Biaxial mechanical properties of the pericardium in normal and volume overload dogs

Combining Unique Planar Biaxial Testing with Full-Field Thickness and Displacement Measurement for Spatial Characterization of Soft Tissues

Soft tissues rely on the incredible complexity of their microstructure for proper function. Local variations in material properties arise as tissues develop and adapt, often in response to changes in loading. A barrier to investigating the heterogeneous nature of soft tissues is the difficulty of developing experimental protocols and analysis tools that can accurately capture spatial variations in mechanical behavior. In this article, we detail protocols enabling mechanical characterizations of anisotropic, heterogeneous soft tissues or tissue analogs. We present a series of mechanical tests designed to maximize inhomogeneous strain fields and in-plane shear forces. A customized, 3D-printable gripping system reduces tissue handling and enhances shear. High-resolution imaging and laser micrometry capture full-field displacement and thickness, respectively. As the equipment necessary to conduct these protocols is commercially available, the experimental methods presented offer an accessible route toward addressing heterogeneity. © 2022 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Unique biaxial testing of soft tissues and tissue analogs Basic Protocol 2: Full-field thickness measurement of soft tissues and tissue analogs Support Protocol 1: Creating and speckling cruciform-shaped samples for mechanical testing Support Protocol 2: Creating custom gripping system to minimize sample handling.

Measuring mechanical anisotropy of the cornea with Brillouin microscopy

Load-bearing tissues are typically fortified by networks of protein fibers, often with preferential orientations. This fiber structure imparts the tissues with direction-dependent mechanical properties optimized to support specific external loads. To accurately model and predict tissues' mechanical response, it is essential to characterize the anisotropy on a microstructural scale. Previously, it has been difficult to measure the mechanical properties of intact tissues noninvasively. Here, we use Brillouin optical microscopy to visualize and quantify the anisotropic mechanical properties of corneal tissues at different length scales. We derive the stiffness tensor for a lamellar network of collagen fibrils and use angle-resolved Brillouin measurements to determine the longitudinal stiffness coefficients (longitudinal moduli) describing the ex vivo porcine cornea as a transverse isotropic material. Lastly, we observe significant mechanical anisotropy of the human cornea in vivo, highlighting the potential for clinical applications of off-axis Brillouin microscopy.

Diastolic Ventricular Interaction in Heart Failure With Preserved Ejection Fraction

Background

Exercise‐induced pulmonary hypertension is common in heart failure with preserved ejection fraction (HFpEF). We hypothesized that this could result in pericardial constraint and diastolic ventricular interaction in some patients during exercise.

Methods and Results

Contrast stress echocardiography was performed in 30 HFpEF patients, 17 hypertensive controls, and 17 normotensive controls (healthy). Cardiac volumes, and normalized radius of curvature (NRC) of the interventricular septum at end‐diastole and end‐systole, were measured at rest and peak‐exercise, and compared between the groups. The septum was circular at rest in all 3 groups at end‐diastole. At peak‐exercise, end‐systolic NRC increased to 1.47±0.05 (P<0.001) in HFpEF patients, confirming development of pulmonary hypertension. End‐diastolic NRC also increased to 1.54±0.07 (P<0.001) in HFpEF patients, indicating septal flattening, and this correlated significantly with end‐systolic NRC (ρ=0.51, P=0.007). In hypertensive controls and healthy controls, peak‐exercise end‐systolic NRC increased, but this was significantly less than observed in HFpEF patients (HFpEF, P=0.02 versus hypertensive controls; P<0.001 versus healthy). There were also small, non‐significant increases in end‐diastolic NRC in both groups (hypertensive controls, +0.17±0.05, P=0.38; healthy, +0.06±0.03, P=0.93). In HFpEF patients, peak‐exercise end‐diastolic NRC also negatively correlated (r=−0.40, P<0.05) with the change in left ventricular end‐diastolic volume with exercise (ie, the Frank‐Starling mechanism), and a trend was noted towards a negative correlation with change in stroke volume (r=−0.36, P=0.08).

Conclusions

Exercise pulmonary hypertension causes substantial diastolic ventricular interaction on exercise in some patients with HFpEF, and this restriction to left ventricular filling by the right ventricle exacerbates the pre‐existing impaired Frank‐Starling response in these patients.

Mechanical and finite element evaluation of a bioprinted scaffold following recellularization in a rat subcutaneous model

Tissue engineered heart valves (TEHV) provide several advantages over currently available aortic heart valve replacements. Bioprinting provides a patient-specific means of developing a TEHV scaffold from imaging data, and the capability to embed the patient's own cells within the scaffold. In this work we investigated the remodeling capacity of a collagen-based bio-ink by implanting bioprinted disks in a rat subcutaneous model for 2, 4 and 12 weeks and evaluating the mechanical response using biaxial testing and subsequent finite element (FE) modeling. Samples explanted after 2 and 4 weeks showed inferior mechanical properties compared to native tissues while 12 week explants showed a mechanical response of similar magnitude but did not demonstrate the anisotropy present in native tissues. In the FE analysis, the model utilizing mechanical properties from samples explanted after 12 weeks showed the closest mechanical behavior to the native tissues. However, in diastole native tissues showed higher stress in the leaflet belly and lower strain at the commissures compared to 12 week explants, likely due to the anisotropy present in the native tissues. Thus, either further remodeling is required in situ in the aortic valve position or by in vitro preconditioning in an environment such as a bioreactor. Regardless, these results demonstrate the utility of FE analysis to optimize bioprinting process parameters for the most favorable in vivo mechanical performance.

