1976","journal-title":"Circul. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/S0022-5223(19)40619-3","article-title":"Stress-strain characteristics of fresh and frozen human aortic and mitral leaflets and chordae tendineae. Implications for clinical use","volume":"66","author":"Clark","year":"1973","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_51","first-page":"320","article-title":"Myxomatous mitral valve chordae. I: Mechanical properties","volume":"10","author":"Barber","year":"2001","journal-title":"J. Heart. Valve Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1536\/ihj.24.539","article-title":"Ultrastructure and mechanical properties of chordae tendineae from a myxomatous tricuspid valve","volume":"24","author":"Lim","year":"1983","journal-title":"Jpn. Heart J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jmbbm.2012.03.016","article-title":"Determination of the mechanical properties of normal and calcified human mitral chordae tendineae","volume":"13","author":"Casado","year":"2012","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.jbiomech.2005.01.024","article-title":"The material properties of the native porcine mitral valve chordae tendineae: An in vitro investigation","volume":"39","author":"Ritchie","year":"2006","journal-title":"J. Biomech."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.actbio.2018.12.029","article-title":"Comparative mechanical, morphological, and microstructural characterization of porcine mitral and tricuspid leaflets and chordae tendineae","volume":"85","author":"Sulejmani","year":"2019","journal-title":"Acta Biomater."},{"key":"ref_56","first-page":"644","article-title":"Failure mechanics of mitral valve chordae tendineae","volume":"11","author":"Sedransk","year":"2002","journal-title":"J. Heart. Valve Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jmbbm.2016.01.009","article-title":"The effects of decellularization and cross-linking techniques on the fatigue life and calcification of mitral valve chordae tendineae","volume":"57","author":"Gunning","year":"2016","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.actbio.2015.06.015","article-title":"Characterisation of the fatigue life, dynamic creep and modes of damage accumulation within mitral valve chordae tendineae","volume":"24","author":"Gunning","year":"2015","journal-title":"Acta Biomater."},{"key":"ref_59","first-page":"93","article-title":"Effect of glutaraldehyde based cross-linking on the viscoelasticity of mitral valve basal chordae tendineae","volume":"17","author":"Constable","year":"2018","journal-title":"Biomed. Eng."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Ross, C.J., Laurence, D.W., Hsu, M.-C., Baumwart, R., Zhao, D.Y., Mir, A., Burkhart, H.M., Holzapfel, G.A., Wu, Y., and Lee, C.-H. (2020). Mechanics of porcine heart valves\u2019 strut chordae tendineae investigated as a leaflet-chordae-papillary muscle entity. Ann. Biomed. Eng.","DOI":"10.1007\/s10439-020-02464-6"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Madhurapantula, R.S., Krell, G., Morfin, B., Roy, R., Lister, K., and Orgel, J.P. (2020). Advanced methodology and preliminary measurements of molecular and mechanical properties of heart valves under dynamic strain. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21030763"},{"key":"ref_62","first-page":"M405","article-title":"Mechanical properties of basal and marginal mitral valve chordae tendineae","volume":"36","author":"Kunzelman","year":"1990","journal-title":"ASAIO J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"20190069","DOI":"10.1098\/rsif.2019.0069","article-title":"An investigation of the glycosaminoglycan contribution to biaxial mechanical behaviors of porcine atrioventricular heart valve leaflets","volume":"16","author":"Ross","year":"2019","journal-title":"J. R. Soc. Interface"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Krishnamurthy, V.K., and Grande-Allen, K.J. (2018). The role of proteoglycans and glycosaminoglycans in heart valve biomechanics. Advances in Heart Valve Biomechanics, Springer.","DOI":"10.1007\/978-3-030-01993-8_3"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"081004","DOI":"10.1115\/1.4001682","article-title":"Mechanics of the mitral valve strut chordae insertion region","volume":"132","author":"Padala","year":"2010","journal-title":"J. Biomech. Eng."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.actbio.2019.11.028","article-title":"Integration of polarized spatial frequency domain imaging (pSFDI) with a biaxial mechanical testing system for quantification of load-dependent collagen architecture in soft collagenous tissues","volume":"102","author":"Jett","year":"2020","journal-title":"Acta Biomater."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1007\/s10439-019-02233-0","article-title":"Non-destructive reflectance mapping of collagen fiber alignment in heart valve leaflets","volume":"47","author":"Goth","year":"2019","journal-title":"Ann. Biomed. Eng."