Prediction of Hemodynamic-Related Hemolysis in Carotid Stenosis and Aiding in Treatment Planning and Risk Stratification Using Computational Fluid Dynamics

Atherosclerosis affects human health in many ways, leading to disability or premature death due to ischemic heart disease, stroke, or limb ischemia. Poststenotic blood flow disruption may also play an essential role in artery wall impairment linked with hemolysis related to shear stress. The maximum shear stress in the atherosclerotic plaque area is the main parameter determining hemolysis risk. In our work, a 3D internal carotid artery model was built from CT scans performed on patients qualified for percutaneous angioplasty due to its symptomatic stenosis. The obtained stenosis geometries were used to conduct a series of computer simulations to identify critical parameters corresponding to the increase in shear stress in the arteries. Stenosis shape parameters responsible for the increase in shear stress were determined. The effect of changes in the carotid artery size, length, and degree of narrowing on the change in maximum shear stress was demonstrated. Then, a correlation for the quick initial diagnosis of atherosclerotic stenoses regarding the risk of hemolysis was developed. The developed relationship for rapid hemolysis risk assessment uses information from typical non-invasive tests for treated patients. Practical guidelines have been developed regarding which stenosis shape parameters pose a risk of hemolysis, which may be adapted in medical practice.

Hemolysis of red blood cells in blood vessels modeled via computational fluid dynamics

The research aims to verify the universal relationship between vessel shape and the risk of hemolysis using a rheological model of blood reflecting the physiological processes related to blood for any blood vessel. Blood is a multi-component fluid, the rheology of which depends on many factors, such as the concentration of red blood cells and local shear stress, which significantly affect the process of hemolysis. Blood rheology models used so far cannot be used for all flows and geometries. Therefore, a new rheology model has been introduced suitable for modeling hemolytic flows observed in arteries with atherosclerotic lesions in the in vivo environment. The previously presented model also has advantages in modeling local viscosity in stenosis. Geometries of the blood vessels from computed tomography scans and simplified models of the actual arteries observed during medical procedures were used in the calculations. Population Balance Based Rheology model predicts the concentration of single, deagglomerated red blood cells and the concentration and size of red blood cell agglomerates, which affect blood rheology and hemolysis. Based on the simulations carried out, a correlation was found between the shape of the vessel cavity and the risk of hemolysis. Presented results can be used in the future to create a correlation between the shape of the atherosclerotic lesions and the risk of hemolysis in the blood to make an initial risk assessment for a given patient.

Particle Image Velocimetry of 3D-Printed Anatomical Blood Vascular Models Affected by Atherosclerosis

Improvements in the diagnosis and treatment of cardiovascular diseases facilitate a better understanding of the ongoing process. The study of biomedical fluid dynamics using non-intrusive visualizing methods on a micro-scale has become possible using a proper 3D printing process. The computed tomography scan of a patient with atherosclerosis was processed, and a 3D-printed artery with an inlet diameter of 4.2 mm was developed and measured using three different constant flow rates. To mimic blood, a solution of glycerin and water was used. The procedure to obtain a proper 3D-printed model using low-force stereolithography technology with high-quality optical access usable for PIV was described and discussed. The paper presents the results of PIV as multi-stitched, color-coded vector maps from the axis cross section along the whole 3D-printed model. The obtained data allowed a resolution of 100 × 100 µm per single vector to be achieved. Furthermore, the results of the stitched 16 base images of the artery and the 3D-printed model prepared were included. The results of this study show that 3D prints allow for the creation of the desired geometry and can be used to investigate severe pathologies of the human circulatory system. The strengths and weaknesses of this methodology were discussed and compared to other techniques used to obtain transparent objects.