In Silico Performance of a Recellularized Tissue Engineered Transcatheter Aortic Valve

Commercially available heart valves have many limitations, such as a lack of re-modeling, risk of calcification and thromboembolic problems. Many state-of-the-art tissue engineered heart valves rely on recellularization. Current in vitro testing is insufficient in characterizing a soon to be living valve. It is imperative to understand the performance of an in situ valve, but due to the complex in vivo environment this is difficult to accomplish. Finite element analysis has become a standard tool for modeling mechanical behavior of heart valves; yet, research to date has mostly focused on commercial valves. The purpose of this study has been to develop finite element models of a decellularized and recellularized tissue engineered heart valve. Mechanical properties from porcine aortic valves were utilized to develop finite element models, which were run through a full physiological cardiac cycle. Maximum principal stresses and strains from the leaflets and commissures were analyzed. The results of this study demonstrate that the explanted tissues had reduced mechanical strength compared to the implants but were similar to the native tissues. For the finite element models the explanted recellularized leaflets showed lower stress but increased compliance in the leaflet belly compared to native tissues and higher compliance than implant tissues. Histology demonstrated recellularization and remodeling although remodeled collagen had no clear directionality. In conclusion, we observed successful recellularization and remodeling of the tissue, however, the mechanical response indicates the further remodeling is required following implantation in the aortic/pulmonary position.

MR, CT, and PET imaging in pericardial disease

Although echocardiography remains the standard diagnostic tool for identifying pericardial diseases, procedures with better delineation of morphology and heart function are often required. The pericardium consists of an inner visceral (epicardium) and outer parietal layer (pericardium), which constitute for the pericardial cavity. Pericardial effusion can occur as transudate, exudate, pyopneumopericardium, or hemopericardium. Potential causes are inflammatory processes, that is, pericarditis due to autoimmune or infective reasons, neoplasms, irradiation, or systemic disorders, chronic renal failure, endocrine, or metabolic diseases. Pericardial fat can mimic pericardial effusion. Using various image-acquisition sequences, MRI allows identifying and separating fluid and solid structures. Fast spin-echo T1-weighted sequences with black-blood preparation are favourably used for morphological evaluation. Fast spin-echo T2-weighted sequences, particularly with fat saturation, and short-tau inversion-recovery sequences are useful to visualize oedema and inflammation. For further tissue characterization, delayed inversion-recovery imaging is used. Therefore, image acquisition is performed at 5-20 min subsequent to contrast agent administration, the so-called technique of late gadolinium enhancement. Ventricular volumes and myocardial mass can be assessed accurately by steady-state free-precession sequences, which is required to measure cardiac function and ventricular wall stress. Constrictive pericarditis usually results from chronic inflammatory processes leading to increased stiffness, which impedes the slippage of both pericardial layers and thereby the normal cardiac filling. CT imaging can favourably assess pericardial calcification. Thus, MR and CT imaging allow a comprehensive delineation of the pericardium. Superior to echocardiography, both methods provide a larger field of view and depiction of the complete chest including abnormalities of the surrounding mediastinum and lungs. PET provides unique information on the in vivo metabolism of 18-fluorodeoxyglucose that can be superimposed on CT findings and is useful for identifying inflammatory processes or masses, for example neoplasms. These imaging techniques provide advanced information of anatomy and cardiac function to optimize the pericardial access, for example by the AttachLifter system, for diagnosis and treatment.

Diastolic ventricular interaction and ventricular diastolic filling

Because the ventricles share a common septum, the filling of one may influence the compliance of the other, a phenomenon known as direct diastolic ventricular interaction (DVI). This interaction is markedly enhanced when the force exerted by the surrounding pericardium is raised (pericardial constraint). In health, in the resting state, we operate near the top of the flat component of a J-shaped pericardial stress-strain relation. Therefore, pericardial constraint (and hence DVI) is only minor. When right ventricular volume/pressure acutely increases, such as during exercise, massive pulmonary embolism, or right ventricular infarction, pericardial constraint increases and significant DVI develops. In this setting, the measured left ventricular intracavitary diastolic pressure markedly overestimates the true left ventricular filling pressure, because the external forces must be subtracted. Although the pericardium can grow during chronic cardiac enlargement, we present evidence that in certain chronic disease processes, including heart failure, DVI may also be important.

