Outflow boundary conditions for 3D simulations of non-periodic blood flow and pressure fields in deformable arteries

The simulation of blood flow and pressure in arteries requires outflow boundary conditions that incorporate models of downstream domains. We previously described a coupled multidomain method to couple analytical models of the downstream domains with 3D numerical models of the upstream vasculature. This prior work either included pure resistance boundary conditions or impedance boundary conditions based on assumed periodicity of the solution. However, flow and pressure in arteries are not necessarily periodic in time due to heart rate variability, respiration, complex transitional flow or acute physiological changes. We present herein an approach for prescribing lumped parameter outflow boundary conditions that accommodate transient phenomena. We have applied this method to compute haemodynamic quantities in different physiologically relevant cardiovascular models, including patient-specific examples, to study non-periodic flow phenomena often observed in normal subjects and in patients with acquired or congenital cardiovascular disease. The relevance of using boundary conditions that accommodate transient phenomena compared with boundary conditions that assume periodicity of the solution is discussed

A Modular Framework for Implicit 3D-0D Coupling in Cardiac Mechanics

In numerical simulations of cardiac mechanics, coupling the heart to a model of the circulatory system is essential for capturing physiological cardiac behavior. A popular and efficient technique is to use an electrical circuit analogy, known as a lumped parameter network or zero-dimensional (0D) fluid model, to represent blood flow throughout the cardiovascular system. Due to the strong physical interaction between the heart and the blood circulation, developing accurate and efficient numerical coupling methods remains an active area of research. In this work, we present a modular framework for implicitly coupling three-dimensional (3D) finite element simulations of cardiac mechanics to 0D models of blood circulation. The framework is modular in that the circulation model can be modified independently of the 3D finite element solver, and vice versa. The numerical scheme builds upon a previous work that combines 3D blood flow models with 0D circulation models (3D fluid - 0D fluid). Here, we extend it to couple 3D cardiac tissue mechanics models with 0D circulation models (3D structure - 0D fluid), showing that both mathematical problems can be solved within a unified coupling scheme. The effectiveness, temporal convergence, and computational cost of the algorithm are assessed through multiple examples relevant to the cardiovascular modeling community. Importantly, in an idealized left ventricle example, we show that the coupled model yields physiological pressure-volume loops and naturally recapitulates the isovolumic contraction and relaxation phases of the cardiac cycle without any additional numerical techniques. Furthermore, we provide a new derivation of the scheme inspired by the Approximate Newton Method of Chan (1985), explaining how the proposed numerical scheme combines the stability of monolithic approaches with the modularity and flexibility of partitioned approaches

Methods and Algorithms for Cardiovascular Hemodynamics with Applications to Noninvasive Monitoring of Proximal Blood Pressure and Cardiac Output Using Pulse Transit Time

