Near valve flows and potential blood damage during closure of a bileaflet mechanical heart valve

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.

High-Resolution Measurements of Leakage Flow Inside the Hinge of a Large-scale Bileaflet Mechanical Heart Valve Hinge Model

PURPOSE

It is believed that non-physiological leakage flow through hinge gaps during diastole contributes to thrombus formation in Bileaflet Mechanical Heart Valves (BMHVs). Because of the small scale and difficulty of experimental access, fluid dynamics inside the hinge cavity has not yet been characterised in detail. The objective is to investigate small-scale structure inside the hinge experimentally, and gain insight into its role in stimulating cellular responses.

METHODS

An optically accessible scaled-up model of a BMHV hinge was designed and built, preserving dynamic similarity to a clinical BMHV. Particle Image Velocimetry (PIV) was used to visualize and quantify the flow fields inside the hinge at physiological Reynolds number and dimensionless pressure drop. The flow was measured at in-plane and out-of-plane spatial resolution of 32 and 86 μm, respectively, and temporal resolution of [Formula: see text] RESULTS: Likely flow separation on the ventricular surface of the cavity has been observed for the first time, and is a source of unsteadiness and perhaps turbulence. The shear stress found in all planes exceeds the threshold of platelet activation, ranging up to 168 Pa.

CONCLUSIONS

The scale-up approach provided new insight into the nature of the hinge flow and enhanced understanding of its complexity. This study revealed flow features that may induce blood element damage.

Surgical Aortic Valve Replacement: Are We Able to Improve Hemodynamic Outcome?

Aortic valve replacement (AVR) does not usually restore physiological flow profiles. Complex flow profiles are associated with aorta dilatation, ventricle remodeling, aneurysms, and development of atherosclerosis. All these affect long-term morbidity and often require reoperations. In this pilot study, we aim to investigate an ability to optimize the real surgical AVR procedure toward flow profile associated with healthy persons. Four cases of surgical AVR (two with biological and two with mechanical valve prosthesis) with available post-treatment cardiac magnetic resonance imaging (MRI), including four-dimensional flow MRI and showing abnormal complex post-treatment hemodynamics, were investigated. All cases feature complex hemodynamic outcomes associated with valve-jet eccentricity and strong secondary flow characterized by helical flow and recirculation regions. A commercial computational fluid dynamics solver was used to simulate peak systolic hemodynamics of the real post-treatment outcome using patient-specific MRI measured boundary conditions. Then, an attempt to optimize hemodynamic outcome by modifying valve size and orientation as well as ascending aorta size reduction was made. Pressure drop, wall shear stress, secondary flow degree, helicity, maximal velocity, and turbulent kinetic energy were evaluated to characterize the AVR hemodynamic outcome. The proposed optimization strategy was successful in three of four cases investigated. Although no single parameter was identified as the sole predictor for a successful flow optimization, downsizing of the ascending aorta in combination with the valve orientation was the most effective optimization approach. Simulations promise to become an effective tool to predict hemodynamic outcome. The translation of these tools requires, however, studies with a larger cohort of patients followed by a prospective clinical validation study.

Blood damage through a bileaflet mechanical heart valve: a quantitative computational study using a multiscale suspension flow solver

Bileaflet mechanical heart valves (BMHVs) are among the most popular prostheses to replace defective native valves. However, complex flow phenomena caused by the prosthesis are thought to induce serious thromboembolic complications. This study aims at employing a novel multiscale numerical method that models realistic sized suspended platelets for assessing blood damage potential in flow through BMHVs. A previously validated lattice-Boltzmann method (LBM) is used to simulate pulsatile flow through a 23 mm St. Jude Medical (SJM) Regent™ valve in the aortic position at very high spatiotemporal resolution with the presence of thousands of suspended platelets. Platelet damage is modeled for both the systolic and diastolic phases of the cardiac cycle. No platelets exceed activation thresholds for any of the simulations. Platelet damage is determined to be particularly high for suspended elements trapped in recirculation zones, which suggests a shift of focus in blood damage studies away from instantaneous flow fields and toward high flow mixing regions. In the diastolic phase, leakage flow through the b-datum gap is shown to cause highest damage to platelets. This multiscale numerical method may be used as a generic solver for evaluating blood damage in other cardiovascular flows and devices.

High-Resolution Measurements of Velocity and Shear Stress in Leakage Jets From Bileaflet Mechanical Heart Valve Hinge Models

In flow through cardiovascular implants, hemolysis, and thrombosis may be initiated by nonphysiological shear stress on blood elements. To enhance understanding of the small-scale flow structures that stimulate cellular responses, and ultimately to design devices for reduced blood damage, it is necessary to study the flow-field at high spatial and temporal resolution. In this work, we investigate flow in the reverse leakage jet from the hinge of a bileaflet mechanical heart valve (BMHV). Scaled-up model hinges are employed, enabling measurement of the flow-field at effective spatial resolution of 167 μm and temporal resolution of 594 μs using two-component particle image velocimetry (PIV). High-velocity jets were observed at the hinge outflow, with time-average velocity up to 5.7 m/s, higher than reported in previous literature. Mean viscous shear stress is up to 60 Pa. For the first time, strongly unsteady flow has been observed in the leakage jet. Peak instantaneous shear stress is up to 120 Pa, twice as high as the average value. These high-resolution measurements identify the hinge leakage jet as a region of very high fluctuating shear stress which is likely to be thrombogenic and should be an important target for future design improvement.

Effect of hypertension on the closing dynamics and Lagrangian blood damage index measure of the b-datum regurgitant jet in a bileaflet mechanical heart valve

We hypothesize that the formation of the closing vortex and subsequent b-datum regurgitation jet in bileaflet mechanical heart valves is governed by the magnitude of the driving mean aortic pressure (MAP), and that this sensitivity does impact the blood damage index (BDI) corresponding to platelet activation and lysis. High spatial resolution time resolved (1 kHz) as well as phase locked particle image velocimetry techniques captured the dynamic leaflet closure and regurgitation jet of a model 25 mm St. Jude Medical BMHV. Cell trajectories were estimated using Lagrangian particle tracking analysis while the leaflet kinematics was quantified by tracking the leaflet tip-position throughout closure. The non-principal as well as principal shear stress loading histories along each cell trajectory revealed BDI for platelet activation and lysis as a function of cell initial position, release time-point, and blood pressure. Results show that the leaflet closing time reduces by roughly 10 ms, in response to an increase in MAP by 40 mmHg. We report that higher MAP leads to a stronger b-datum vortex and jet formation. Platelet activation BDI lowers with a higher MAP due to reduction in exposure times despite an increase in principal shear stress experienced. Platelet lysis BDI however increases with higher MAP. Maximum BDI may occur for cells initially in the b-datum zone during the onset of leaflet closure. Our results provide a better understanding of BDI of the regurgitant b-datum jet and sheds light on the potential importance of blood damage testing under hypertensive conditions.