In-vitro wall shear measurements at aortic valve prostheses

An Intracardiac Flow Based Electromagnetic Energy Harvesting Mechanism for Cardiac Pacing

Contemporary cardiac implantable electronic devices such as pacemakers or event recorders are powered by primary batteries. Device replacement due to battery depletion may cause complications and is costly. The goal of energy harvesting devices is to power the implant with energy from intracorporeal power sources such as vibrations and blood flow. By replacing primary batteries with energy harvesters, reinterventions can be avoided and the size of the total device might be reduced. This paper introduces a device with a lever, which is deflected by the blood stream within the right ventricular outflow tract (RVOT), an attractive site for cardiac pacing. The resulting torque is converted to electrical energy by an electromagnetic mechanism. The blood flow harvester weighs 6.4 g and has a volume of 2 cm³, making the harvester small enough for catheter implantation. It was tested in an experimental setup mimicking flow conditions in the RVOT. The blood flow harvester generated a mean power of 14.39 ± 8.38 μW at 60 bpm (1 Hz) and up to 82.64 ± 17.14 μW at 200 bpm (3.33 Hz) during bench experiments at 1 m/s peak flow velocity. Therefore, it presents a viable alternative to power batteryless and leadless cardiac pacemakers.

Velocity and Shear Stress Distribution Downstream of Mechanical Heart Valves in Pulsatile Flow

Ten mechanical valves (TAD 27 mm): Starr-Edwards Silastic Ball, Björk-Shiley Standard, Björk-Shiley Concave-Convex, Björk-Shiley Monostrut, Hall-Kaster (Medtronic-Hall), OmniCarbon, Bicer Val, Sorin, Saint-Jude Medical and Hemex (Duromedics) are investigated in a comparative in vitro study. The velocity and turbulent shear stress profiles of the valves were determined by Laser Doppler anemometry in two different downstream axes within a model aortic root. Depending on the individual valve design, velocity peaks up to 1.5 m/s and turbulent shear stress peaks up to 150 N/m2 were measured during the systolic phase. These shear stress peaks mainly occurred in areas of flow separation and intense momentum exchange. Directly downstream of the valves (measuring axis 0.55.dAorta) turbulent shear stress peaks occurred at peak systole and during the deceleration phase, while in the second measuring axis (1.5.dAorta) turbulence levels were lower. Shear stress levels were high at the borders of the fluid jets. The results are discussed from a fluid-dynamic point of view.

Estimation of Shear Stress-related Blood Damage in Heart Valve Prostheses - in Vitro Comparison of 25 Aortic Valves

The hemodynamics of heart valve prostheses can be reproducibly investigated in vitro within circulatory mock loops. By measuring the downstream velocity and shear stress fields the shear stresses which are clinically responsible for damage to platelets and red blood cells can be determined.

The mechanisms of damage and the effects of shear stresses on blood corpuscles were investigated by Wurzinger et al. (3, 4) at the Aerodynamics Institute of the RWTH Aachen. In the present study, the above data are incorporated into a mathematical correlation, which serves as a basic model for the estimation of blood damage.

This mathematical model was applied to in vitro investigations of 25 different aortic valve prostheses. The results were compared to clinical findings. In most cases agreement was good, indicating that this model may be directly applied to the clinical situation. This new method facilitates the estimation of clinically expected blood damage from in vitro measurements. It may be useful for the development and evaluation of new valve prostheses. By comparative evaluation of different valve types it also provides additional information to help the implanting surgeon select the optimum valve for his patient.

Analysis of Velocity in the Ascending Aorta in Humans

To analyze velocity spectral energy distribution in humans, blood velocities were recorded by means of hot-film anemometry at 41 predetermined measurement points in the cross-sectional area of the ascending aorta approximately 6 cm downstream of the aortic valves. Measurements were made in 8 patients with normal aortic valves, in 4 after insertion of a St. Jude Medical (SJM) aortic valve and in 3 after insertion of a Starr-Edwards Silastic Ball (SSB) aortic valve. Data analysis based on Fast Fourier Transform demonstrated that turbulence energy was lower in patients with normal aortic valves than in patients after insertion of an artificial valve in the aortic position and probably more pronounced after SSB valves than after SJM valves. The spatial distribution of the turbulence energy above 100 Hz was more irregular than corresponding laminar velocities previously presented. The Ver100 (Velocity Energy Ratio at 100 Hz, i.e. the velocity energy above 100 Hz divided by the total velocity energy) proved useful for evaluating differences in flow disturbances downstream of different aortic valves. The mean VER100 in the three categories of patients were respectively 0.3, 1.4, and 2.1%.