Advanced health monitoring and diagnostics technology are essential to reduce the unrivaled number of human fatalities due to cardiovascular diseases (CVDs). Traditionally, gold standard CVD diagnosis involves direct measurements of the aortic blood pressure (central BP) and flow by cardiac catheterization, which can lead to certain complications. Understanding the inner-workings of the cardiovascular system through patient-specific cardiovascular modeling can provide new means to CVD diagnosis and relating treatment. BP and flow waves propagate back and forth from heart to the peripheral sites, while carrying information about the properties of the arterial network. Their speed of propagation, magnitude and shape are directly related to the properties of blood and arterial vasculature. Obtaining functional and anatomical information about the arteries through clinical measurements and medical imaging, the digital twin of the arterial network of interest can be generated. The latter enables prediction of BP and flow waveforms along this network. Point of care devices (POCDs) can now conduct in-home measurements of cardiovascular signals, such as electrocardiogram (ECG), photoplethysmogram (PPG), ballistocardiogram (BCG) and even direct measurements of the pulse transit time (PTT). This vital information provides new opportunities for designing accurate patient-specific computational models eliminating, in many cases, the need for invasive measurements. One of the main efforts in this area is the development of noninvasive cuffless BP measurement using patient’s PTT. Commonly, BP prediction is carried out with regression models assuming direct or indirect relationships between BP and PTT. However, accounting for the nonlinear FSI mechanics of the arteries and the cardiac output is indispensable. In this work, a monotonicity-preserving quasi-1D FSI modeling platform is developed, capable of capturing the hyper-viscoelastic vessel wall deformation and nonlinear blood flow dynamics in arbitrary arterial networks. Special attention has been dedicated to the correct modeling of discontinuities, such as mechanical properties mismatch associated with the stent insertion, and the intertwining dynamics of multiscale 3D and 1D models when simulating the arterial network with an aneurysm. The developed platform, titled Cardiovascular Flow ANalysis (CardioFAN), is validated against well-known numerical, in vitro and in vivo arterial network measurements showing average prediction errors of 5.2%, 2.8% and 1.6% for blood flow, lumen cross-sectional area, and BP, respectively. CardioFAN evaluates the local PTT, which enables patient-specific calibration and its application to input signal reconstruction. The calibration is performed based on BP, stroke volume and PTT measured by POCDs. The calibrated model is then used in conjunction with noninvasively measured peripheral BP and PTT to inversely restore the cardiac output, proximal BP and aortic deformation in human subjects. The reconstructed results show average RMSEs of 1.4% for systolic and 4.6% for diastolic BPs, as well as 8.4% for cardiac output. This work is the first successful attempt in implementation of deterministic cardiovascular models as add-ons to wearable and smart POCD results, enabling continuous noninvasive monitoring of cardiovascular health to facilitate CVD diagnosis

Integrated Heart - Coupling multiscale and multiphysics models for the simulation of the cardiac function

Mathematical modelling of the human heart and its function can expand our understanding of various cardiac diseases, which remain the most common cause of death in the developed world. Like other physiological systems, the heart can be understood as a complex multiscale system involving interacting phenomena at the molecular, cellular, tissue, and organ levels. This article addresses the numerical modelling of many aspects of heart function, including the interaction of the cardiac electrophysiology system with contractile muscle tissue, the sub-cellular activation-contraction mechanisms, as well as the hemodynamics inside the heart chambers. Resolution of each of these sub-systems requires separate mathematical analysis and specially developed numerical algorithms, which we review in detail. By using specific sub-systems as examples, we also look at systemic stability, and explain for example how physiological concepts such as microscopic force generation in cardiac muscle cells, translate to coupled systems of differential equations, and how their stability properties influence the choice of numerical coupling algorithms. Several numerical examples illustrate three fundamental challenges of developing multiphysics and multiscale numerical models for simulating heart function, namely: (i) the correct upscaling from single-cell models to the entire cardiac muscle, (ii) the proper coupling of electrophysiology and tissue mechanics to simulate electromechanical feedback, and (iii) the stable simulation of ventricular hemodynamics during rapid valve opening and closure

A mathematical model that integrates cardiac electrophysiology, mechanics, and fluid dynamics: Application to the human left heart

: We propose a mathematical and numerical model for the simulation of the heart function that couples cardiac electrophysiology, active and passive mechanics and hemodynamics, and includes reduced models for cardiac valves and the circulatory system. Our model accounts for the major feedback effects among the different processes that characterize the heart function, including electro-mechanical and mechano-electrical feedback as well as force-strain and force-velocity relationships. Moreover, it provides a three-dimensional representation of both the cardiac muscle and the hemodynamics, coupled in a fluid-structure interaction (FSI) model. By leveraging the multiphysics nature of the problem, we discretize it in time with a segregated electrophysiology-force generation-FSI approach, allowing for efficiency and flexibility in the numerical solution. We employ a monolithic approach for the numerical discretization of the FSI problem. We use finite elements for the spatial discretization of partial differential equations. We carry out a numerical simulation on a realistic human left heart model, obtaining results that are qualitatively and quantitatively in agreement with physiological ranges and medical images

