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Duman ZM, Apaydın Z, Can İ, Kaplan MC, Buğra AK, Timur B, Bayram M, Karakurt ST, Güler GB, Kadiroğulları E, Onan B. Impact of Bileaflet Mechanical Mitral Valve Orientation on Pannus Overgrowth. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:466-471. [PMID: 37705309 DOI: 10.1177/15569845231199100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Pannus overgrowth is a chronic inflammatory process that can cause valve dysfunction and threaten the durability of prosthetic valves. Bileaflet mechanical mitral valve can be implanted in either an anatomical (parallel to the anatomical axis) or nonanatomical (perpendicular or oblique to the anatomical axis) orientation. The effect of the rotational orientation of the bileaflet mechanical mitral valve on excessive pannus enlargement is unknown. The present study compared the effect of bileaflet mechanical mitral valve orientation on pannus overgrowth. METHODS The study included patients who underwent bileaflet mechanical mitral valve replacement for rheumatic mitral valve stenosis. The pannus formation was confirmed by reexamining all transesophageal echocardiography images in the picture archiving and communication systems between May 2017 and April 2021. The primary aim of this study was the development of pannus overgrowth. Patients were divided into 2 groups based on their implantation orientation of the bileaflet mechanical mitral valve. RESULTS Pannus overgrowth was found in 26 patients (56.5%) in the anatomical orientation group and 71 patients (74.7%) in the nonanatomical orientation group (P = 0.03). Anatomical orientation reduced the development of pannus overgrowth (odds ratio [OR] = 0.39, P = 0.04), and double left heart valve replacement increased the development of pannus overgrowth (OR = 2.73, P = 0.04). CONCLUSIONS Pannus overgrowth was less common in bileaflet mechanical mitral valves implanted in the anatomical orientation.
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Affiliation(s)
- Zihni Mert Duman
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - Zinar Apaydın
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - İsa Can
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - Mustafa Can Kaplan
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - Abdül Kerim Buğra
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - Barış Timur
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - Muhammed Bayram
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - Seda Tükenmez Karakurt
- Department of Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - Gamze Babür Güler
- Department of Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - Ersin Kadiroğulları
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Turkey
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2
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Asadi H, Hedayat M, Borazjani I. The Effects of Implantation Orientation of a Bileaflet Mechanical Heart Valve in an Anatomic Left Ventricle-Aorta Configuration. J Biomech Eng 2022; 144:1140397. [PMID: 35466356 DOI: 10.1115/1.4054411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 11/08/2022]
Abstract
We have performed three-dimensional high-resolution numerical simulations of a bi-leaflet mechanical heart valve (BMHV) implanted at different orientations in an anatomic left ventricle-aorta obtained from magnetic resonance imaging (MRI) of a volunteer. The thoroughly validated overset curvilinear-immersed boundary (overset-CURVIB) fluid-structure interaction (FSI) flow solver is used in which the aorta and LV are discretized with boundary-conforming and non-conforming curvilinear grids, respectively. The motion of the LV wall is prescribed based on a lumped parameter model while the motion of the leaflets are calculated using a strong coupled FSI algorithm enhanced with Aitken convergence technique. We carried out simulations for three valve orientations, which differ from each other by 45 degrees and compared the leaflet motion and flow field for multiple cycles. Our results show reproducible and relatively symmetrical opening for all valve orientations. The presence of small-scale vortical structures after peak systole, cause significant cycle-to-cycle variations in valve kinematics during the closing phase for all valve orientations. Furthermore, our results show that valve orientation does not have a significant effect on the distribution of viscous shear stress in the ascending aorta. Additionally, two different mathematical activation models including linear level of activation and Soares model are used to quantify the platelet activation in the ascending aorta. The results show that the valve orientation does not significantly affect (less than 8%) the total platelet activation in the ascending aorta.
