Flow through a defective mechanical heart valve: a steady flow analysis

Simulation of Mechanical Heart Valve Dysfunction and the Non-Newtonian Blood Model Approach

The mechanical heart valve (MHV) is commonly used for the treatment of cardiovascular diseases. Nonphysiological hemodynamic in the MHV may cause hemolysis, platelet activation, and an increased risk of thromboembolism. Thromboembolism may cause severe complications and valve dysfunction. This paper thoroughly reviewed the simulation of physical quantities (velocity distribution, vortex formation, and shear stress) in healthy and dysfunctional MHV and reviewed the non-Newtonian blood flow characteristics in MHV. In the MHV numerical study, the dysfunction will affect the simulation results, increase the pressure gradient and shear stress, and change the blood flow patterns, increasing the risks of hemolysis and platelet activation. The blood flow passes downstream and has obvious recirculation and stagnation region with the increased dysfunction severity. Due to the complex structure of the MHV, the non-Newtonian shear-thinning viscosity blood characteristics become apparent in MHV simulations. The comparative study between Newtonian and non-Newtonian always shows the difference. The shear-thinning blood viscosity model is the basics to build the blood, also the blood exhibiting viscoelastic properties. More details are needed to establish a complete and more realistic simulation.

Hemodynamic Performance of Dysfunctional Prosthetic Heart Valve with the Concomitant Presence of Subaortic Stenosis: In Silico Study

The prosthetic heart valve is vulnerable to dysfunction after surgery, thus a frequent assessment is required. Doppler electrocardiography and its quantitative parameters are commonly used to assess the performance of the prosthetic heart valves and provide detailed information on the interaction between the heart chambers and related prosthetic valves, allowing early detection of complications. However, in the case of the presence of subaortic stenosis, the accuracy of Doppler has not been fully investigated in previous studies and guidelines. Therefore, it is important to evaluate the accuracy of the parameters in such cases to get early detection, and a proper treatment plan for the patient, at the right time. In the current study, a CFD simulation was performed for the blood flow through a Bileaflet Mechanical Heart Valve (BMHV) with concomitant obstruction in the Left Ventricle Outflow Tract (LVOT). The current study explores the impact of the presence of the subaortic on flow patterns. It also investigates the accuracy of (BMHV) evaluation using Doppler parameters, as proposed in the American Society of Echocardiography (ASE) guidelines.

Adverse Hemodynamic Conditions Associated with Mechanical Heart Valve Leaflet Immobility

Artificial heart valves may dysfunction, leading to thrombus and/or pannus formations. Computational fluid dynamics is a promising tool for improved understanding of heart valve hemodynamics that quantify detailed flow velocities and turbulent stresses to complement Doppler measurements. This combined information can assist in choosing optimal prosthesis for individual patients, aiding in the development of improved valve designs, and illuminating subtle changes to help guide more timely early intervention of valve dysfunction. In this computational study, flow characteristics around a bileaflet mechanical heart valve were investigated. The study focused on the hemodynamic effects of leaflet immobility, specifically, where one leaflet does not fully open. Results showed that leaflet immobility increased the principal turbulent stresses (up to 400%), and increased forces and moments on both leaflets (up to 600% and 4000%, respectively). These unfavorable conditions elevate the risk of blood cell damage and platelet activation, which are known to cascade to more severe leaflet dysfunction. Leaflet immobility appeared to cause maximal velocity within the lateral orifices. This points to the possible importance of measuring maximal velocity at the lateral orifices by Doppler ultrasound (in addition to the central orifice, which is current practice) to determine accurate pressure gradients as markers of valve dysfunction.

Purely phase-encoded MRI of turbulent flow through a dysfunctional bileaflet mechanical heart valve

OBJECT

We have used a purely phase-encoded magnetic resonance imaging (MRI) technique, single-point ramped imaging with T1 enhancement (SPRITE), to investigate the steady, turbulent flow dynamics through a bileaflet mechanical heart valve (BMHV).

MATERIALS AND METHODS

We have measured in vitro the turbulent diffusivity and velocity downstream of the valve in two configurations (fully opened and partially opened), which mimic normal and dysfunctional operation. Our constant-time implementation of the MRI measurement is unusually robust to fast turbulent flows, and to artefacts caused by the pyrolytic carbon construction of the valve.

RESULTS

Turbulent diffusivity downstream of the normally functioning valve peaks at 1.05 × 10(-6)m(2)/s, while the turbulent diffusivity is higher downstream of the dysfunctional valve (peaking at 3.15 × 10(-6) m(2)/s) and is accompanied by a high-velocity fluid jet and re-circulating flow. The fluid jet is not along the centreline of the valve, as might be anticipated in conventional Doppler echocardiography measurements.

CONCLUSION

The nature of motion-sensitized SPRITE makes it unusually capable in turbulent flows and near to boundaries between different magnetic susceptibilities. These qualities have allowed us to compare the three-dimensional flow fields through normal and dysfunctional BMHVs.

Biomechanical assessment of surgical repair of the mitral valve

Repair of the mitral valve is defined (loosely) as a procedure that alters the valve structure, without replacement, enabling the natural valve itself to continue to perform under the physical conditions to which it is exposed. As the mitral valve is driven by flow and pressure, it should be feasible to analyse and assess its function, failure and repair as a mechanical system. This article reviews the current state of mechanical evaluation of surgical repairs of the failed mitral valve of the heart. This review describes the anatomy and physiology of the mitral valve, followed by the failure of the mitral valve from a mechanical point of view. The surgical methods used to repair failed valves are introduced, while the use of engineering analysis to aid understanding of mitral valve repair is also reviewed. Finally, a section on recommendations for development and future uses of engineering techniques to surgical repair are presented.

A new index measured by cardiovascular magnetic resonance imaging to detect mechanical heart valve malfunction

More than two thirds of valve replacement operations performed each year used mechanical heart valve. These valves are subject to complications such: pannus and/or thrombus formation. One other potential complication is a malfunction in one of the valve leaflets. It is then important to develop parameters that will allow a non-invasive diagnosis of such valve malfunction. In the present study, we evaluated under steady low flow (1-8 L/min) and pulsatile flow (3, 5 and 7 L/min) a bileafleat mechanical heart valve with normal function, 50% and 100% of one valve leaflet malfunction. Image analysis was performed using cardiovascular magnetic resonance imaging to evaluate transvalvular pressure gradients (TPG), effective orifice area and a new index given by central/lateral velocity ratio downstream of the valve. Our results showed that the flow upstream and downstream of the defective valve is highly influenced by malfunction severity. TPG did not allow differentiating valve malfunction at low flow under steady and pulsatile conditions. However the new index given by central/lateral ratio allowed differentiating the presence of valve malfunction using a single transverse velocity measurement.