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Xu F, Johnson EL, Wang C, Jafari A, Yang CH, Sacks MS, Krishnamurthy A, Hsu MC. Computational investigation of left ventricular hemodynamics following bioprosthetic aortic and mitral valve replacement. MECHANICS RESEARCH COMMUNICATIONS 2021; 112:103604. [PMID: 34305195 PMCID: PMC8301225 DOI: 10.1016/j.mechrescom.2020.103604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The left ventricle of the heart is a fundamental structure in the human cardiac system that pumps oxygenated blood into the systemic circulation. Several valvular conditions can cause the aortic and mitral valves associated with the left ventricle to become severely diseased and require replacement. However, the clinical outcomes of such operations, specifically the postoperative ventricular hemodynamics of replacing both valves, are not well understood. This work uses computational fluid-structure interaction (FSI) to develop an improved understanding of this effect by modeling a left ventricle with the aortic and mitral valves replaced with bioprostheses. We use a hybrid Arbitrary Lagrangian-Eulerian/immersogeometric framework to accommodate the analysis of cardiac hemodynamics and heart valve structural mechanics in a moving fluid domain. The motion of the endocardium is obtained from a cardiac biomechanics simulation and provided as an input to the proposed numerical framework. The results from the simulations in this work indicate that the replacement of the native mitral valve with a tri-radially symmetric bioprosthesis dramatically changes the ventricular hemodynamics. Most significantly, the vortical motion in the left ventricle is found to reverse direction after mitral valve replacement. This study demonstrates that the proposed computational FSI framework is capable of simulating complex multiphysics problems and can provide an in-depth understanding of the cardiac mechanics.
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Affiliation(s)
- Fei Xu
- Ansys Inc., Austin, TX 78746, USA
| | - Emily L. Johnson
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | | | - Arian Jafari
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Cheng-Hau Yang
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Michael S. Sacks
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Adarsh Krishnamurthy
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
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Johnson EL, Wu MCH, Xu F, Wiese NM, Rajanna MR, Herrema AJ, Ganapathysubramanian B, Hughes TJR, Sacks MS, Hsu MC. Thinner biological tissues induce leaflet flutter in aortic heart valve replacements. Proc Natl Acad Sci U S A 2020; 117:19007-19016. [PMID: 32709744 PMCID: PMC7431095 DOI: 10.1073/pnas.2002821117] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Valvular heart disease has recently become an increasing public health concern due to the high prevalence of valve degeneration in aging populations. For patients with severely impacted aortic valves that require replacement, catheter-based bioprosthetic valve deployment offers a minimally invasive treatment option that eliminates many of the risks associated with surgical valve replacement. Although recent percutaneous device advancements have incorporated thinner, more flexible biological tissues to streamline safer deployment through catheters, the impact of such tissues in the complex, mechanically demanding, and highly dynamic valvular system remains poorly understood. The present work utilized a validated computational fluid-structure interaction approach to isolate the behavior of thinner, more compliant aortic valve tissues in a physiologically realistic system. This computational study identified and quantified significant leaflet flutter induced by the use of thinner tissues that initiated blood flow disturbances and oscillatory leaflet strains. The aortic flow and valvular dynamics associated with these thinner valvular tissues have not been previously identified and provide essential information that can significantly advance fundamental knowledge about the cardiac system and support future medical device innovation. Considering the risks associated with such observed flutter phenomena, including blood damage and accelerated leaflet deterioration, this study demonstrates the potentially serious impact of introducing thinner, more flexible tissues into the cardiac system.
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Affiliation(s)
- Emily L Johnson
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Michael C H Wu
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Fei Xu
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Nelson M Wiese
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Manoj R Rajanna
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Austin J Herrema
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | | | - Thomas J R Hughes
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712;
| | - Michael S Sacks
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712;
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011;
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Xu F, Morganti S, Zakerzadeh R, Kamensky D, Auricchio F, Reali A, Hughes TJ, Sacks MS, Hsu MC. A framework for designing patient-specific bioprosthetic heart valves using immersogeometric fluid-structure interaction analysis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e2938. [PMID: 29119728 PMCID: PMC5893448 DOI: 10.1002/cnm.2938] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/08/2017] [Accepted: 10/22/2017] [Indexed: 05/07/2023]
Abstract
Numerous studies have suggested that medical image derived computational mechanics models could be developed to reduce mortality and morbidity due to cardiovascular diseases by allowing for patient-specific surgical planning and customized medical device design. In this work, we present a novel framework for designing prosthetic heart valves using a parametric design platform and immersogeometric fluid-structure interaction (FSI) analysis. We parameterize the leaflet geometry using several key design parameters. This allows for generating various perturbations of the leaflet design for the patient-specific aortic root reconstructed from the medical image data. Each design is analyzed using our hybrid arbitrary Lagrangian-Eulerian/immersogeometric FSI methodology, which allows us to efficiently simulate the coupling of the deforming aortic root, the parametrically designed prosthetic valves, and the surrounding blood flow under physiological conditions. A parametric study is performed to investigate the influence of the geometry on heart valve performance, indicated by the effective orifice area and the coaptation area. Finally, the FSI simulation result of a design that balances effective orifice area and coaptation area reasonably well is compared with patient-specific phase contrast magnetic resonance imaging data to demonstrate the qualitative similarity of the flow patterns in the ascending aorta.
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Affiliation(s)
- Fei Xu
- Department of Mechanical Engineering, Iowa State University, 2025 Black Engineering, Ames, IA 50011, USA
| | - Simone Morganti
- Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, via Ferrata 3, 27100, Pavia Italy
| | - Rana Zakerzadeh
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 East 24th St, Stop C0200, Austin, TX 78712, USA
| | - David Kamensky
- Department of Structural Engineering, University of California, San Diego, 9500 Gilman Drive, Mail Code 0085 La Jolla, CA 92093, USA
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, via Ferrata 3, 27100, Pavia, Italy
| | - Alessandro Reali
- Department of Civil Engineering and Architecture, University of Pavia, via Ferrata 3, 27100, Pavia, Italy
| | - Thomas J.R. Hughes
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 East 24th St, Stop C0200, Austin, TX 78712, USA
| | - Michael S. Sacks
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 East 24th St, Stop C0200, Austin, TX 78712, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, 2025 Black Engineering, Ames, IA 50011, USA
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