Simulation of personalised haemodynamics by various mounting positions of a prosthetic valve using computational fluid dynamics

Diseases of the cardiovascular system account for nearly 42% of all deaths in the European Union. In Germany, approximately 12,000 patients receive surgical replacement of the aortic valve due to heart valve disease alone each year. A three-dimensional (3D) numerical model based on patient-specific anatomy derived from four-dimensional (4D) magnetic resonance imaging (MRI) data was developed to investigate preoperatively the flow-induced impact of mounting positions of aortic prosthetic valves to select the best orientation for individual patients. Systematic steady-state analysis of blood flow for different rotational mounting positions of the valve is only possible using a virtual patient model. A maximum velocity of 1 m/s was used as an inlet boundary condition, because the opening angle of the valve is at its largest at this velocity. For a comparative serial examination, it is important to define the standardised general requirements to avoid impacts other than the rotated implantation of the prosthetic aortic valve. In this study, a uniform velocity profile at the inlet for the inflow of the aortic valve and the real aortic anatomy were chosen for all simulations. An iterative process, with the weighted parameters flow resistance (1), shear stress (2) and velocity (3), was necessary to determine the best rotated orientation. Blood flow was optimal at a 45° rotation from the standard implantation orientation, which will offer a supply to the coronary arteries.

[Analysis of flow in artificial stenosis models of mid-sized arteries using 3D PC-MRI]

Phase contrast MRI allows access to tri-directional encoded velocity information and therefore, measurement of flow in the human hemodynamic system. The aim of this work was to investigate whether this technology could be applied to support the grading of stenosis in mid-size arteries. Using a specially constructed flow phantom and a stenosis model with tube diameter of 5mm and 8mm and a stenosis of 50%, experiments at different flow rates (180-640 ml/min), slice thickness (1-4 mm), field strength (1.5 and 3.0 T), and multi-slice as well as 3D volume acquisition were performed. The observations were assessed visually and evaluated by signal-to-noise (SNR) ratios in regions before and after the stenosis. The obtained results show that examinations should be performed at high field (3.0 T) and at flow rates up to 500 ml/min without hampering the measurements by areas of signal loss. In comparison, no detectable differences in the flow patterns of the two acquisition schemes could be observed. However, the SNR was higher using the 3D volume acquisition and thick slices. In summary, 3D PC-MRI of mid-size vessels with stenosis is feasible for certain flow rates. The presented results could be seen as guidance for in vivo situations to assess if an examination of a patient is reasonable in terms of outcome.