Computational analysis of blood flow and stress patterns in the aorta of patients with Marfan syndrome

Personalised external aortic root support (PEARS) was designed to prevent progressive aortic dilatation, and the associated risk of aortic dissection, in patients with Marfan syndrome by providing an additional support to the aorta. The objective of this thesis was to understand the biomechanical implications of PEARS surgery as well as to investigate the altered haemodynamics associated with the disease and its treatment. Finite element (FE) models were developed using patient-specific aortic geometries reconstructed from pre and post-PEARS magnetic resonance (MR) images of three Marfan patients. The wall and PEARS materials were assumed to be isotropic, incompressible and linearly elastic. A static load on the inner wall corresponding to the patients’ pulse pressure was applied with a zero-displacement constraint at all boundaries. Results showed that peak aortic stresses and displacements before PEARS were located at the sinuses of Valsalva but following PEARS surgery, they were shifted to the aortic arch, at the intersection between the supported and unsupported aorta. The zero-displacement constraint at the aortic root was subsequently removed and replaced with downward motion measured from in vivo images. This revealed significant increases in the longitudinal wall stress, especially in the pre-PEARS models. Computational fluid dynamics (CFD) models were developed to evaluate flow characteristics. The correlation-based transitional Shear Stress Transport (SST-Tran) model was adopted to simulate potential transitional and turbulence flow during part of the cardiac cycle and flow waveforms derived from phase-contrast MR images were imposed at the inlets. Qualitative patterns of the haemodynamics were similar pre- and post-PEARS with variations in mean helicity flow index (HFI) of -10%, 35% and 20% in the post-PEARS aortas of the three patients. A fluid-structure interaction (FSI) model was developed for one patient, pre- and post-PEARS in order to examine the effect of wall compliance on aortic flow as well as the effect of pulsatile flow on wall stress. This model excluded the sinuses and was based on the laminar flow assumption. The results were similar to those obtained using the rigid wall and static structural models, with minor quantitative differences. Considering the higher computational cost of FSI simulations and the relatively small differences observed in peak wall stress, it is reasonable to suggest that static structural models would be sufficient for wall stress prediction. Additionally, aortic root motion had a more profound effect on wall stress than wall compliance. Further studies are required to assess the statistical significance of the findings outlined in this thesis. Recommendations for future work were also highlighted, with emphasis on model assumptions including material properties, residual stress and boundary conditions.Open Acces

Immersed boundary-finite element model of fluid-structure interaction in the aortic root

It has long been recognized that aortic root elasticity helps to ensure efficient aortic valve closure, but our understanding of the functional importance of the elasticity and geometry of the aortic root continues to evolve as increasingly detailed in vivo imaging data become available. Herein, we describe fluid-structure interaction models of the aortic root, including the aortic valve leaflets, the sinuses of Valsalva, the aortic annulus, and the sinotubular junction, that employ a version of Peskin's immersed boundary (IB) method with a finite element (FE) description of the structural elasticity. We develop both an idealized model of the root with three-fold symmetry of the aortic sinuses and valve leaflets, and a more realistic model that accounts for the differences in the sizes of the left, right, and noncoronary sinuses and corresponding valve cusps. As in earlier work, we use fiber-based models of the valve leaflets, but this study extends earlier IB models of the aortic root by employing incompressible hyperelastic models of the mechanics of the sinuses and ascending aorta using a constitutive law fit to experimental data from human aortic root tissue. In vivo pressure loading is accounted for by a backwards displacement method that determines the unloaded configurations of the root models. Our models yield realistic cardiac output at physiological pressures, with low transvalvular pressure differences during forward flow, minimal regurgitation during valve closure, and realistic pressure loads when the valve is closed during diastole. Further, results from high-resolution computations demonstrate that IB models of the aortic valve are able to produce essentially grid-converged dynamics at practical grid spacings for the high-Reynolds number flows of the aortic root

Evolution and rupture of vulnerable plaques: a review of mechanical effects

Atherosclerosis occurs as a result of the buildup and infiltration of lipid streaks in artery walls, leading to plaques. Understanding the development of atherosclerosis and plaque vulnerability is of critical importance, since plaque rupture can result in heart attack or stroke. Plaques can be divided into two distinct types: those that rupture (vulnerable) and those that are less likely to rupture (stable). In the last few decades, researchers have been interested in studying the influence of the mechanical effects (blood shear stress, pressure forces, and structural stress) on the plaque formation and rupture processes. In the literature, physiological experimental studies are limited by the complexity of in vivo experiments to study such effects, whereas the numerical approach often uses simplified models compared with realistic conditions, so that no general agreement of the mechanisms responsible for plaque formation has yet been reached. In addition, in a large number of cases, the presence of plaques in arteries is asymptomatic. The prediction of plaque rupture remains a complex question to elucidate, not only because of the interaction of numerous phenomena involved in this process (biological, chemical, and mechanical) but also because of the large time scale on which plaques develop. The purpose of the present article is to review the current mechanical models used to describe the blood flow in arteries in the presence of plaques, as well as reviewing the literature treating the influence of mechanical effects on plaque formation, development, and rupture. Finally, some directions of research, including those being undertaken by the authors, are described

