A Parametric Model of the Mitral Valve for Finite Element Patient-Specific Simulations

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The present manuscript has several severe issues that preclude its acceptance for publication.

1. Title. The title is completely inappropriate. There is no discussion of finite element simulation or discretization anywhere in the text.

2. Introduction. The introduction fails to clearly state the research question, the specific problems addressed, or the relevant prior work. The main objective of the manuscript remains unclear.

3. Materials and Methods. This section is poorly written and reads like a rough draft. There is no proper explanation of how the valve geometry was reconstructed; the only description refers to vague "natural curves" without any detail. Strange boundary conditions are proposed. 

Overall, this work does not meet the standards of a scientific paper and should be rejected.

Author Response

Please see the attachment. A highlighted version of the manuscript has been uploaded separately, as non-published material. Minor grammatical and consistency errors have been corrected throughout the manuscript and might not be highlighted, such as changing "is" for "are" or changing the order of a sentence.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

1. The manuscript presents a clinically relevant attempt to develop a simplified parametric finite element (FE) model of the mitral valve using routinely obtained ultrasound parameters. The concept of creating a rapid patient-specific model for clinical applications is valuable and potentially useful for surgical planning and digital-twin development. However, the novelty should be articulated more clearly by explicitly comparing this approach with existing parametric mitral valve models and emphasising the specific advantages in computational efficiency and clinical implementation.
2. The current proof-of-concept model was tested using data from only one healthy patient. Validation should include multiple datasets with varying anatomies and pathological conditions to demonstrate reproducibility, robustness, and generalizability of the proposed model. Consider the suggestion and revise the manuscript accordingly.
3. The manuscript relies primarily on visual comparison between simulated valve geometries and ultrasound images. A suggestion is to include quantitative validation metrics such as root mean square error (RMSE), dice similarity coefficient, and geometric deviation maps. The addition of these quantitative measurements would substantially strengthen model validation.
4. The leaflets are modelled using an isotropic linear elastic material despite the known anisotropic and nonlinear behaviour of mitral valve tissue. Provide stronger justification for this simplification and discuss its possible influence on stress distributions, deformation behaviour, and predictive accuracy.
5. Instead of explicitly modelling the chordae tendineae structure, their influence is approximated using edge loads. Discuss how this approximation may affect valve mechanics and compare the proposed approach with previous studies that modelled explicit chordal structures.
6. The manuscript does not discuss mesh characteristics or mesh convergence studies. A suggestion is to include element type, number of elements, mesh quality measures, and mesh independence analysis. This information is important for ensuring numerical reliability.
7. The Discussion section primarily summarises the study findings without sufficiently analysing limitations or comparing outcomes with previous literature. Please update accordingly.
8. The manuscript contains several short paragraphs and abrupt transitions between ideas, especially in the Introduction and Discussion sections. Merge related short paragraphs and improve transitions between sections to ensure smoother connectivity, stronger logical progression, and improved readability.
9. The manuscript is generally understandable; however, grammatical inconsistencies and awkward sentence structures are observed throughout the text. A suggestion is to do a thorough language revision to improve readability and remove repetitive wording.
10. Considering all the suggested comments and suggestions, update the abstract for better clarity and readability.
11. Add the latest and relevant references in the revised manuscript to improve the quality of the manuscript.

Author Response

Please see the attachment. A highlighted version of the manuscript has been uploaded separately, as non-published material. Minor grammatical and consistency errors have been corrected throughout the manuscript and might not be highlighted, such as changing "is" for "are" or changing the order of a sentence.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

All comments have been addressed.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have made significant changes to the revised manuscript and incorporated the suggested revisions. The latest manuscript can now be accepted and considered for publication.