Tricuspid chordae tendineae mechanics: Insertion site, leaflet, and size-specific analysis and constitutive modelling.

Background: Tricuspid valve chordae tendineae play a vital role in our cardiovascular system. They function as "parachute cords" to the tricuspid leaflets to prevent prolapse during systole. However, in contrast to the tricuspid annulus and leaflets, the tricuspid chordae tendineae have received little attention. Few previous studies have described their mechanics and their structure-function relationship. Objective: In this study, we aimed to quantify the mechanics of tricuspid chordae tendineae based on their leaflet of origin, insertion site, and size. Methods: Specifically, we uniaxially stretched 53 tricuspid chordae tendineae from sheep and recorded their stress-strain behavior. We also analyzed the microstructure of the tricuspid chordae tendineae based on two-photon microscopy and histology. Finally, we compared eight different hyperelastic constitutive models and their ability to fit our data. Results: We found that tricuspid chordae tendineae are highly organized collageneous tissues, which are populated with cells throughout their thickness. In uniaxial stretching, this microstructure causes the classic J-shaped nonlinear stress-strain response known from other collageneous tissues. We found differences in stiffness between tricuspid chordae tendineae from the anterior, posterior, or septal leaflets only at small strains. Similarly, we found significant differences based on their insertion site or size also only at small strains. Of the models we fit to our data, we recommend the Ogden two-parameter model. This model fit the data excellently and required a minimal number of parameters. For future use, we identified and reported the Ogden material parameters for an average data set. Conclusion: The data presented in this study help to explain the mechanics and structure-function relationship of tricuspid chordae tendineae and provide a model recommendation (with parameters) for use in computational simulations of the tricuspid valve.