Computational analysis of the hemodynamic performance of novel endovascular and surgical procedures for complex aortic diseases

Novel branched stent-grafts (BSG) have been developed for endovascular repair of complex thoracic aortic aneurysms (TAA) involving the aortic arch or thoracoabdominal aorta, but their haemodynamic performance has not been adequately studied. In addition, surgical replacement of the ascending aorta with a Dacron graft remains the gold standard for type A aortic dissection (TAAD), although 12% of patients are at risk of aortic rupture due to further dilatation of the residual dissected aorta. The underlying mechanisms for progressive aortic dilatation following TAAD repair are poorly understood, but haemodynamic and biomechanical factors are believed to play an important role. Therefore, the present study aims to provide more insights into the haemodynamics in novel BSGs developed for treating complex aortic diseases, and a comprehensive evaluation of flow and biomechanical conditions in post-surgery TAADs by means of state-of-the-art computational methods. The first part of this thesis focuses on evaluating the haemodynamic performance of novel BSG designs, including thoracoabdominal branch endoprosthesis (TAMBE) and dual-branched thoracic endograft. Haemodynamics in idealised and patient-specific BSG models has been analysed by examining side branch outflow waveforms, wall shear stress related indices, and displacement forces, in order to assess their long-term durability. The numerical results show that all the stent-graft models examined in this study are capable of providing normal blood perfusion to side vessels, and are at low risk of in-stent thrombosis and device migration. Furthermore, it has been shown that geometric variations in TAMBE do not affect the key haemodynamic results, indicating its potential suitability for a variety of visceral artery anatomies. Comparisons of dual-branched thoracic endograft models with different inner tunnel diameters suggest that BSGs with larger inner tunnel diameters than the respective vessels would be preferred. Comparisons between the pre- and post-intervention models show that insertion of a dual-branched stent-graft significantly alters the flow pattern in the aortic arch, some of which may have a detrimental effect in the long term, thus requiring follow-up studies. The second part of the thesis provides a comprehensive analysis of the haemodynamic and biomechanical conditions in surgically repaired TAAD. Geometric and haemodynamic parameters have been analyzed and compared between the group of patients with stable aortic diameter and another group with progressive aortic dilatation. The number of re-entry tears (6±5 vs 2±1;P= 0.02) and luminal pressure difference (1.3 ±1 vs 11.7 ±14.6 mmHg;P= 0.001) have been identified as potential predictors of progressive aortic dilatation in TAAD patients following surgical repair. This is an important finding and can potentially assist clinicians to make the most appropriate choice or surgical plan for individual patients. Based on the finite element analysis of four patient-specific cases, there are no clear differences in biomechanical parameters between the stable and unstable groups. Furthermore, a preliminary fluid-solid interaction (FSI) simulation performed on a single TAAD model has demonstrated the important influence of wall compliance on pressures in the true and false lumen. Compared to a rigid wall model, the FSI simulation results show a reduction in systolic pressure by up to 10 mmHg and a slight increase in diastolic pressure. However, pressures in the true and false lumen are affected in the same way, so that the luminal pressure difference remains the same between the rigid and FSI models.Open Acces

Computational analysis of flow and stress patterns in thoracic aortic aneurysms : a patient specific study

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A study of blood flow in normal and dilated aorta