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Affiliation(s)
- Hossein Asadi
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas 77843, USA
| | - Mohammadali Hedayat
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas 77843, USA
| | - Iman Borazjani
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas 77843, USA
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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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4
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Lantz J, Bäck S, Carlhäll CJ, Bolger A, Persson A, Karlsson M, Ebbers T. Impact of prosthetic mitral valve orientation on the ventricular flow field: Comparison using patient-specific computational fluid dynamics. J Biomech 2020; 116:110209. [PMID: 33422725 DOI: 10.1016/j.jbiomech.2020.110209] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
Significant mitral valve regurgitation creates progressive adverse remodeling of the left ventricle (LV). Replacement of the failing valve with a prosthesis generally improves patient outcomes but leaves the patient with non-physiological intracardiac flow patterns that might contribute to their future risk of thrombus formation and embolism. It has been suggested that the angular orientation of the implanted valve might modify the postoperative distortion of the intraventricular flow field. In this study, we investigated the effect of prosthetic valve orientation on LV flow patterns by using heart geometry from a patient with LV dysfunction and a competent native mitral valve to calculate intracardiac flow fields with computational fluid dynamics (CFD). Results were validated using in vivo 4D Flow MRI. The computed flow fields were compared to calculations following virtual implantation of a mechanical heart valve oriented in four different angles to assess the effect of leaflet position. Flow patterns were visualized in long- and short-axes and quantified with flow component analysis. In comparison to a native valve, valve implantation increased the proportion of the mitral inflow remaining in the basal region and further increased the residual volume in the apical area. Only slight changes due to valve orientation were observed. Using our numerical framework, we demonstrated quantitative changes in left ventricular blood flow due to prosthetic mitral replacement. This framework may be used to improve design of prosthetic heart valves and implantation procedures to minimize the potential for apical flow stasis, and potentially assist personalized treatment planning.
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Affiliation(s)
- Jonas Lantz
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Sophia Bäck
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann Bolger
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Medicine, University of California, San Francisco, United States
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Division of Radiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Matts Karlsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Division of Applied Thermodynamics and Fluid Mechanics, Department of Management and Engineering, Linköping University, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
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Vellguth K, Sündermann S, Escher A, Bierewirtz T, Schmidt T, Alogna A, Kertzscher U, Goubergrits L, Fraser KH, Granegger M. Intraventricular flow features and cardiac mechano-energetics after mitral valve interventions – feasibility of an isolated heart model. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2020. [DOI: 10.1515/cdbme-2020-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The aim of this work was the development of an isolated heart setup to delineate the interactions between intraventricular flow features, hemodynamic parameters and mechano-energetics after certain mitral valve therapies. Five porcine hearts were explanted and prepared for (i) edge-to-edge mitral valve repair, (ii) implantation of a rotatable biscupid mechanical valve prosthesis. Flow structures were visualized using echocardiography while hemodynamics was recorded in terms of pressures, flow rates and ventricular volume. Hemodynamic and cardiac mechano-energetics implied a marginal effect (<5%) of alternating leaflet orientation on ventricular pre-load and stroke work. After edge-to-edge repair, substantial variations in flow structures were observed. Beside promoting profound insights into fundamental physiologic mechanisms, the setup may be used for validation of computer aided therapy planning tools.
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Affiliation(s)
| | - Simon Sündermann
- Charité – Universitätsmedizin , Berlin , Germany
- German Heart Center , Berlin , Germany
| | - Andreas Escher
- Charité – Universitätsmedizin , Berlin , Germany
- Division of Cardiac Surgery, Medical University of Vienna , Vienna , Austria
| | | | | | | | | | | | | | - Marcus Granegger
- Charité – Universitätsmedizin , Berlin , Germany
- Division of Cardiac Surgery, Medical University of Vienna , Vienna , Austria
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6
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Deng Y, Belfar A, Powell T. Early Prosthetic Valve Malfunction Leading to Cardiogenic Shock and Emergency Redo Mitral Valve Replacement. J Cardiothorac Vasc Anesth 2019; 33:2866-2869. [PMID: 31072708 DOI: 10.1053/j.jvca.2019.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/12/2019] [Accepted: 03/09/2019] [Indexed: 11/11/2022]
Abstract
Early onset prosthetic valve stenosis is an uncommon complication after valve replacement surgery and is often caused by thrombus formation. Frequently it can be diagnosed by echocardiography and managed with optimizing anticoagulation and/or thrombolysis. We review a unique case of early bi-leaflet mechanical heart valve (BMHV) dysfunction where the patient rapidly progressed to cardiogenic shock requiring emergent re-do mitral valve surgery. Intraoperatively, the valve leaflets were found to be almost completely immobile secondary to thrombus formation directly on the hinges of the valve. This case demonstrates how the leaflet orientation of a BMHV affects transmitral flow and fluid dynamics. Furthermore, we also discuss left atrial vortex formation in the setting of atrial fibrillation, kinetic energy transfer through an anatomically implanted mechanical mitral valve, and their roles in contributing to early prosthetic valve thrombosis despite adequate anticoagulation.