Resilience of riverbed vegetation to uprooting by flow

Riverine ecosystem biodiversity is largely maintained by ecogeomorphic processes including vegetation renewal via uprooting and recovery times to flow disturbances. Plant roots thus heavily contribute to engineering resilience to perturbation of such ecosystems. We show that vegetation uprooting by flow occurs as a fatigue-like mechanism, which statistically requires a given exposure time to imposed riverbed flow erosion rates before the plant collapses. We formulate a physically based stochastic model for the actual plant rooting depth and the time-to-uprooting, which allows us to define plant resilience to uprooting for generic time-dependent flow erosion dynamics. This theory shows that plant resilience to uprooting depends on the time-to-uprooting and that root mechanical anchoring acts as a process memory stored within the plant–soil system. The model is validated against measured data of time-to-uprooting of Avena sativa seedlings with various root lengths under different flow conditions. This allows for assessing the natural variance of the uprooting-by-flow process and to compute the prediction entropy, which quantifies the relative importance of the deterministic and the random components affecting the process.

Shear Stress Related Blood Damage along the Cusp of a Tri-Leaflet Prosthetic Valve

Blood flowing through a prosthetic heart valve can be damaged by flow-induced shear forces. Fluid dynamics variables and geometric factors play an important role in the evaluation of shear-stress-related blood damage. Central-flow prosthetic valves have been considered as an optimal replacement for mechanical and biological valves. Recently it was shown that shear stress distribution along the surface of a polyurethane cusp reaches values that can damage the blood elements. A mathematical model correlating the effects of shear stresses on blood corpuscles with clinical findings was employed in vitro. The model can be applied to the effects of blood-surface interaction and is of clinical relevance

19 mm Sized Bileaflet Valve Prostheses’ flow Field Investigated by Bidimensional Laser Doppler Anemometry (part II: Maximum Turbulent Shear Stresses)

The investigation of the flow field generated by cardiac valve prostheses is a necessary task to gain knowledge on the possible relationship between turbulence-derived stresses and the hemolytic and thrombogenic complications in patients after valve replacement. The study of turbulence flows downstream of cardiac prostheses, in literature, especially concerns large-sized prostheses with a variable flow regime from very low up to 6 L/min. The Food and Drug Administration draft guidance requires the study of the minimum prosthetic size at a high cardiac output to reach the maximum Reynolds number conditions.

Within the framework of a national research project regarding the characterization of cardiovascular endoprostheses, an in-depth study of turbulence generated downstream of bileaflet cardiac valves is currently under way at the Laboratory of Biomedical Engineering of the Istituto Superiore di Sanità. Four models of 19 mm bileaflet valve prostheses were used: St Jude Medical HP, Edwards Tekna, Sorin Bicarbon, and CarboMedics. The prostheses were selected for the nominal Tissue Annulus Diameter as reported by manufacturers without any assessment of valve sizing method, and were mounted in aortic position. The aortic geometry was scaled for 19 mm prostheses using angiographic data. The turbulence-derived shear stresses were investigated very close to the valve (0.35 D0), using a bidimensional Laser Doppler anemometry system and applying the Principal Stress Analysis.

Results concern typical turbulence quantities during a 50 ms window at peak flow in the systolic phase. Conclusions are drawn regarding the turbulence associated to valve design features, as well as the possible damage to blood constituents.

A Cellular Model of Shear-Induced Hemolysis

A novel model is presented to study red blood cell (RBC) hemolysis at cellular level. Under high shear rates, pores form on RBC membranes through which hemoglobin (Hb) leaks out and increases free Hb content of plasma leading to hemolysis. By coupling lattice Boltzmann and spring connected network models through immersed boundary method, we estimate hemolysis of a single RBC under various shear rates. First, we use adaptive meshing to find local strain distribution and critical sites on RBC membranes, and then we apply underlying molecular dynamics simulations to evaluate damage. Our approach comprises three sub-models: defining criteria of pore formation, calculating pore size, and measuring Hb diffusive flux out of pores. Our damage model uses information of different scales to predict cellular level hemolysis. Results are compared with experimental studies and other models in literature. The developed cellular damage model can be used as a predictive tool for hydrodynamic and hematologic design optimization of blood-wetting medical devices.

