5,144 research outputs found
Modelling mitral valvular dynamicsâcurrent trend and future directions
Dysfunction of mitral valve causes morbidity and premature mortality and remains a leading medical problem worldwide. Computational modelling aims to understand the biomechanics of human mitral valve and could lead to the development of new treatment, prevention and diagnosis of mitral valve diseases. Compared with the aortic valve, the mitral valve has been much less studied owing to its highly complex structure and strong interaction with the blood flow and the ventricles. However, the interest in mitral valve modelling is growing, and the sophistication level is increasing with the advanced development of computational technology and imaging tools. This review summarises the state-of-the-art modelling of the mitral valve, including static and dynamics models, models with fluid-structure interaction, and models with the left ventricle interaction. Challenges and future directions are also discussed
A finite strain nonlinear human mitral valve model with fluid structure interaction
A simulated human mitral valve under a physiological pressure loading is developed using a hybrid finite element immersed boundary method, which incorporates experimentally based constitutive laws in a three-dimensional fluid-structure interaction framework. A transversely isotropic material constitutive model is used for characterizing the mechanical behaviour of the mitral valve tissue based on recent mechanical tests of healthy human mitral leaflets. Our results show good agreement, in terms of the flow rate and the closing and opening configurations, with the measurements from the magnetic resonance images. The stresses in the anterior leaflet are found to be higher than those in the posterior leaflet, and concentrated around the annulus trigons and free edges of the valve leaflets. Those areas are located where the leaflet has the highest curvature. Effects of the chordae tendineae in the material model are studied and the results show that these chordae play an important role in providing a secondary orifice for the flow when valve opens. Although there are some discrepancies to be overcome in future works, our simulations show that the developed computational model is promising in mimicking the in vivo mitral valve dynamics and providing important information that are not obtainable by in vivo measurements. This article is protected by copyright. All rights reserved
A coupled mitral valve -- left ventricle model with fluid-structure interaction
Understanding the interaction between the valves and walls of the heart is
important in assessing and subsequently treating heart dysfunction. With
advancements in cardiac imaging, nonlinear mechanics and computational
techniques, it is now possible to explore the mechanics of valve-heart
interactions using anatomically and physiologically realistic models. This
study presents an integrated model of the mitral valve (MV) coupled to the left
ventricle (LV), with the geometry derived from in vivo clinical magnetic
resonance images. Numerical simulations using this coupled MV-LV model are
developed using an immersed boundary/finite element method. The model
incorporates detailed valvular features, left ventricular contraction,
nonlinear soft tissue mechanics, and fluid-mediated interactions between the MV
and LV wall. We use the model to simulate the cardiac function from diastole to
systole, and investigate how myocardial active relaxation function affects the
LV pump function. The results of the new model agree with in vivo measurements,
and demonstrate that the diastolic filling pressure increases significantly
with impaired myocardial active relaxation to maintain the normal cardiac
output. The coupled model has the potential to advance fundamental knowledge of
mechanisms underlying MV-LV interaction, and help in risk stratification and
optimization of therapies for heart diseases.Comment: 25 pages, 6 figure
A parallel interaction potential approach coupled with the immersed boundary method for fully resolved simulations of deformable interfaces and membranes
In this paper we show and discuss the use of a versatile interaction
potential approach coupled with an immersed boundary method to simulate a
variety of flows involving deformable bodies. In particular, we focus on two
kinds of problems, namely (i) deformation of liquid-liquid interfaces and (ii)
flow in the left ventricle of the heart with either a mechanical or a natural
valve. Both examples have in common the two-way interaction of the flow with a
deformable interface or a membrane. The interaction potential approach (de
Tullio & Pascazio, Jou. Comp. Phys., 2016; Tanaka, Wada and Nakamura,
Computational Biomechanics, 2016) with minor modifications can be used to
capture the deformation dynamics in both classes of problems. We show that the
approach can be used to replicate the deformation dynamics of liquid-liquid
interfaces through the use of ad-hoc elastic constants. The results from our
simulations agree very well with previous studies on the deformation of drops
in standard flow configurations such as deforming drop in a shear flow or a
cross flow. We show that the same potential approach can also be used to study
the flow in the left ventricle of the heart. The flow imposed into the
ventricle interacts dynamically with the mitral valve (mechanical or natural)
and the ventricle which are simulated using the same model. Results from these
simulations are compared with ad- hoc in-house experimental measurements.