Direct numerical simulation of a pulsatile flow in a stenotic channel using immersed boundary method

A three-dimensional direct numerical simulation model coupled with the immersed boundary method has been developed to simulate a pulsatile flow in a planar channel with single and double one-sided semicircular constrictions. For relevance to blood flow in large arteries, simulations have been performed at Reynolds numbers of 750 and 1000. Flow physics and resultant wall shear stress (WSS)-based hemodynamic parameters are presented. The instantaneous vortex dynamics, mean flow characteristics, and turbulent energy spectra are evaluated for flow physics. Subsequently, three WSS-based parameters, namely the time-averaged WSS, oscillatory shear index, and relative residence time, are calculated over the stenotic wall and correlated with flow physics to identify the regions prone to atherosclerotic plaque progression. Results show that the double stenotic channel leads to high-intensity and broadband turbulent characteristics downstream, promoting critical values of the WSS-based parameters in the post-stenotic areas. In addition, the inter-space area between two stenoses displays multiple strong recirculations, making this area highly prone to atherosclerosis progression. The effect of stenosis degree on the WSS-based parameters is studied up to 60% degree. As the degree of occlusion is increased, larger regions are involved with the nonphysiological ranges of the WSS-based parameters

ANALYSE NUMÉRIQUE ET SIMULATIONS DE PROBLÈMES COUPLÉS POUR LE SYSTÈME CARDIOVASCULAIRE

In this thesis we present the numerical analysis and the development of partitioned algorithms in order to couple the blood dynamics in different cardiovascular compartments (3D-3D, 3D-0D). In the first par t a fluid-fluid coupled problem is introduced. On the interface between the domains Robin-Robin boundary conditions, derived from the Nitsche’s interface formulation, are considered. We suggest different staggered explicit schemes whose stability is analyzed in the energy norm. Extensive numerical experiments illustrate the accuracy of the methods presented. The second par t deals with more realistic cardiovascular applications. First a reduced order model for the hear t valves is described. Without dealing with fluid-structure interaction with the blood flow, the valves are replaced by immersed surfaces acting as resistances on the fluid. Numerical simulations show the efficiency and the robustness of this model in the framework of a fluid-fluid interaction scheme. In the end, an ALE formulation is used to solve a fluid model in a moving domain. We show that adding a suitable consistent term, a stable energy inequality can be obtained without considering any Geometric Conservation Laws. The work ends with numerical simulations on blood dynamics in the left ventricle coupled with the blood flowing in the aortaDans cette thèse, nous proposons l’analyse numérique et le développement d’algorithmes par titionnés pour coupler l’écoulement du sang dans différents compar ti- ments cardiovasculaires (3D-3D, 3D-0D). Dans une première par tie, un problème couplé fluide-fluide est introduit. Sur l’interface qui sépare les domaines, des conditions aux limites de type Robin-Robin dérivées de la formulation d’interface de Nitsche sont considérées. Nous proposons différents schémas explicites dont la stabilité est analysée dans la norme de l’énergie. Des simulations numé- riques illustrent le potentiel des méthodes présentées. La deuxième par tie propose des applications cardiovasculaires plus réalistes. Tout d’abord, un modèle d’ordre réduit pour les valves cardiaques est décrit. Sans traiter l’interaction fluide-structure avec le sang, les valves sont remplacées par des surfaces agissant comme des résistances immergées dans le fluide. Des simulations numériques montrent l’efficacité et la robustesse de ce modèle. Pour finir, une formulation ALE est utilisée pour la résolution d’un modèle fluide sur un domaine mobile. Nous montrons qu’en ajoutant un terme consistent, une inégalité d’énergie stable peut être obtenue sans considérer aucune hypothèse de Loi de Conser vation Géométrique. Le travail se termine avec des simulations numériques sur la dynamique du sang dans le ventricule gauche, couplé avec l’écoulement du sang dans l’aorte