Performance study on newly developed impellers for a left ventricular assist device

Our research develops a performance study on newly developed impellers for a left ventricular assist device. In order to analyze the hemodynamic characteristics of blood flow through the ventricular assist device, the CFX-TASCflow software is adopted to investigate the flow-field characteristics. The numerical results provide not only the flow characteristics for the overall field, but also the data of relationship for flow rate and pressure head. In the conceptual design process, hemodynamic study for an initial impeller design is presented first and a geometry change is recommended. Two design models are developed and the associated flow rate and pressure head performances are evaluated as well. According to design criteria, the most efficient design is the one with a smooth flow passage and with a low possibility for vortex generation. We suggest the superior design be chosen for further in vitro testing and be prepared for the new design generation. It has been shown that the design can provide a flow rate of 3.0 l/min with a pressure head of 127.09 mmHg. Both the flow rate and pressure head can meet requirements for the left ventricular assist device to work normally.

Two-Dimensional Dynamic Simulation of Platelet Activation During Mechanical Heart Valve Closure

A major drawback in the operation of mechanical heart valve prostheses is thrombus formation in the near valve region. Detailed flow analysis in this region during the valve closure phase is of interest in understanding the relationship between shear stress and platelet activation. A fixed-grid Cartesian mesh flow solver is used to simulate the blood flow through a bi-leaflet mechanical valve employing a two-dimensional geometry of the leaflet with a pivot point representing the hinge region. A local mesh refinement algorithm allows efficient and fast flow computations with mesh adaptation based on the gradients of the flow field in the leaflet-housing gap at the instant of valve closure. Leaflet motion is calculated dynamically based on the fluid forces acting on it employing a fluid-structure interaction algorithm. Platelets are modeled and tracked as point particles by a Lagrangian particle tracking method which incorporates the hemodynamic forces on the particles. A platelet activation model is included to predict regions which are prone to platelet activation. Closure time of the leaflet is validated against experimental studies. Results show that the orientation of the jet flow through the gap between the housing and the leaflet causes the boundary layer from the valve housing to be drawn in by the shear layer separating from the leaflet. The interaction between the separating shear layers is seen to cause a region of intensely rotating flow with high shear stress and high residence time of particles leading to high likelihood of platelet activation in that region.

Numerical Estimation of Blood Damage in Artificial Organs

The aim of this study was to determine a method for the numerical estimation of blood damage. Normally, human or animal blood is used for in vitro evaluation of lysis by artificial organs. However, blood has some disadvantages: large biological variability and different initial test conditions lead to nonreproducible test results. For that reason, it would be an advantage to have a numerical method for blood damage estimation. This proposed method is based on the calculation of an integrated hemolysis and platelet lysis index along the path line in the flow field of the artificial organ. The time-dependent shear stress related lysis is based on known experimental data. In order to calibrate these data, the method was first applied to blood circulation in the human body. The results showed that the known data overestimate hemolysis by a factor of approximately 25. Next, the method was applied to a standard Björk-Shiley valve. The flow through a valve was simulated with the computational fluid dynamics program FLUENT. The calculation of lysis was added into FLUENT and done automatically. The results showed that the Björk-Shiley valve increased the hemolysis index by 7% if implanted in the human body circulation.

Potential mechanical blood trauma in vascular access devices: a comparison of case studies

Since vascular access devices may cause disturbances in blood flow, possibly damaging red blood cells (RBCs), the correlated risk of lysis must be assessed. The monodimensional approach for the evaluation of cannulae hydrodynamic behaviour (in vitro measured flow curves) does not furnish information on the local flow field occurring in specific clinical conditions. Researchers consider the prediction of blood trauma, induced by mechanical loading, to optimize the design phase, and to furnish indications on their optimal clinical use. In this study, a model of cannula inserted in a non compliant wall vessel was used as a test bench in a Computational Fluid Dynamics (CFD) problem. By means of CFD the flow field was 3D analysed to achieve information on velocity and shear stress local values, when cannula is used for inflow and outflow cannulation. A prediction of potential blood corpuscle damage, based on a power law, quantified the potential blood damage. Several numerical simulations, with different cannula/vessel flow rate ratios were provided, to investigate the incidence of local sites in the design on blood damaging potential during cannulation. Several regions appeared to be sensitive to the flow rate not only inside the cannula but also in the space between cannula and vessel, suggesting new indications for the assessment of a quality factor based on the evaluation of induced blood cells injury.