Finally, a parallelisation scheme is presented, as parallelisation is
unavoidable when studying large scale problems involving several thousands of
simultaneously deforming bodies on hundreds of distributed memory computing
processors
Material transport in the left ventricle with aortic valve regurgitation
This experimental in vitro work investigates material transport properties in
a model left ventricle in the case of aortic regurgitation, a valvular disease
characterized by a leaking aortic valve and consequently double-jet filling
within the elastic left ventricular geometry. This study suggests that material
transport phenomena are strongly determined by the motion of the
counterrotating vortices driven by the regurgitant aortic and mitral jets. The
overall particle residence time appears to be significantly longer with
moderate aortic regurgitation, attributed to the dynamics resulting from the
timing between the onset of the two jets. Increasing regurgitation severity is
shown to be associated with higher frequencies in the time-frequency spectra of
the velocity signals at various points in the flow, suggesting nonlaminar
mixing past moderate regurgitation. Additionally, a large part of the
regurgitant inflow is retained for at least one cardiac cycle. Such an increase
in particle residence time accompanied by the occurrence and persistence of a
number of attracting Lagrangian coherent structures presents favorable
conditions and locations for activated platelets to agglomerate within the left
ventricle, potentially posing an additional risk factor for patients with
aortic regurgitation
Three-dimensional structure of the flow inside the left ventricle of the human heart
The laboratory models of the human heart left ventricle developed in the last
decades gave a valuable contribution to the comprehension of the role of the
fluid dynamics in the cardiac function and to support the interpretation of the
data obtained in vivo. Nevertheless, some questions are still open and new ones
stem from the continuous improvements in the diagnostic imaging techniques.
Many of these unresolved issues are related to the three-dimensional structure
of the left-ventricular flow during the cardiac cycle. In this paper we
investigated in detail this aspect using a laboratory model. The ventricle was
simulated by a flexible sack varying its volume in time according to a
physiologically shaped law. Velocities measured during several cycles on series
of parallel planes, taken from two orthogonal points of view, were combined
together in order to reconstruct the phase averaged, three-dimensional velocity
field. During the diastole, three main steps are recognized in the evolution of
the vortical structures: i) straight propagation in the direction of the long
axis of a vortex-ring originated from the mitral orifice; ii) asymmetric
development of the vortex-ring on an inclined plane; iii) single vortex
formation. The analysis of three-dimensional data gives the experimental
evidence of the reorganization of the flow in a single vortex persisting until
the end of the diastole. This flow pattern seems to optimize the cardiac
function since it directs velocity towards the aortic valve just before the
systole and minimizes the fraction of blood residing within the ventricle for
more cycles
Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image-Based PatientâSpecific In Silico Modeling
Background: Mixed valvular disease (MVD), mitral regurgitation (MR) from preâexisting disease in conjunction with paravalvular leak (PVL) following transcatheter aortic valve replacement (TAVR), is one of the most important stimuli for left ventricle (LV) dysfunction, associated with cardiac mortality. Despite the prevalence of MVD, the quantitative understanding of the interplay between preâexisting MVD, PVL, LV, and postâTAVR recovery is meager.
Methods and Results: We quantified the effects of MVD on valvularâventricular hemodynamics using an imageâbased patientâspecific computational framework in 72 MVD patients. Doppler pressure was reduced by TAVR (mean, 77%; N=72; P<0.05), but it was not always accompanied by improvements in LV workload. TAVR had no effect on LV workload in 22 patients, and LV workload postâTAVR significantly rose in 32 other patients. TAVR reduced LV workload in only 18 patients (25%). PVL significantly alters LV flow and increases shear stress on transcatheter aortic valve leaflets. It interacts with mitral inflow and elevates shear stresses on mitral valve and is one of the main contributors in worsening of MR postâTAVR. MR worsened in 32 patients postâTAVR and did not improve in 18 other patients.
Conclusions: PVL limits the benefit of TAVR by increasing LV load and worsening of MR and heart failure. PostâTAVR, most MVD patients (75% of N=72; P<0.05) showed no improvements or even worsening of LV workload, whereas the majority of patients with PVL, but without that preâexisting MR condition (60% of N=48; P<0.05), showed improvements in LV workload. MR and its exacerbation by PVL may hinder the success of TAVR
Patient-specific CFD simulation of intraventricular haemodynamics based on 3D ultrasound imaging
Background: The goal of this paper is to present a computational fluid dynamic (CFD) model with moving boundaries to study the intraventricular flows in a patient-specific framework. Starting from the segmentation of real-time transesophageal echocardiographic images, a CFD model including the complete left ventricle and the moving 3D mitral valve was realized. Their motion, known as a function of time from the segmented ultrasound images, was imposed as a boundary condition in an Arbitrary Lagrangian-Eulerian framework.
Results: The model allowed for a realistic description of the displacement of the structures of interest and for an effective analysis of the intraventricular flows throughout the cardiac cycle. The model provides detailed intraventricular flow features, and highlights the importance of the 3D valve apparatus for the vortex dynamics and apical flow.
Conclusions: The proposed method could describe the haemodynamics of the left ventricle during the cardiac cycle. The methodology might therefore be of particular importance in patient treatment planning to assess the impact of mitral valve treatment on intraventricular flow dynamics
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