Three-dimensional ultrasound mosaicing can increase image quality and expand the field of view. However, limited work has been done applying these compounded approaches for cardiac procedures focused on the mitral valve. For procedures targeting the mitral valve, transesophageal echocardiography (TEE) is the primary imaging modality used as it provides clear 3D images of the valve and surrounding tissues. However, TEE suffers from image artefacts and signal dropout, particularly for structures lying below the valve, including chordae tendineae, making it necessary to acquire alternative echo views to visualize these structures. Due to the limited field of view obtainable, the entire ventricle cannot be directly visualized in sufficient detail from a single image acquisition in 3D. We propose applying an image compounding technique to TEE volumes acquired from a mid-esophageal position and several transgastric positions in order to reconstruct a high-detail volume of the mitral valve and sub-valvular structures. This compounding technique utilizes both fully and semi-simultaneous group-wise registration to align the multiple 3D volumes, followed by a weighted intensity compounding step based on the monogenic signal. This compounding technique is validated using images acquired from two excised porcine mitral valve units and three patient data sets. We demonstrate that this compounding technique accurately captures the physical structures present, including the mitral valve, chordae tendineae and papillary muscles. The chordae length measurement error between the compounded ultrasound and ground-truth CT for two porcine valves is reported as 0.7 ± 0.6 mm and 0.6 ± 0.6 mm.

Effective mitral valve repair remains significantly operator-dependent partially due to the lack of standardized training substrates. We aimed to develop a simplified, parametric mathematical model of the mitral valve apparatus and physically validate its ability to accurately recreate the geometry and hemodynamic function of both a healthy valve and specified pathological valves when tested in a dynamic pulse duplicator system. A parametric mathematical framework was employed to define the 3-dimensional saddle-shaped annulus and its leaflet architecture using core, clinically measurable geometric coefficients (eg, annular diameters and segment-specific leaflet lengths). Five distinct silicone valve replicas were manufactured to match the mathematical specifications: 2 healthy baselines and 3 Carpentier Type II Prolapse valve variants (P1, P2, and P3) induced by localized leaflet length adjustments. Each physical model was tested in a dynamic pulse duplicator under physiological pressure and flow conditions. Valve function, geometry and regurgitation severity were quantified using cardiac ultrasound. Derived measurements from the physical valve replicas accurately matched expected anatomical ranges from patient cohorts. The healthy baseline models consistently demonstrated competent function with no regurgitation. Pathological models, generated solely by manipulating the core geometric coefficients (lengthened P-segment, increased annular diameter), consistently exhibited characteristic segmental prolapse and moderate to severe mitral regurgitation. The resulting functional metrics, including regurgitant jet severity, confirmed the predictable functional outcome driven by the specified geometric inputs. We present a physically validated, anatomically configurable mathematical model that demonstrates a direct and predictable link between core geometric parameters and mitral valve functional behavior. Unlike existing physical simulation platforms that rely on biological tissue, this approach provides a standardized, reproducible, and customizable platform for surgical training and in vitro testing of novel repair techniques for segmental mitral valve disease.