Image-Guided Fluid-Structure Interaction Simulation of Transvalvular Hemodynamics: Quantifying the Effects of Varying Aortic Valve Leaflet Thickness

Multiscale structure and function of the aortic valve apparatus

Whereas studying the aortic valve in isolation has facilitated the development of life-saving procedures and technologies, the dynamic interplay of the aortic valve and its surrounding structures is vital to preserving their function across the wide range of conditions encountered in an active lifestyle. Our view is that these structures should be viewed as an integrated functional unit, here referred to as the aortic valve apparatus (AVA). The coupling of the aortic valve and root, left ventricular outflow tract, and blood circulation is crucial for AVA's functions: unidirectional flow out of the left ventricle, coronary perfusion, reservoir function, and support of left ventricular function. In this review, we explore the multiscale biological and physical phenomena that underlie the simultaneous fulfillment of these functions. A brief overview of the tools used to investigate the AVA, such as medical imaging modalities, experimental methods, and computational modeling, specifically fluid-structure interaction (FSI) simulations, is included. Some pathologies affecting the AVA are explored, and insights are provided on treatments and interventions that aim to maintain quality of life. The concepts explained in this article support the idea of AVA being an integrated functional unit and help identify unanswered research questions. Incorporating phenomena through the molecular, micro, meso, and whole tissue scales is crucial for understanding the sophisticated normal functions and diseases of the AVA.

A review of polymeric heart valves leaflet geometric configuration and structural optimization

Valvular heart disease (VHD) is a major cause of loss of physical function, quality of life and longevity, and its prevalence is growing worldwide due to increased survival rates and an aging population. The most common treatment for VHD is surgical heart valve replacement with mechanical heart valves (MHVs) and bioprosthetic heart valves (BHVs), but with different limitations. Polymeric heart valves (PHVs) exhibit promising material properties, valve dynamics and biocompatibility, representing the most feasible alternative to existing artificial heart valves. However, inadequate fatigue performance remains a critical obstacle to their clinical translation. In this case, geometry and material design are essential to obtain the best mechanical properties of the PHV. In this study, we summarized the effects of optimal design of PHVs from geometrical configuration optimization (valve height, thickness and design curve) and structural material optimization (anisotropy, fiber reinforcement, variable thickness, microstructure and asymmetric optimization), and selected the parameters including Effective Orifice Area (EOA), Regurgitant fraction (RF), and Stress Distribution to compare the performance of valves. It would provide the theoretical support for the optimal design of PHVs.

Fluid-structure interaction analysis of a healthy aortic valve and its surrounding haemodynamics

The opening and closing dynamics of the aortic valve (AV) has a strong influence on haemodynamics in the aortic root, and both play a pivotal role in maintaining normal physiological functions of the valve. The aim of this study was to establish a subject-specific fluid-structure interaction (FSI) workflow capable of simulating the motion of a tricuspid healthy valve and the surrounding haemodynamics under physiologically realistic conditions. A subject-specific aortic root was reconstructed from magnetic resonance (MR) images acquired from a healthy volunteer, whilst the valve leaflets were built using a parametric model fitted to the subject-specific aortic root geometry. The material behaviour of the leaflets was described using the isotropic hyperelastic Ogden model, and subject-specific boundary conditions were derived from 4D-flow MR imaging (4D-MRI). Strongly coupled FSI simulations were performed using a finite volume-based boundary conforming method implemented in FlowVision. Our FSI model was able to simulate the opening and closing of the AV throughout the entire cardiac cycle. Comparisons of simulation results with 4D-MRI showed a good agreement in key haemodynamic parameters, with stroke volume differing by 7.5% and the maximum jet velocity differing by less than 1%. Detailed analysis of wall shear stress (WSS) on the leaflets revealed much higher WSS on the ventricular side than the aortic side and different spatial patterns amongst the three leaflets.

Research on fatigue optimization simulation of polymeric heart valve based on the iterative sub-regional thickened method

Prosthetic polymeric heart valves (PHVs) have the potential to overcome the inherent material and design limitations of traditional valves in the treatment of valvular heart disease; however, their durability remains limited. Optimal design of the valve structure is necessary to improve their durability. This study aimed to enhance the fatigue resistance of PHVs by improving the stress distribution. Iterative subregional thickening of the leaflets was used, and the mechanical stress distribution and hemodynamics of these polymeric tri-leaflet valves were characterized using a fluid-structure interaction approach. Subregional thickening led to a reduction in stress concentration on the leaflet, with the effective orifice area still meeting ISO 5840-3 and the regurgitant volume achieving a similar value to those in previous studies. The maximum stress in the final iteration was reduced by 28% compared with that of the prototype. The proposed method shows potential for analyzing the stress distribution and hemodynamic performance of subregional thickened valves and can further improve the durability of PHVs.