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Affiliation(s)
- Yi Deng
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX.
| | - Alexandra Belfar
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Thomas Powell
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX
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7
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Mitral Valve Prosthesis Design Affects Hemodynamic Stasis and Shear In The Dilated Left Ventricle. Ann Biomed Eng 2019; 47:1265-1280. [DOI: 10.1007/s10439-019-02218-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/23/2019] [Indexed: 11/26/2022]
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8
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The influence of bileaflet prosthetic aortic valve orientation on the blood flow patterns in the ascending aorta. Med Eng Phys 2018; 60:61-69. [DOI: 10.1016/j.medengphy.2018.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022]
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9
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Post-operative ventricular flow dynamics following atrioventricular valve surgical and device therapies: A review. Med Eng Phys 2018; 54:1-13. [DOI: 10.1016/j.medengphy.2018.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/17/2017] [Accepted: 01/28/2018] [Indexed: 01/26/2023]
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10
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Experimental Study of Right Ventricular Hemodynamics After Tricuspid Valve Replacement Therapies to Treat Tricuspid Regurgitation. Cardiovasc Eng Technol 2017; 8:401-418. [DOI: 10.1007/s13239-017-0328-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
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11
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Johansen P, Travis BR, Smerup M, Decker Christensen T, Funder J, Nyboe C, Nygaard H, Hasenkam JM. The effect of the aortic valve orientation on cavitation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4305-4308. [PMID: 28269232 DOI: 10.1109/embc.2016.7591679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
When implanting a mechanical aortic valve the annulus orientation is important with respect to turbulence. However, the effect on cavitation has not yet been investigated. The aim of this study was to investigate how cavitation is influenced hereof in vivo. Three pigs were included in the study. An Omnicarbon 21mm valve equipped with a rotating mechanism enabling controlled rotation of the valve was implanted in aortic position. Under stable hemodynamic conditions, measurements were performed using a hydrophone positioned at the aortic root. The valve was rotated from 0-360° in increments of 30°. From the pressure fluctuations recorded by the hydrophone the root mean square of the 50 kHz high pass filtered signal as well as the non-deterministic signal energy was calculated as indirect measures of cavitation. Various degrees of cavitation were measured but no relationship was found between either of the two cavitation measures and the valve orientation. Hemodynamics varied during the experiments for all pigs (3.9-5.7 l/min; 5.0-7.2 l/min; 3.1-7.5 l/min). Changes in cavitation quantities seemed to be caused by changes in hemodynamics rather than valve angular position. In conclusion, these results do not favor any position over another in terms of cavitation potential.
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12
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In Vitro 2D PIV Measurements and Related Aperture Areas of Tricuspid Bioprosthetic Mitral Valves at the beginning of Diastole. Int J Artif Organs 2016; 39:253-7. [DOI: 10.5301/ijao.5000494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/20/2022]
Abstract
Purpose Besides ventricular parameters, the design and angular orientation of a prosthetic heart valve induce a specific flow field. The aim of this study was to know the inflow characteristics of a left ventricular model (LVM), investigating the behavior of tricuspid bioprosthetic mitral valves in terms of velocity profiles and related valve aperture areas at the beginning of diastole, under different conditions. Methods 3 heart rates (HRs) were established in the LVM and each mitral bioprosthesis (27 and 31 mm diameter) was installed in 2 orientations, rotated by 180°. For each experimental setup, 2-dimensional particle image velocimetry (2D PIV) measurements and simultaneous mitral valve (MV) area detection were obtained from 50 samples. Results The results from the velocity profiles immediately downstream of mitral bioprostheses showed the influence of valve orientation for moderate HRs, although for a similar magnitude of mean velocity vectors. The geometries of MV open areas for each HR were similar regardless of valve orientation, except for the 27-mm valve at 90 beats per minute (bpm), and for the 31-mm valve at 60 bpm. Moreover, for each HR, similar percentages of valve open area were obtained regardless of MV nominal diameters. Conclusions In conclusion, the experimental setup for the 2D PIV measurements synchronized with the MV area detection was a useful tool for knowing the inflow characteristics of the LVM.