Parameters of Flow through Paravalvular Leak Channels from Computational Fluid Dynamics Simulations—Data from Real-Life Cases and Comparison with a Simplified Model

Background: Shear forces affecting erythrocytes in PVL channels can be calculated with computational fluid dynamics (CFD). The presence of PVLs is always associated with some degree of hemolysis in a simplified model of the left ventricle (LV); however, data from real-life examples is lacking. Methods: Blood flow through PVL channels was assessed in two variants. Firstly, a PVL channel, extracted from cardiac computed tomography (CCT), was placed in a simplified model of the LV. Secondly, a real-life model of the LV was created based on CCT data from a subject with a PVL. The following variables were assessed: wall shear stress (τ_w) shear stress in fluid (τ), volume of PVL channel with wall shear stress above 300 Pa (V₃₀₀), duration of exposure of erythrocytes to shear stress above 300 Pa (Vt₃₀₀) and compared with lactate dehydrogenase (LDH) activity levels. Results: τ_w and τ were higher in the simplified model. V₃₀₀ and Vt₃₀₀ were almost identical in both models. Conclusions: Parameters that describe blood flow through PVL channels can be reliably assessed in a simplified model. LDH levels in subjects with PVLs may be related to V₃₀₀ and Vt₃₀₀. Length and location of PVL channels may contribute to a risk of hemolysis in mitral PVLs.

Potential Applications of Computational Fluid Dynamics for Predicting Hemolysis in Mitral Paravalvular Leaks

Paravalvular leaks (PVLs) may lead to hemolysis. In vitro shear stress forces above 300 Pa cause erythrocyte destruction. PVL channel dimensions may determine magnitude of shear stress forces that affect erythrocytes; however, this has not been tested. It remains unclear how different properties of PVL channels contribute to presence of hemolysis. A model of a left ventricle was created based on data from computer tomography with Slicer software PVLs of various shapes and sizes were introduced. Blood flow was simulated using ANSYS Fluent software. The following variables were examined: wall shear stress, shear stress in fluid, volume of PVL channel with shear stress exceeding 300 Pa, and duration of exposure of erythrocytes to shear stress values above 300 Pa. In all models, shear stress forces exceeded 300 Pa. Shear stress increased with blood flow rates and cross-sectional areas of any PVL. There was no linear relationship between cross-sectional area of a PVL and volume of a PVL channel with shear stress > 300 Pa. Blood flow through mitral PVLs is associated with shear stress above 300 Pa. Cross-sectional area of a PVL does not correlate with volume of a PVL channel with shear stress > 300 Pa and duration of exposure of erythrocytes to shear stress > 300 Pa.

Computational Fluid Dynamics Simulations of Mitral Paravalvular Leaks in Human Heart

In recent years, computational fluid dynamics (CFD) has been extensively used in biomedical research on heart diseases due to its non-invasiveness and relative ease of use in predicting flow patterns inside the cardiovascular system. In this study, a modeling approach involving CFD simulations was employed to study hemodynamics inside the left ventricle (LV) of a human heart affected by a mitral paravalvular leak (PVL). A simplified LV geometry with four PVL variants that varied in shape and size was studied. Predicted blood flow parameters, mainly velocity and shear stress distributions, were used as indicators of how presence of PVLs correlates with risk and severity of hemolysis. The calculations performed in the study showed a high risk of hemolysis in all analyzed cases, with the maximum shear stress values considerably exceeding the safe level of 300 Pa. Results of our study indicated that there was no simple relationship between PVL geometry and the risk of hemolysis. Two factors that potentially played a role in hemolysis severity, namely erythrocyte exposure time and the volume of fluid in which shear stress exceeded a critical value, were not directly proportional to any of the characteristic geometrical parameters (shape, diameters, circumference, area, volume) of the PVL channel. Potential limitations of the proposed simplified approach of flow analysis are discussed, and possible modifications to increase the accuracy and plausibility of the results are presented.

Comparison of Large Eddy Simulations and κ-ε Modelling of Fluid Velocity and Tracer Concentration in Impinging Jet Mixers

Simulations of turbulent mixing in two types of jet mixers were carried out using two CFD models, large eddy simulation and κ-ε model. Modelling approaches were compared with experimental data obtained by the application of particle image velocimetry and planar laser-induced fluorescence methods. Measured local microstructures of fluid velocity and inert tracer concentration can be used for direct validation of numerical simulations. Presented results show that for higher tested values of jet Reynolds number both models are in good agreement with the experiments. Differences between models were observed for lower Reynolds numbers when the effects of large scale inhomogeneity are important.