Aortic Leaflet Stresses Are Substantially Lower Using Pulmonary Visceral Pleura Than Pericardial Tissue

Background: Porcine heart and bovine pericardium valves, which are collagen-based with relatively little elastin, have been broadly utilized to construct bioprosthetic heart valves (BHVs). With a larger proportion of elastin, the pulmonary visceral pleura (PVP) has greater elasticity and could potentially serve as an advantageous biomaterial for the construction/repair of BHVs. The question of how the aortic valve’s performance is affected by its bending rigidity has not been well studied.

Methods: Based on the stress–strain relationships of the pericardium and PVP determined by planar uni-axial tests, a three-dimensional (3D) computational fluid–structure interaction (FSI) framework is employed to numerically investigate the aortic valve’s performance by considering three different cases with Young’s modulus as follows: E=375, 750, and 1500 kPa, respectively.

Results: The stroke volumes are 112, 99.6, and 91.4 ml as Young’s modulus increases from 375 to 750 and 1500 kPa, respectively. Peak geometric opening area (GOA) values are 2.3, 2.2, and 2.0 cm² for E=375, 750, and 1500 kPa, respectively. The maximum value of the aortic leaflet stress is about 271 kPa for E=375 kPa, and it increases to about 383 and 540 kPa for E=750 and 1500 kPa in the belly region at the peak systole, while it reduces from 550 kPa to 450 and 400 kPa for E=375, 750, and 1500 kPa, respectively, at the instant of peak “water-hammer”.

Conclusion: A more compliant PVP aortic leaflet valve with a smaller Young’s modulus, E, has a higher cardiac output, larger GOA, and lower hemodynamic resistance. Most importantly, the aortic leaflet stresses are substantially lower in the belly region within the higher compliance PVP aortic valve tissue during the systole phase, even though some stress increase is also found during the fast-closing phase due to the “water-hammer” effect similar to that in the pericardial tissue. Future clinical studies will be conducted to test the hypothesis that the PVP-based valve leaflets with higher compliance will have lower fatigue or calcification rates due to the overall lower stress.

Scale-Resolving Simulations of Steady and Pulsatile Flow Through Healthy and Stenotic Heart Valves

Blood-flow downstream of stenotic and healthy aortic valves exhibits intermittent random fluctuations in the velocity field which are associated with turbulence. Such flows warrant the use of computationally demanding scale-resolving models. The aim of this work was to compute and quantify this turbulent flow in healthy and stenotic heart valves for steady and pulsatile flow conditions. Large eddy simulations (LESs) and Reynolds-averaged Navier-Stokes (RANS) simulations were used to compute the flow field at inlet Reynolds numbers of 2700 and 5400 for valves with an opening area of 70 mm2 and 175 mm2 and their projected orifice-plate type counterparts. Power spectra and turbulent kinetic energy were quantified on the centerline. Projected geometries exhibited an increased pressure-drop (>90%) and elevated turbulent kinetic energy levels (>147%). Turbulence production was an order of magnitude higher in stenotic heart valves compared to healthy valves. Pulsatile flow stabilizes flow in the acceleration phase, whereas onset of deceleration triggered (healthy valve) or amplified (stenotic valve) turbulence. Simplification of the aortic valve by projecting the orifice area should be avoided in computational fluid dynamics (CFD). RANS simulations may be used to predict the transvalvular pressure-drop, but scale-resolving models are recommended when detailed information of the flow field is required.

Numerical Investigation and Fluid-Structure Interaction (FSI) Analysis on a Double-Element Simplified Formula One (F1) Composite Wing in the Presence of Ground Effect

This research paper focuses on a novel coupling of the aerodynamic and structural behaviour of a double-element composite front wing of a Formula One (F1) vehicle, which was simulated and studied for the first time here. To achieve this goal, a modified two-way coupling method was employed in the context of high performance computing (HPC) to simulate a steady-state fluid-structure interaction (FSI) configuration using the ANSYS software package. The front wing plays a key role in generating aerodynamic forces and controlling the fresh airflow to maximise the aerodynamic performance of an F1 car. Therefore, the composite front wing becomes deflected under aerodynamic loading conditions due to its elastic behaviour which can lead to changes in the flow field and the aerodynamic performance of the wing. To reduce the uncertainty of the simulations, a grid sensitivity study and the assessment of different engineering turbulence models were carried out. The practical contribution of our investigations is the quantification of the coupled effect of the aerodynamic and structural performance of the wing and an understanding of the influence of ride heights on the ground effect. It was found that the obtained numerical surface pressure distributions, the aerodynamic forces, and the wake profiles show an accurate agreement with experimental data taken from the literature.

Analysis of Turbulence Effects in a Patient-Specific Aorta with Aortic Valve Stenosis

Blood flow in the aorta is often assumed laminar, however aortic valve pathologies may induce transition to turbulence and our understanding of turbulence effects is incomplete. The aim of the study was to provide a detailed analysis of turbulence effects in aortic valve stenosis (AVS).