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13
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Bazan O, Ortiz JP, Fukumasu NK, Pacifico AL, Yanagihara JI. Influence of Tricuspid Bioprosthetic Mitral Valve Orientation Regarding the Flow Field Inside the Left Ventricle: In Vitro Hydrodynamic Characterization Based on 2D PIV Measurements. Artif Organs 2015; 40:175-9. [DOI: 10.1111/aor.12515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ovandir Bazan
- Department of Mechanical Engineering; Polytechnic School of the University of São Paulo; São Paulo Brazil
| | - Jayme P. Ortiz
- Department of Mechanical Engineering; Polytechnic School of the University of São Paulo; São Paulo Brazil
| | - Newton K. Fukumasu
- Department of Mechanical Engineering; Polytechnic School of the University of São Paulo; São Paulo Brazil
| | - Antonio L. Pacifico
- Department of Mechanical Engineering; Polytechnic School of the University of São Paulo; São Paulo Brazil
| | - Jurandir I. Yanagihara
- Department of Mechanical Engineering; Polytechnic School of the University of São Paulo; São Paulo Brazil
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14
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Westerdale JC, Adrian R, Squires K, Chaliki H, Belohlavek M. Effects of Bileaflet Mechanical Mitral Valve Rotational Orientation on Left Ventricular Flow Conditions. Open Cardiovasc Med J 2015; 9:62-8. [PMID: 26312080 PMCID: PMC4541318 DOI: 10.2174/1874192401509010062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/10/2015] [Accepted: 05/12/2015] [Indexed: 11/22/2022] Open
Abstract
We studied left ventricular flow patterns for a range of rotational orientations of a bileaflet mechanical heart valve (MHV) implanted in the mitral position of an elastic model of a beating left ventricle (LV). The valve was rotated through 3 angular positions (0, 45, and 90 degrees) about the LV long axis. Ultrasound scans of the elastic LV were obtained in four apical 2-dimensional (2D) imaging projections, each with 45 degrees of separation. Particle imaging velocimetry was performed during the diastolic period to quantify the in-plane velocity field obtained by computer tracking of diluted microbubbles in the acquired ultrasound projections. The resulting velocity field, vorticity, and shear stresses were statistically significantly altered by angular positioning of the mechanical valve, although the results did not show any specific trend with the valve angular position and were highly dependent on the orientation of the imaging plane with respect to the valve. We conclude that bileaflet MHV orientation influences hemodynamics of LV filling. However, determination of ‘optimal’ valve orientation cannot be made without measurement techniques that account for the highly 3-dimensional (3D) intraventricular flow.
