Finite element modelling and simulations in cardiovascular mechanics and cardiology: A bibliography 1993–2004

Patient-Specific Inverse Modeling of In Vivo Cardiovascular Mechanics with Medical Image-Derived Kinematics as Input Data: Concepts, Methods, and Applications

Inverse modeling approaches in cardiovascular medicine are a collection of methodologies that can provide non-invasive patient-specific estimations of tissue properties, mechanical loads, and other mechanics-based risk factors using medical imaging as inputs. Its incorporation into clinical practice has the potential to improve diagnosis and treatment planning with low associated risks and costs. These methods have become available for medical applications mainly due to the continuing development of image-based kinematic techniques, the maturity of the associated theories describing cardiovascular function, and recent progress in computer science, modeling, and simulation engineering. Inverse method applications are multidisciplinary, requiring tailored solutions to the available clinical data, pathology of interest, and available computational resources. Herein, we review biomechanical modeling and simulation principles, methods of solving inverse problems, and techniques for image-based kinematic analysis. In the final section, the major advances in inverse modeling of human cardiovascular mechanics since its early development in the early 2000s are reviewed with emphasis on method-specific descriptions, results, and conclusions. We draw selected studies on healthy and diseased hearts, aortas, and pulmonary arteries achieved through the incorporation of tissue mechanics, hemodynamics, and fluid-structure interaction methods paired with patient-specific data acquired with medical imaging in inverse modeling approaches.

Application of fuzzy neural network model and current-voltage analysis of biologically active points for prediction post-surgery risks

The work investigates neural network model for prediction of post-surgical treatment risks. The descriptors of the risk classifiers are formed on the basis of the analysis of the current-voltage characteristics of one, two and three biologically active points. The training and verification samples were formed by examining 120 patients with a diagnosis of benign prostatic hyperplasia. Of these, 62 patients were successfully operated on (class C1), 30 had various complications after surgery (class C2), 28 patients required additional treatment (class C3). The constructed classifiers showed a high quality of predicting critical conditions during surgical treatment.

Aortic Valve Cusp Coaptation Surface Area Using 3-Dimensional Transesophageal Echocardiography Correlates with Severity of Aortic Valve Insufficiency

OBJECTIVE

The aim of this study was to test both in humans and using finite element (FE) aortic valve (AV) models whether the coaptation surface area (CoapSA) correlates with aortic insufficiency (AI) severity due to dilated aortic roots to determine the validity and utility of 3-dimensional transesophageal echocardiographic-measured CoapSA.

DESIGN

Two-pronged, clinical and computational approach.

SETTING

Single university hospital.

PARTICIPANTS

The study comprised 10 patients with known AI and 98 FE simulations of increasingly dilated human aortic roots.

INTERVENTIONS

The CoapSA was calculated using intraoperative 3-dimensional transesophageal echocardiography data of patients with isolated AI and compared with established quantifiers of AI. In addition, the CoapSA and effective regurgitant orifice area (EROA) were determined using FE simulations.

MEASUREMENTS AND MAIN RESULTS

In the 10 AI patients, regurgitant fraction (RF) increased with EROA (R² = 0.77, p = 0.0008); CoapSA decreased with RF (R² = 0.72, p = 0.0020); CoapSA decreased with EROA (R² = 0.71, p = 0.0021); and normalized CoapSA (CoapSA / [Ventriculo-Aortic Junction × Sinotubular Junction]) decreased with EROA (R² = 0.60, p = 0.0088). In the 98 FE simulations, normalized CoapSA decreased with EROA (R² = 0.50, p = 0.0001).

CONCLUSIONS

In both human and FE AV models, CoapSA was observed to be inversely correlated with AI severity, EROA, and RF, thereby supporting the validity and utility of 3D TEE-measured CoapSA. A clinical implication is the expectation that high values of CoapSA, measured intraoperatively after AV repairs, would correlate with better long-term outcomes of those repairs.

Integration of geometric separation mechanisms by implementing curved constrictions in a biochip microchannel fluidic separator

This paper investigates the effectiveness of using curved constrictions in the bifurcation region of T-type fluid separators for promoting flow development in the intervals between bifurcations. A design of biofluid separator is proposed and a mathematical analysis and a numerical simulation of the blood flow in microchannels are conducted. The design is based on a modification of an existing T-shaped biochip device which consists of a main channel and a series of perpendicularly positioned side channels. By means of bifurcation effect, the blood is separated into plasma concentration flow from the side channels and blood cell concentration flow from the main channel. In this design, curved constrictions are inserted between bifurcations to replace the original straight channel section, so that the constriction and curved channel effects can be induced apart from the existing bifurcation effect. The mathematical analysis is aimed to the flow field and shear stress of the blood fluid in the microchannel geometries employed in the current design, including bifurcation, constriction and curved channel. The numerical simulation and mathematical analysis result in agreed conclusions, giving some insights into the importance of the relevant geometries in promoting biofluid separation. The main results can be summarised as follows: (i) the constrictions can largely increase the shear stress by the ratio of square of the reduction of the sections between the constriction and parent main channel. (ii) The curved channel intervals can induce centrifugal force, smoothly transit the flow field and increase the chances depleting fluid from the cell-free layer. (iii) The thickness of the boundary layer skimmed into the side channels from the main channel is decreased in this design and can be controlled, falling into the cell-free layer region by adjusting the geometry of the side channels.