[Model fluids of blood for in vitro testing of artificial heart valves]

The increasing development and implantation of artificial organs subject to perfusion with human blood once implanted (grafts, heart-valve prostheses and assist systems) require extensive testing of hydrodynamic performance in mock circulation models. As human blood ist not always available in the necessary quantities, different fluids (water, saline or glycerine solutions) are employed for measurements of flow characteristics. However, these model fluids do not possess the non-Newtonian rheological properties of blood. In addition, they do not allow estimation of possible blood damage. Aqueous solutions of high molecular weight polyacrylamides (PAA) have rheological properties similar to blood, displaying also molecular degradation due to shear stress in the flow. Therefore, they were used as model fluid for blood. Different model solutions were compared to blood with regard to their influence on characteristic flow parameters of mechanical heart valves. Likewise, the shear damage of erythrocytes could be compared to flow-induced polymer degradation. It was shown that PAA solutions in definite concentrations are suitable models for blood, not only in terms of non-Newtonian rheology, but also in terms of estimation of hemolytic potential of artificial heart valves.

Evaluation of four blood pump geometries: the optical tracer technique

Artificial blood pump assistance of the failing human heart can allow it to recover. Analysis of blood pump fluid flow is a useful tool for design development and thrombosis minimization. The aim of this study was to investigate fluid flow, particularly ventricular clearance rate and stagnation areas, in four different blood pump geometries and to determine the best design. The blood pumps consisted of a polyurethane ventricle, and combinations of inlet/outlet pipe angles and compression plate shapes. A video camera recorded the motion of fluid labelled with an optical tracer (Methyl Blue histological dye). A novel processing method was developed to produce colour maps of tracer concentration, experimentally calibrated. An overall picture of fluid flow in each pump geometry was generated by considering clearance curves, tracer concentration maps and inflow jet animations. Overall and local mixing coefficients are calculated for each pump. The best geometry featured straight inlet/outlet pipes and a domed compression plate. This optical tracer technique has proven convenient, economical, sensitive to low concentrations of tracer and provides instantaneous pictures of tracer distribution in a ventricle.

Flow characteristics past jellyfish and St. Vincent valves in the aortic position under physiological pulsatile flow conditions

Thrombus formation and hemolysis have been linked to the dynamic flow characteristics of heart valve prostheses. To enhance our understanding of the flow characteristics past the aortic position of a Jellyfish (JF) valve in the left ventricle, in vitro laser Doppler anemometry (LDA) measurements were carried out under physiological pulsatile flow conditions. The hemodynamic performance of the JF valve was then compared with that of the St. Vincent (SV) valve. The comparison was given in terms of mean systolic pressure drop, back flow energy losses, flow velocity, and shear stresses at various locations downstream of both valves and at cardiac outputs of 3.5 L/min, 4.5 L/min, and 6.5 L/min respectively. The results indicated that both valves created disturbed flow fields with elevated levels of turbulent shear stress as well as higher levels of turbulence in the immediate vicinity of the valve and up to 1 diameter of the pipe (D) downstream of the valve. At a location further downstream, the JF valve showed better flow characteristics than the SV in terms of velocity profiles and turbulent shear stresses. The closure volume of the SV valve was found to be 2.5 times higher than that of the JF valve. Moreover, the total back flow losses and mean systolic pressure drop also were found to be higher in the SV than the JF valve.

Evaluation of four blood pump geometries: fluorescent particle flow visualisation technique

Artificial blood pumps play an increasingly important role in the treatment of end-stage cardiac failure. The fluid dynamics of blood flow through such devices crucially affects their clinical effectiveness. Specifically, if the flow of blood stagnates or slowly re-circulates thrombus formation can occur and the avoidance of such flow features is a primary consideration in the design of pumps. The present study concerns the development of a fluorescent particle visualisation technique and its application to investigate the flow environments in four prototype blood pump designs. The procedure involves recording video images of eight illuminated cross sections through the pumping chambers as the pumps operate in a mock circulatory loop using a test fluid seeded with fluorescent particles. The technique enabled a semi-quantitative characterisation of the entire flow field, throughout the pumping cycle, to be performed for each pump design. Flow features were then related to design properties of the individual pumps and recommendations made for design optimisation.