Indiana University-Purdue University Indianapolis (IUPUI)Atherosclerotic lesions of human beings are common diagnosed in regions of arte- rial branching and curvature. The prevalence of atherosclerosis is usually associated with hardening and ballooning of aortic wall surfaces because of narrowing of flow path by the deposition of fatty materials, platelets and influx of plasma through in- timal wall of Aorta. High Wall Shear Stress (WSS) is proved to be the main cause behind all these aortic diseases by physicians and researchers. Due to the fact that the atherosclerotic regions are associated with complex blood flow patterns, it has believed that hemodynamics and fluid-structure interaction play important roles in regulating atherogenesis. As one of the most complex flow situations found in cardio- vascular system due to the strong curvature effects, irregular geometry, tapering and branching, and twisting, theoretical prediction and in vivo quantitative experimental data regarding to the complex blood flow dynamics are substantial paucity. In recent years, computational fluid dynamics (CFD) has emerged as a popular research tool to study the characteristics of aortic flow and aim to enhance the understanding of the underlying physics behind arteriosclerosis. In this research, we study the hemo- dynamics and flow-vessel interaction in patient specific normal (healthy) and dilated (diseased) aortas using Ansys-Fluent and Ansys-Workbench. The computation con- sists of three parts: segmentation of arterial geometry for the CFD simulation from computed tomography (CT) scanning data using MIMICS; finite volume simulation of hemodynamics of steady and pulsatile flow using Ansys-Fluent; an attempt to perform the Fluid Structure Simulation of the normal aorta using Ansys-Workbench. Instead of neglecting the branching or smoothing out the wall for simplification as a lot of similar computation in literature, we use the exact aortic geometry. Segmen- tation from real time CT images from two patients, one young and another old to represent healthy and diseased aorta respectively, is on MIMICS. The MIMICS seg- mentation operation includes: first cropping the required part of aorta from CT dicom data of the whole chest, masking of the aorta from coronal, axial and saggital views of the same to extract the exact 3D geometry of the aorta. Next step was to perform surface improvement using MIMICS 3-matic module to repair for holes, noise shells and overlapping triangles to create a good quality surface of the geometry. A hexahe- dral volume mesh was created in T-Grid. Since T-grid cannot recognize the geometry format created by MIMICS 3-matic; the required step geometry file was created in Pro-Engineer. After the meshing operation is performed, the mesh is exported to Ansys Fluent to perform the required fluid simulation imposing adequate boundary conditions accordingly. Two types of study are performed for hemodynamics. First is a steady flow driven by specified parabolic velocity at inlet. We captured the flow feature such as skewness of velocity around the aortic arch regions and vortices pairs, which are in good agreement with open data in literature. Second is a pulsatile flow. Two pulsatile velocity profiles are imposed at the inlet of healthy and diseased aorta respectively. The pulsatile analysis was accomplished for peak systolic, mid systolic and diastolic phase of the entire cardiac cycle. During peak systole and mid-systole, high WSS was found at the aortic branch roots and arch regions and diastole resulted in flow reversals and low WSS values due to small aortic inflow. In brief, areas of sudden geometry change, i.e. the branch roots and irregular surfaces of the geom- etry experience more WSS. Also it was found that dilated aorta has more sporadic nature of WSS in different regions than normal aorta which displays a more uniform WSS distribution all over the aorta surface. Fluid-Structure Interaction simulation is performed on Ansys-WorkBench through the coupling of fluid dynamics and solid mechanics. Focus is on the maximum displacement and equivalent stress to find out the future failure regions for the peak velocity of the cardiac cycle

Fluid-structure interaction analysis of the aortic valve in young healthy, ageing and post treatment conditions

Optimal aortic valve function, limitation of blood damage, and frequency of thromboembolic events are all dependent upon the haemodynamics within the aortic root. Improved understanding of the young healthy physiological state via investigation of the fluid dynamics around and through the aortic valve is essential to identify detrimental changes leading to pathologies and develop novel therapeutic procedures. The aim of this study is to develop a numerical model that can support a better comprehension of the valve function and serve as a reference to identify the changes produced by specific pathologies and treatments. A Fluid-structure interaction (FSI) numerical model was developed and adapted to accurately replicate the conditions of a previous in vitro investigation into aortic valve dynamics, performed by means of particle image velocimetry (PIV). The model was validated on equivalent physical settings, in a pulse duplicator replicating the physiological healthy flow and pressure experienced in the left heart chambers. The resulting velocity fields and hydrodynamic valve performance indicators of the two analyses were qualitatively and quantitatively compared to validate the numerical model. The validated FSI model was then used to describe realistic young healthy, ageing and post treatment conditions, by eliminating the experimental and methodological limitations and approximations. In detail, in terms of treatments, both surgical and transcatheter valve replacement procedures were investigated. In terms of pathologies, typical alterations frequently due to ageing, namely thickening of the valve leaflets and progressive dilation of the aortic chamber, were studied. The analysis was performed by comparing the data obtained for the ageing and post treatment configurations with those of the young healthy root environment. The results were analysed in terms of leaflets kinematics, flow dynamics, pressure and valve performance parameters. The study suggests a new operating mechanism for the young healthy aortic valve leaflets considerably different from what reported in the literature to date and largely more efficient in terms of hydrodynamic performance