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/jocs.12799","article-title":"A study of the mechanical properties of ePTFE suture used as artificial mitral chordae","volume":"31","author":"Caimmi","year":"2016","journal-title":"J. Card. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Goth, W., Yang, B., Lesicko, J., Allen, A., Sacks, M.S., and Tunnell, J.W. (2016, January 24). Polarized spatial frequency domain imaging of heart valve fiber structure. In Proceedings of SPIE, Optical Elastography and Tissue Biomechanics III, San Francisco, CA, USA.","DOI":"10.1117\/12.2212812"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/0021-9290(83)90068-4","article-title":"Stresses in the closed mitral valve: A model study","volume":"16","author":"Arts","year":"1983","journal-title":"J. Biomech."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"H1095","DOI":"10.1152\/ajpheart.1982.242.6.H1095","article-title":"Fluid dynamics of the mitral valve: Physiological aspects of a mathematical model","volume":"242","author":"McQueen","year":"1982","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_72","first-page":"386","article-title":"Three-dimensional asymmetrical modeling of the mitral valve: A finite element study with dynamic boundaries","volume":"14","author":"Lim","year":"2005","journal-title":"J. Heart. Valve Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s10439-012-0620-6","article-title":"Finite element modeling of mitral valve dynamic deformation using patient-specific multi-slices computed tomography scans","volume":"41","author":"Wang","year":"2013","journal-title":"Ann. Biomed. Eng."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/j.1540-8191.1996.tb00028.x","article-title":"Replacement of mitral valve posterior chordae tendineae with expanded polytetrafluoroethylene suture: A finite element study","volume":"11","author":"Kunzelman","year":"1996","journal-title":"J. Card. Surg."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1007\/s11517-012-0952-2","article-title":"Finite element modeling of mitral leaflet tissue using a layered shell approximation","volume":"50","author":"Wenk","year":"2012","journal-title":"Med. Biol Eng. Comput"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1007\/s10439-016-1775-3","article-title":"Mitral valve chordae tendineae: Topological and geometrical characterization","volume":"45","author":"Khalighi","year":"2017","journal-title":"Ann. Biomed. Eng."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.actbio.2019.11.039","article-title":"A detailed mechanical and microstructural analysis of ovine tricuspid valve leaflets","volume":"102","author":"Meador","year":"2020","journal-title":"Acta Biomater."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s10439-018-02122-y","article-title":"Development of a functionally equivalent model of the mitral valve chordae tendineae through topology optimization","volume":"47","author":"Khalighi","year":"2019","journal-title":"Ann. Biomed. Eng."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s10439-013-0908-1","article-title":"Mitral valve repair using ePTFE sutures for ruptured mitral chordae tendineae: A computational simulation study","volume":"42","author":"Rim","year":"2014","journal-title":"Ann. Biomed. Eng."},{"key":"ref_80","unstructured":"S\u00e9bastien, O., Rueckert, D., and Smith, N. (2013, January 20\u201322). Patient-specific modeling of heart valves: From image to simulation. Proceedings of the International Conference on Functional Imaging and Modeling of the Heart, London, UK."},{"key":"ref_81","unstructured":"Ionasec, R.I. (2010). Patient-Specific Modeling and Quantification of the Heart Valves from Multimodal Cardiac Images, Technische Universit\u00e4t M\u00fcnchen."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s13239-014-0175-9","article-title":"Quantitative evaluation of annuloplasty on mitral valve chordae tendineae forces to supplement surgical planning model development","volume":"5","author":"Siefert","year":"2014","journal-title":"Cardiovasc. Eng. Technol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.medengphy.2010.08.013","article-title":"Finite element modelling of the tricuspid valve: A preliminary study","volume":"32","author":"Stevanella","year":"2010","journal-title":"Med. Eng. Phys."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/7\/1\/25\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:06:16Z","timestamp":1760173576000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/7\/1\/25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,12]]},"references-count":83,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,3]]}},"alternative-id":["bioengineering7010025"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering7010025","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,12]]}}}