Assessment of prosthetic aortic valve performance by magnetic resonance velocity imaging

OBJECTIVES

Magnetic resonance (MRI) velocity mapping was used to evaluate non-invasively the flow profiles of the ascending aorta in normal volunteers and in patients with an aortic (mechanical) valve prosthesis.

BACKGROUND

In patients with artificial aortic valves the flow profile in the ascending aorta is severely altered. These changes have been associated with an increased risk of thrombus formation and mechanical hemolysis.

METHODS

Velocity profiles were determined 30 mm distal to the aortic valve in six healthy volunteers and seven patients with aortic valve replacement (replacement within the last 2 years) using ECG triggered phase contrast MRI. Peak flow, mean flow and mean reverse flow were measured in intervals of 25 ms during the entire heart cycle. Systolic reverse flow, end-systolic closing and diastolic leakage volume were calculated for all subjects.

RESULTS

Peak flow velocity during mid-systole was significantly higher in patients with valvular prosthesis than in normals (mean + SD, 1.9 +/- 0.4 m/s vs. 1.2 +/- 0.03 m/s, P < 0.001) with a double peak and a zone of reversed flow close to the inner (left lateral) wall of the ascending aorta of the patients. Closing volume was significantly larger in patients than in controls (-3.3 +/- 1.2 ml/beat vs. -0.9 +/- 0.5 ml/beat; P < 0.001). There was reverse flow during systole in valvular patients amounting to 15.7 +/- 6.7% of total cardiac output compared to 2.3 +/- 1.2% in controls (P < 0.001). Diastolic mean flow was negative in patients after valve replacement but not in controls (-11.0 +/- 15.2 ml/beat vs. 6.8 +/- 3.2 ml/beat; P < 0.01).

CONCLUSIONS

The following three major quantitative observations have been made in the present study: (1) Mechanical valve prostheses have an increased peak flow velocity with a systolic reverse flow at the inner (left lateral) wall of the ascending aorta. (2) A double peak flow velocity pattern can be observed in patients with bileaflet (mechanical) prosthesis. (3) The blood volume required for leaflet closure and the diastolic leakage blood volume are significantly higher for the examined bileaflet valve than for native heart valves.

Correlation of radionuclide and optical tracer assessments of fluid flow in artificial ventricles

Characterization of flow properties of an artificial ventricle may aid development of designs to minimize thrombosis. Techniques for determining two such flow properties, viz. ventricular clearance rate and ejection fraction, are compared and validated here for polyurethane and silicone rubber ventricles operated in a mock circulatory loop at various stroke volumes and pulse rates. Ventricular clearance rats were measured both by clinical radionuclide tracer techniques and by an optical tracer method. Ejection fractions were measured by radionuclide imaging and validated by direct measurements of flow rate and ventricular volume. Results from the two methods for ventricular clearance are in close agreement. The optical tracer method is superior in spatial resolution, convenience and economy, but the radionuclide tracer method for ejection fraction gives excellent agreement with the absolute measurements.

Impact of size mismatch and left ventricular function on performance of the St. Jude disc valve after aortic valve replacement

BACKGROUND

The hemodynamic function of the St. Jude valve may change relative to changes in left ventricular function after aortic valve replacement for aortic stenosis. From theoretical reasons one may hypothesize that prosthetic valve hemodynamic function is related to left ventricular failure and mismatch between valve size and patient/ventricular chamber size.

METHODS

Forty patients aged 24 to 82 years who survived aortic valve replacement for aortic stenosis with a standard St. Jude disc valve (mean size, 23.5 mm; range, 19 to 29 mm) were followed up prospectively with Doppler echocardiography and radionuclide left ventriculography preoperatively and 9 days, 3 months, and 18 months after the operation with assessment of intravascular hemolysis at 18 months. Follow-up to a maximum of 7.4 years (mean, 6.3 years) was 100% complete.