Biaxial mechanical properties of the natural and glutaraldehyde treated aortic valve cusp--Part I: Experimental results

To date, there are no constitutive models for either the natural or bioprosthetic aortic valve (AV), in part due to experimental complications related to the AV's small size and heterogeneous fibrous structure. In this study, we developed specialized biaxial testing techniques for the AV cusp, including a method to determine the local structure-strain relationship to assess the effects of boundary tethering forces. Natural and glutaraldehyde (GL) treated cusps were subjected to an extensive biaxial testing protocol in which the ratios of the axial tensions were held at constant values. Results indicated that the local fiber architecture clearly dominated cuspal deformation, and that the tethering effects at the specimen boundaries were negligible. Due to unique aspects of cuspal fiber architecture, the most uniform region of deformation was found at the lower portion as opposed to the center of the cuspal specimen. In general, the circumferential strains were much smaller than the radial strains, indicating a profound degree of mechanical anisotropy, and that natural cusps were significantly more extensible than the GL treated cusps. Strong mechanical coupling between biaxial stretch axes produced negative circumferential strains under equibiaxial tension. Further, the large radial strains observed could not be explained by uncrimping of the collagen fibers, but may be due to large rotations of the highly aligned, circumferential-oriented collagen fibers in the fibrosa. In conclusion, this study provides new insights into the AV cusp's structure-function relationship in addition to requisite data for constitutive modeling.

A method for planar biaxial mechanical testing that includes in-plane shear

A limitation in virtually all planar biaxial studies of soft tissues has been the inability to include the effects of in-plane shear. This is due to the inability of current mechanical testing devices to induce a state of in-plane shear, due to the added cost and complexity. In the current study, a straightforward method is presented for planar biaxial testing that induces a combined state of in-plane shear and normal strains. The method relies on rotation of the test specimen's material axes with respect to the device axes and on rotating carriages to allow the specimen to undergo in-plane shear freely. To demonstrate the method, five glutaraldehyde treated bovine pericardium specimens were prepared with their preferred fiber directions (defining the material axes) oriented at 45 deg to the device axes to induce a maximum shear state. The test protocol included a wide range of biaxial strain states, and the resulting biaxial data re-expressed in material axes coordinate system. The resulting biaxial data was then fit to the following strain energy function W: [equation: see text] where E'ij is the Green's strain tensor in the material axes coordinate system and c and Ai are constants. While W was able to fit the data very well, the constants A5 and A6 were found not to contribute significantly to the fit and were considered unnecessary to model the shear strain response. In conclusion, while not able to control the amount of shear strain independently or induce a state of pure shear, the method presented readily produces a state of simultaneous in-plane shear and normal strains. Further, the method is very general and can be applied to any anisotropic planar tissue that has identifiable material axes.

A finite element based method to determine the properties of planar soft tissue

A finite element based method to determine the incremental elastic material properties of planar membranes was developed and evaluated. The method is applicable to tissues that exhibit inhomogeneity, geometric and material nonlinearity, and anisotropy. Markers are placed on the tissue to form a four-node quadrilateral element. The specimen is loaded to an initial reference state, then three incremental loading sets are applied and the nodal displacements recorded. One of these loadings must include shear. These data are used to solve an over-determined system of equations for the tangent stiffness matrix. The method was first verified using analytical data. Next, data obtained from a latex rubber sheet were used to evaluate experimental procedures. Finally, experiments conducted on preconditioned rat skin revealed nonlinear orthotropic behavior. The vector norm comparing the applied and calculated nodal force vectors was used to evaluate the accuracy of the solutions.

The degree of nonlinearity and anisotropy of blood vessel elasticity

Blood vessel elasticity is important to physiology and clinical problems involving surgery, angioplasty, tissue remodeling, and tissue engineering. Nonlinearity in blood vessel elasticity in vivo is important to the formation of solitons in arterial pulse waves. It is well known that the stress-strain relationship of the blood vessel is nonlinear in general, but a controversy exists on how nonlinear it is in the physiological range. Another controversy is whether the vessel wall is biaxially isotropic. New data on canine aorta were obtained from a biaxial testing machine over a large range of finite strains referred to the zero-stress state. A new pseudo strain energy function is used to examine these questions critically. The stress-strain relationship derived from this function represents the sum of a linear stress-strain relationship and a definitely nonlinear relationship. This relationship fits the experimental data very well. With this strain energy function, we can define a parameter called the degree of nonlinearity, which represents the fraction of the nonlinear strain energy in the total strain energy per unit volume. We found that for the canine aorta, the degree of nonlinearity varies from 5% to 30%, depending on the magnitude of the strains in the physiological range. In the case of canine pulmonary artery in the arch region, Debes and Fung [Debes, J. C. & Fung, Y. C.(1995) Am. J. Physiol. 269, H433-H442] have shown that the linear regime of the stress-strain relationship extends from the zero-stress state to the homeostatic state and beyond. Both vessels, however, are anisotropic in both the linear and nonlinear regimes.