METHODS

Large-eddy simulation (LES) of flow through a patient-specific aorta with AVS was conducted. Magnetic resonance imaging (MRI) was performed and used for geometric reconstruction and patient-specific boundary conditions. Computed velocity field was compared with 4D flow MRI to check qualitative and quantitative consistency. The effect of turbulence was evaluated in terms of fluctuating kinetic energy, turbulence-related wall shear stress (WSS) and energy loss.

RESULTS

Our analysis suggested that turbulence was induced by a combination of a high velocity jet impinging on the arterial wall and a dilated ascending aorta which provided sufficient space for turbulence to develop. Turbulent WSS contributed to 40% of the total WSS in the ascending aorta and 38% in the entire aorta. Viscous and turbulent irreversible energy losses accounted for 3.9 and 2.7% of the total stroke work, respectively.

CONCLUSIONS

This study demonstrates the importance of turbulence in assessing aortic haemodynamics in a patient with AVS. Neglecting the turbulent contribution to WSS could potentially result in a significant underestimation of the total WSS. Further work is warranted to extend the analysis to more AVS cases and patients with other aortic valve diseases.

Fluid-structure coupled biotransport processes in aortic valve disease

Biological transport processes near the aortic valve play a crucial role in calcific aortic valve disease initiation and bioprosthetic aortic valve thrombosis. Hemodynamics coupled with the dynamics of the leaflets regulate these transport patterns. Herein, two-way coupled fluid-structure interaction (FSI) simulations of a 2D bicuspid aortic valve and a 3D mechanical heart valve were performed and coupled with various convective mass transport models that represent some of the transport processes in calcification and thrombosis. Namely, five different continuum transport models were developed to study biochemicals that originate from the blood and the leaflets, as well as residence-time and flow stagnation. Low-density lipoprotein (LDL) and platelet activation were studied for their role in calcification and thrombosis, respectively. Coherent structures were identified using vorticity and Lagrangian coherent structures (LCS) for the 2D and 3D models, respectively. A very close connection between vortex structures and biochemical concentration patterns was shown where different vortices controlled the concentration patterns depending on the transport mechanism. Additionally, the relationship between leaflet concentration and wall shear stress was revealed. Our work shows that blood flow physics and coherent structures regulate the flow-mediated biological processes that are involved in aortic valve calcification and thrombosis, and therefore could be used in the design process to optimize heart valve replacement durability.

Hemodynamic effects of aortic valve and heart rate on coronary perfusion

BACKGROUND

Reduced coronary flow reserve in aortic stenosis and after transcatheter aortic valve implantation is usually attributed to physiological factors taking place during systole, such as an increase in coronary resistance, and backward waves intensity. In this paper, we suggest an additional factor related to the diastolic hemodynamics in the aortic root.

METHODS

We measured left ventricle, aortic and coronary pressure and coronary perfusion in in-vitro models of healthy, aortic stenosis and an artificial valve at different heart rates and cardiac output conditions, to isolate the effect of hemodynamic factors in the aortic root during diastole.

FINDINGS

Our results show that during diastole, coronary perfusion depends on the pressure gradient between the aorta and the coronary inlet. This aorta-coronary pressure gradient is influenced by the hemodynamic flow field in the aortic root. The ratio between the aorta-coronary pressure gradient magnitude in stress to that under rest conditions of a healthy model is ten times higher than the same ratio in the aortic stenosis model and twice higher as compared to the artificial valve model result. The coronary flow reserve of the healthy model is correspondingly higher compared to the artificial valve and the aortic stenosis models. These results are in agreement with the clinical evidence.

INTERPRETATION

This study supports the hypothesis of a hemodynamic mechanism in the aortic root that increases coronary flow during rest but reduces the coronary flow reserve in aortic stenosis and artificial valve cases. The results may provide valuable insights regarding valve design.

Experiments on Flexible Filaments in Air Flow for Aeroelasticity and Fluid-Structure Interaction Models Validation

Several problems in science and engineering are characterized by the interaction between fluid flows and deformable structures. Due to their complex and multidisciplinary nature, these problems cannot normally be solved analytically and experiments are frequently of limited scope, so that numerical simulations represent the main analysis tool. Key to the advancement of numerical methods is the availability of experimental test cases for validation. This paper presents results of an experiment specifically designed for the validation of numerical methods for aeroelasticity and fluid-structure interaction problems. Flexible filaments of rectangular cross-section and various lengths were exposed to air flow of moderate Reynolds number, corresponding to laminar and mildly turbulent flow conditions. Experiments were conducted in a wind tunnel, and the flexible filaments dynamics was recorded via fast video imaging. The structural response of the filaments included static reconfiguration, small-amplitude vibration, large-amplitude limit-cycle periodic oscillation, and large-amplitude non-periodic motion. The present experimental setup was designed to incorporate a rich fluid-structure interaction physics within a relatively simple configuration without mimicking any specific structure, so that the results presented herein can be valuable for models validation in aeroelasticity and also fluid-structure interaction applications.