RESULTS

Left ventricular muscle mass index decreased from 198 +/- 62 g.m-2 preoperatively to 153 +/- 53 g.m-2 at 18 months (p < 0.001), paralleled by a significant increase in left ventricular ejection fraction, peak ejection rate, and peak filling rate; only 18% of the patients had normal left ventricular muscle mass index and only 32% normal ventricular function (normal left ventricular ejection fraction, peak ejection rate, peak filling rate, early filling fraction, and late filling fraction during atrial contraction) at 18 months. Prosthetic valve peak Doppler gradient dropped from 20 +/- 6 mm Hg at 9 days to 17 +/- 5 mm Hg at 18 months (p < 0.05). Reduction of left ventricular muscle mass index was unrelated to peak gradient and size of the valve. Peak gradient at 18 months rose with valve orifice diameter of 17 mm or less (by 6 mm Hg), orifice diameter/body surface area of 9 mm.m-2 or less (by 5 mm Hg), left ventricular enddiastolic dimension (by 23 mm Hg per 10 mm increase), and impaired ventricular function (by 3 mm Hg). All but 2 patients (5%) had intravascular hemolysis; none had anemia. Two patients with moderate paravalvular leak had the highest serum lactic dehydrogenase levels; 4 patients with trivial leak had higher serum lactic dehydrogenase levels than those without leak. Serum lactic dehydrogenase levels rose with moderate paravalvular leak, impaired ventricular function, and valve orifice diameter. Six patients with trivial or moderate paravalvular leak had a cumulative 7-year freedom from bleeding and thromboembolism of 44% +/- 22% compared with 87% +/- 5% for those without leak (p < 0.05).

CONCLUSIONS

The peak gradient of the St. Jude aortic valve dropped marginally over the first 18 postoperative months in association with incomplete left ventricular hypertrophy regression and marginal improvement of ventricular function. Mismatch between valve size and ventricular cavity size or patient size and impaired function of a dilated ventricle significantly compromised the performance of the St. Jude valve. Probably explained by platelet destruction or activation, paravalvular leak was related to bleeding and thromboembolic complications.

A comparison of the hydrodynamical behaviour of three heart aortic prostheses by numerical methods

The behaviour of the blood flow passing through artificial heart values in aortic position is numerically simulated by discretizing the Navier-Stokes equations for viscous incompressible flow through the finite element method. Three different artificial valves, Starr-Edwards, St Jude and disc valves, are modelled by using the finite element method as well as the Navier-Stokes equations for viscous incompressible flow. The blood flow behaviour is characterized by discretizing both planar and axisymmetric domains of the value devices. The streamlines as well as the velocity distributions are studied and compared. Likewise, the pressure patterns are analysed and compared. Some numerical examples of the three valves are presented and discussed herein.

In vitro testing of artificial heart valves: comparison between Newtonian and non-Newtonian fluids

The in vitro testing of artificial heart valves is often performed with simple fluids like glycerol solutions. Blood, however, is a non-Newtonian fluid with a complex viscoelastic behavior, and different flow fields in comparable geometries may result. Therefore, we used different polymer solutions (Polyacrylamid, Xanthan gum) with blood-like rheological properties as well as various Newtonian fluids (water, glycerol solutions) in our heart valve test device. Hydrodynamic parameters of Björk-Shiley heart valves with a tissue annulus diameter (TAD) of 21-29 mm were investigated under aortic flow conditions. Major results can be summarized as follows. The mean systolic pressure differences depend on the model fluids tested. Closing time and closing volume are not influenced by the rheological behavior of fluids. These parameters depend on TAD and the pressure differences across the valve. In contrast, rheological behavior has a pronounced influence upon leakage flow and leakage volume, respectively. Results show furthermore that the apparent viscosity data as a function of shear rate are not sufficient to characterize the rheological fluid behavior relevant to hydrodynamic parameters of the heart valves investigated. Therefore, similarity in the yield curves of non-Newtonian test fluids mimicing blood is only a pre-requisite for a suitable test fluid. More information about the viscous and elastic component of the fluid viscosity is required, especially in geometries where a complex flow field exists as in the case of leakage flow.

A review of the in vitro evaluation of conduit-mounted cardiac valve prostheses

This review concerns the issues affecting the in vitro evaluation of conduit-mounted prosthetic heart valves at the design development stage, and the question of standardisation of testing at the quality assurance stage. Particular attention is given to areas of conduit valve development and research which have been neglected, ambiguously covered or left to the discretion of the researcher in the current standard for conventional prosthetic valves, ISO 5840.