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Affiliation(s)
- John C Westerdale
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona, USA
| | - Ronald Adrian
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona, USA
| | - Kyle Squires
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona, USA
| | - Hari Chaliki
- Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
| | - Marek Belohlavek
- Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
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15
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Witschey WR, Zhang D, Contijoch F, McGarvey JR, Lee M, Takebayashi S, Aoki C, Han Y, Han J, Barker AJ, Pilla JJ, Gorman RC, Gorman JH. The Influence of Mitral Annuloplasty on Left Ventricular Flow Dynamics. Ann Thorac Surg 2015; 100:114-121. [PMID: 25975941 DOI: 10.1016/j.athoracsur.2015.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/03/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mitral valve (MV) repair using annuloplasty rings is the preferred method of treatment for MV regurgitation, but the impact of annuloplasty ring placement on left ventricular intraventricular flow has not been studied. METHODS Annuloplasty rings of varying sizes were placed in 5 healthy sheep (intercommissural ring sizes were 24, 26, 28, 30, and 32 mm), and three-dimensional phase contrast magnetic resonance imaging (4D flow MRI) was performed before and 1 week after ring placement. RESULTS Normal diastolic flow consisted of diastolic intraventricular vortices that naturally unwound during systole. Postsurgical intraventricular flow was highly disturbed in all sheep, and the disturbance was greatest for undersized rings. Ring size was highly correlated with the diastolic inflow angle (Pearson's r = -0.62, p < 0.1, 95% confidence interval: -0.92 to 0.14). There was a mean angle increase of mean diastolic inflow angle increase of 12.3 degrees (< 30 mm, p < 0.01, 95% confidence interval: 4.8 to 19.6) for rings less than 30 mm. There was an inverse relationship between peak velocity and annuloplasty ring area (Pearson's r = -0.80, p < 0.05, 95% confidence interval: -0.96 to -0.2). Transmitral pressure gradients increased significantly from baseline 0.73 ± 0.18 mm Hg to after annuloplasty 2.31 ± 1.04 mm Hg (p < 0.05). CONCLUSIONS Mitral valve annuloplasty ring placement disturbs normal left ventricular intraventricular flow patterns, and the degree of disturbance is closely associated with annuloplasty ring size.
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Affiliation(s)
- Walter Rt Witschey
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Donald Zhang
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA
| | - Francisco Contijoch
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy R McGarvey
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA
| | - Madonna Lee
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA
| | - Satoshi Takebayashi
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA
| | - Chikashi Aoki
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuchi Han
- Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce Han
- Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, USA
| | | | - James J Pilla
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA
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16
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Su B, Kabinejadian F, Phang HQ, Kumar GP, Cui F, Kim S, Tan RS, Hon JKF, Allen JC, Leo HL, Zhong L. Numerical Modeling of Intraventricular Flow during Diastole after Implantation of BMHV. PLoS One 2015; 10:e0126315. [PMID: 25961285 PMCID: PMC4427484 DOI: 10.1371/journal.pone.0126315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/31/2015] [Indexed: 12/20/2022] Open
Abstract
This work presents a numerical simulation of intraventricular flow after the implantation of a bileaflet mechanical heart valve at the mitral position. The left ventricle was simplified conceptually as a truncated prolate spheroid and its motion was prescribed based on that of a healthy subject. The rigid leaflet rotation was driven by the transmitral flow and hence the leaflet dynamics were solved using fluid-structure interaction approach. The simulation results showed that the bileaflet mechanical heart valve at the mitral position behaved similarly to that at the aortic position. Sudden area expansion near the aortic root initiated a clockwise anterior vortex, and the continuous injection of flow through the orifice resulted in further growth of the anterior vortex during diastole, which dominated the intraventricular flow. This flow feature is beneficial to preserving the flow momentum and redirecting the blood flow towards the aortic valve. To the best of our knowledge, this is the first attempt to numerically model intraventricular flow with the mechanical heart valve incorporated at the mitral position using a fluid-structure interaction approach. This study facilitates future patient-specific studies.
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Affiliation(s)
- Boyang Su
- National Heart Research Institute of Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Foad Kabinejadian
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Hui Qun Phang
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | | | - Fangsen Cui
- Institute of High Performance Computing, ASTAR, Singapore, Singapore
| | - Sangho Kim
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Ru San Tan
- National Heart Research Institute of Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Jimmy Kim Fatt Hon
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | | | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Liang Zhong
- National Heart Research Institute of Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
- * E-mail:
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17
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Domenichini F, Pedrizzetti G. Asymptotic Model of Fluid-Tissue Interaction for Mitral Valve Dynamics. Cardiovasc Eng Technol 2014; 6:95-104. [PMID: 26577230 DOI: 10.1007/s13239-014-0201-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/03/2014] [Indexed: 11/24/2022]
Abstract
The vortex formation process inside the left ventricle is intrinsically connected to the dynamics of the mitral leaflets while they interact with the flow crossing the valve during diastole. The description of the dynamics of a natural mitral valve still represents a challenging issue, especially because its material properties are not measurable in vivo. Medical imaging can provide some indications about the geometry of the valve, but not about its mechanical properties. In this work, we introduce a parametric model of the mitral valve geometry, whose motion is described in the asymptotic limit under the assumption that it moves with the flow, without any additional resistance other than that given by its shape, and without the need to specify its material properties. The mitral valve model is coupled with a simple description of the left ventricle geometry, and their dynamics is solved numerically together with the equations ruling the blood flow. The intra-ventricular flow is analyzed in its relationship with the valvular motion. It is found that the initial valve opening anticipates the peak velocity of the Early filling wave with little influence of the specific geometry; while subsequent closure and re-opening are more dependent on the intraventricular vortex dynamics and thus on the leaflets' geometry itself. The limitations and potential applications of the proposed model are discussed.