Modelling and simulation of the behaviour of a biofluid in a microchannel biochip separator

This paper reports an investigation into the flow behaviour of a biofluid in a microchannel systems through conceptual analysis and modelling. The application is the design of a microfluidic chip developed for the separation of plasma from blood. The effect of key design features of the microchannels on the flow behaviour of the biofluid is explored. These include geometric features such as the constriction, bending channel, bifurcation and the channel length ratio between the main and side channels. The performance of each design is discussed in terms of separation efficiency of the red blood cells with respect to the rest of the medium. Particular phenomena such as the Fahraeus and Fahraeus-Lindqvist effects, the Zweifach-Fung bifurcation law and the cell-free layer are discussed. In this paper, the fluid is modelled as a single-phase flow assuming either Newtonian or Non-Newtonian behaviour to investigate the effect of the fluid viscosity on both flow and separation efficiency. For a flow rate-controlled Newtonian flow system, it is found that viscosity and outlet pressure have little effect on the velocity distribution through each of the microchannels. For a diluted fluid where the flow in the whole channel system is modelled with a uniform viscosity, less plasma is separated from blood than observed in the non-Newtonian case. This results in an increase in the flow rate ratio between the main and side channels. A comparison of Newtonian and non-Newtonian flows shows that both flows tend to behave identically with an increase in the shear strain rate.

Utilizing FEM-Software to quantify pre- and post-interventional cardiac reconstruction data based on modelling data sets from surgical ventricular repair therapy (SVRT) and cardiac resynchronisation therapy (CRT)

BACKGROUND

Left ventricle (LV) 3D structural data can be easily obtained using standard transesophageal echocardiography (TEE) devices but quantitative pre- and intraoperative volumetry and geometry analysis of the LV is presently not feasible in the cardiac operation room (OR). Finite element method (FEM) modelling is necessary to carry out precise and individual volume analysis and in the future will form the basis for simulation of cardiac interventions.

METHOD

A Philips/HP Sonos 5500 ultrasound device stores volume data as time-resolved 4D volume data sets. In this prospective study TomTec LV Analysis TEE Software was used for semi-automatic endocardial border detection, reconstruction, and volume-rendering of the clinical 3D echocardiographic data. With the software FemCoGen a quantification of partial volumes and surface directions of the LV was carried out for two patients data sets. One patient underwent surgical ventricular repair therapy (SVR) and the other a cardiac resynchronisation therapy (CRT).

RESULTS

For both patients a detailed volume and surface direction analysis is provided. Partial volumes as well as normal directions to the LV surface are pre- and post-interventionally compared.

CONCLUSION

The operation results for both patients are quantified. The quantification shows treatment details for both interventions (e.g. the elimination of the discontinuities for CRT intervention and the segments treated for SVR intervention). The LV quantification is feasible in the cardiac OR and it gives a detailed and immediate quantitative feedback of the quality of the intervention to the medical.

Finite-element-method (FEM) model generation of time-resolved 3D echocardiographic geometry data for mitral-valve volumetry

Introduction

Mitral Valve (MV) 3D structural data can be easily obtained using standard transesophageal echocardiography (TEE) devices but quantitative pre- and intraoperative volume analysis of the MV is presently not feasible in the cardiac operation room (OR). Finite element method (FEM) modelling is necessary to carry out precise and individual volume analysis and in the future will form the basis for simulation of cardiac interventions.

Method

With the present retrospective pilot study we describe a method to transfer MV geometric data to 3D Slicer 2 software, an open-source medical visualization and analysis software package. A newly developed software program (ROIExtract) allowed selection of a region-of-interest (ROI) from the TEE data and data transformation for use in 3D Slicer. FEM models for quantitative volumetric studies were generated.

Results

ROI selection permitted the visualization and calculations required to create a sequence of volume rendered models of the MV allowing time-based visualization of regional deformation. Quantitation of tissue volume, especially important in myxomatous degeneration can be carried out. Rendered volumes are shown in 3D as well as in time-resolved 4D animations.

Conclusion

The visualization of the segmented MV may significantly enhance clinical interpretation. This method provides an infrastructure for the study of image guided assessment of clinical findings and surgical planning. For complete pre- and intraoperative 3D MV FEM analysis, three input elements are necessary: 1. time-gated, reality-based structural information, 2. continuous MV pressure and 3. instantaneous tissue elastance. The present process makes the first of these elements available.

Volume defect analysis is essential to fully understand functional and geometrical dysfunction of but not limited to the valve. 3D Slicer was used for semi-automatic valve border detection and volume-rendering of clinical 3D echocardiographic data. FEM based models were also calculated.

Method

A Philips/HP Sonos 5500 ultrasound device stores volume data as time-resolved 4D volume data sets. Data sets for three subjects were used. Since 3D Slicer does not process time-resolved data sets, we employed a standard movie maker to animate the individual time-based models and visualizations.

Calculation time and model size were minimized.

Pressures were also easily available. We speculate that calculation of instantaneous elastance may be possible using instantaneous pressure values and tissue deformation data derived from the animated FEM.