Studies by pulsed Doppler ultrasonography of velocity fields downstream of graded stenoses on the abdominal aorta in pigs

PURPOSE

To investigate local hemodynamics downstream of arterial stenoses, a perivascular five-element Doppler ultrasound transducer was used for registration of one-dimensional velocity profiles and estimation of Reynolds (turbulent) normal stresses downstream of smooth, graded stenoses on the abdominal aorta in six 90 kg pigs.

METHODS

Blood velocities were registered by a 10 MHz pulsed Doppler velocimeter that used a modified zero-crossing detector with an upper -3 dB cutoff frequency of 200 Hz. Signal analysis included ensemble averaging, turbulence analysis, and dimensional visualization of velocity profiles.

RESULTS

Velocity profiles downstream of minor (< or = 40%) and moderate (40% to 65%) stenoses were skewed with the highest systolic velocities toward the anterior vessel wall and diastolic flow reversal occasionally present at the posterior vessel wall. Immediately downstream of severe (> or = 65%) stenoses a prominent poststenotic jet and systolic recirculation zones were present. Further downstream, vortices and eddies dominated the flow field. Reynolds normal stresses were highest at locations in the velocity field with high-velocity gradients corresponding to the parajet zone.

CONCLUSIONS

The present study demonstrated that pulsed Doppler ultrasonography can provide detailed and quantitative information of flow phenomena such as jetlike flow, vortices, and recirculation zones in a poststenotic flow field in the abdominal aorta.

Leakage of mechanical heart valve prostheses of Björk-Shiley type: in vitro investigations using Newtonian fluids

The leakage of mechanical heart valve prostheses with tilting disc occluders was investigated. A U tube apparatus and a quasi-stationary method were used for measuring the backflow pressure characteristics. The method has several advantages over pulsatile or oscillatory techniques described in the literature. We have attempted to interpret the results of our measurements in terms of laminar and turbulent losses of energy. This leads to dimensionless loss numbers for valve leakage which are independent of arbitrary experimental conditions.

Estimation of turbulent shear stresses in pulsatile flow immediately downstream of two artificial aortic valves in vitro

Measuring turbulent shear stresses is of major importance in artificial heart valve evaluation. Bi- and unidirectional fluid velocity measurements enable calculation of Reynolds shear stress [formula: see text] and Reynolds normal stress [formula: see text]. tau is important due to the relation to hemolysis and thrombus formation, but sigma is the only obtainable parameter in vivo. Therefore, determination of a correlation factor between tau and sigma is pertinent. In a pulsatile flow model, laser Doppler (LDA) and hot-film (HFA) anemometry were used for simultaneous bi- and unidirectional fluid velocity measurements downstream of a Hall Kaster and a Hancock Porcine aortic valve. Velocities were registered in two flow field locations and at four cardiac outputs. The velocity signals were subjected to analog signal processing prior to digital turbulence analysis, as a basis for calculation of tau and sigma. A correlation factor of 0.5 with a correlation coefficient of 0.97 was found between the maximum Reynolds shear stress and Reynolds normal stress, implying [formula: see text]. In vitro estimation of turbulent shear stresses downstream of artificial aortic valves, based on the axial velocity component alone, seems possible.

Wall shear stress distribution along the cusp of a tri-leaflet prosthetic valve

High levels of wall shear stress on the surface of valvular cusps can cause mechanical damage to the blood cells and the cusp surfaces. The shear stresses are also responsible for mechanical failure of prosthetic heart valves. Qualitative measurements of wall shear stress in the vicinity of the leaflets are thus essential for diagnosis of suspected complications and provide important information for the design and fabrication of bioprosthetic heart valves. For this purpose we measured the velocity distribution along the inside wall of the cusps of a tri-leaflet heart valve with a two colour laser Doppler anemometer system. The wall shear stresses on the cusp surface were computed and found to range from 80 to 120 N/m2 during the ejection phase. Wall shear stresses of up to 180 N/m2 were measured in loci of cusp flexure and the accelerated boundary layer. The results of this study show a correlation between the high shear stress loci and the clinically (animal) observed regions of cusp calcification.