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Affiliation(s)
- Federico Domenichini
- Dipartimento di Ingegneria Civile e Ambientale, Università di Firenze, Via S. Marta 3, 50139, Florence, Italy.
| | - Gianni Pedrizzetti
- Dipartimento di Ingegneria e Architettura, Università di Trieste, P. le Europa 1, 34127, Trieste, Italy
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18
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Choi YJ, Vedula V, Mittal R. Computational Study of the Dynamics of a Bileaflet Mechanical Heart Valve in the Mitral Position. Ann Biomed Eng 2014; 42:1668-80. [DOI: 10.1007/s10439-014-1018-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
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Sawai T, Nakahira J, Shimoyama Y, Oka M, Imanaka H, Minami T. Prosthetic valve malfunction caused by chordal entrapment detected by transesophageal echocardiography. J Cardiothorac Vasc Anesth 2010; 25:495-7. [PMID: 20638868 DOI: 10.1053/j.jvca.2010.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Toshiyuki Sawai
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Japan.
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20
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Faludi R, Szulik M, D'hooge J, Herijgers P, Rademakers F, Pedrizzetti G, Voigt JU. Left ventricular flow patterns in healthy subjects and patients with prosthetic mitral valves: An in vivo study using echocardiographic particle image velocimetry. J Thorac Cardiovasc Surg 2010; 139:1501-10. [DOI: 10.1016/j.jtcvs.2009.07.060] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 06/10/2009] [Accepted: 07/06/2009] [Indexed: 10/19/2022]
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21
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Affiliation(s)
- Carl Johan Carlhäll
- Department of Clinical Physiology, University Hospital and Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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22
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On the Left Ventricular Vortex Reversal after Mitral Valve Replacement. Ann Biomed Eng 2010; 38:769-73. [DOI: 10.1007/s10439-010-9928-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2008] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
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23
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Watanabe H, Sugiura S, Hisada T. The looped heart does not save energy by maintaining the momentum of blood flowing in the ventricle. Am J Physiol Heart Circ Physiol 2008; 294:H2191-6. [DOI: 10.1152/ajpheart.00041.2008] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Previous studies suggested that the reconstruction or maintenance of physiological blood flow paths in the heart is important to obtain a good outcome following cardiac surgery, but this concept has no established theoretical foundation. We developed a multiscale, multiphysics heart simulator, based on the finite element method, and compared the hemodynamics of ventricles with physiological and nonphysiological flow paths. We found that the physiological flow path did not have an energy-saving effect but facilitated the separation of the outflow and inflow paths, so avoiding any mixing of the blood. The work performed by the ventricular wall was comparable at slower and faster heart rates (physiological vs. nonphysiological, 0.864 vs. 0.874 J, heart rate = 60 beats/min; and 0.599 vs. 0.590 J, heart rate = 100 beats/min), indicating that chiral asymmetry of the flow paths in the mammalian heart has minimal functional merit. At lower heart rates, the blood coming in the first beat was cleared almost completely by the ninth beat in both models. However, at high heart rates, such complete clearance was observed only in the physiological model, whereas 27.0% of blood remained in the nonphysiological model. This multiscale heart simulator provided detailed information on the cardiac mechanics and flow dynamics and could be a useful tool in cardiac physiology.
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