Turbulent stresses downstream of porcine and pericardial aortic valves implanted in pigs

Because late valve-related complications such as hemolysis and thromboembolic events are considered related to flow disturbances caused by the inserted valve, velocity fields downstream of aortic valve prostheses were studied in pigs. Acute hemodynamic evaluation of size 25-mm porcine and pericardial aortic valve prostheses 1 diameter downstream of the valve ring was performed using dynamic three-dimensional visualization of velocity profiles and spatial distribution of turbulence. Point blood velocity signals obtained with a 1-mm hot-film anemometer needle probe were used to compute Reynolds normal stresses (RNS) by calculation of the turbulent velocity energy of the axial velocity component in the systole. The porcine valves caused a skewed velocity and turbulence profile revealing mean spatial systolic RNS at 70 nm-2 +/- 35 nm-2 (+/- SD). The spatial maximum RNS was 275 +/- 139 nm-2. Corresponding values for the pericardial valves were 20 +/- 11 nm-2 and 72 +/- 46 nm-2. The pericardial valves revealed plug-shaped velocity profiles and turbulent profiles with slightly higher RNS values at the stent posts. From a hemodynamic point of view, these acute studies indicate superiority of the pericardial valves compared to the porcine valves. The turbulent stresses found in this study are of a magnitude that may cause blood corpuscular and endothelial damage.

In vitro stress measurements in the vicinity of six mechanical aortic valves using hot-film anemometry in steady flow

Based on hot-film anemometry, point velocity measurements in the total cross sectional area 1 and 2 diameters downstream of: Björk-Shiley Standard, Convex-Concave and Monostrut, Hall-Kaster (Medtronic-Hall), St. Jude Medical and Starr-Edwards Silastic Ball aortic valves were made. The spatial distribution of Reynolds Normal Stresses (RNS) was visualized three-dimensionally in order to point out where and to what extent the highest RNSs were found. The measurements were made in steady flowing glycerol mixture at flow rates 10, 20 and 30 l. min-1 corresponding to mean velocities of 27, 54 and 81 cm s-1. The highest maximum RNS values were around 250 Nm-2 and were found downstream of the Björk-Shiley Monostrut and Starr-Edwards Ball valves. The lowest maximum RNSs were found downstream of the St. Jude Medical and Hall-Kaster (Medtronic-Hall) valves (125-140 Nm-2). The Starr-Edwards valve had the highest mean RNS (117 Nm-2) followed by the Björk-Shiley Monostrut (87 Nm-2). These simplified measurements of artificial heart valve performances concerning RNS, enhance the interpretation of results in more complicated flow models not to say in vivo.

Turbulent stress measurements downstream of six mechanical aortic valves in a pulsatile flow model

In a pulsatile flow model aortic Björk-Shiley Standard, Convex-Concave and Monostrut valves were investigated together with the Hall-Kaster (Medtronic-Hall), St Jude Medical and Starr-Edwards Silastic Ball valve using hot-film anemometry. Three-dimensional visualization of average systolic Reynolds normal stresses (RNS) reflected the design of the valves. Mean average RNS were used for comparison of the fluid dynamic performance along with Velocity Energy Ratio (VER100) and Turbulence Energy Ratio (TER) as a relative turbulence intensity for pulsatile flow. Mean average RNS ranged from 13.2 to 37.6 Nm-2 for all the valves with the highest levels for the Björk-Shiley Standard and Starr-Edwards Ball valve and lowest values for the St Jude Medical valve and with the Hall-Kaster (Medtronic-Hall), Björk-Shiley Convex-Concave and Monostrut valves in between.

Ultrastructural investigations on the question of mechanical activation of blood platelets

The present study addresses the question whether platelets are activated by mechanical stresses as they occur in pathologically accelerated blood flow. Their potential mechanoreceptive properties were tested by subjecting human platelets to defined fluid mechanical forces for periods of milliseconds. Platelet activation was assessed by quantitative morphology, revealing besides activated platelets, irreversibly ballooned, lytic platelets. However, this morphometrically documented "shear activation" of platelets can be suppressed almost completely by the addition of enzyme-substrate systems, capable of removing adenosine diphosphate from the suspending medium. This is in keeping with a recent study from our laboratory showing that the behaviour of lactic dehydrogenase as marker for platelet lysis and beta-thromboglobulin as release marker refuted earlier data, suggesting a direct activation of platelets by shear. It is concluded that former evidence of "shear induced platelet activation" must be interpreted as the consequence of lytic damage to a small proportion of platelets.