Simulation of the Three-Dimensional Hinge Flow Fields of a Bileaflet Mechanical Heart Valve Under Aortic Conditions

Thromboembolic complications of bileaflet mechanical heart valves (BMHV) are believed to be due to detrimental stresses imposed on blood elements by the hinge flows. Characterization of these flows is thus crucial to identify the underlying causes for complications. In this study, we conduct three-dimensional pulsatile flow simulations through the hinge of a BMHV under aortic conditions. Hinge and leaflet geometries are reconstructed from the Micro-Computed Tomography scans of a BMHV. Simulations are conducted using a Cartesian sharp-interface immersed-boundary methodology combined with a second-order accurate fractional-step method. Physiologic flow boundary conditions and leaflet motion are extracted from the Fluid–Structure Interaction simulations of the bulk of the flow through a BMHV. Calculations reveal the presence, throughout the cardiac cycle, of flow patterns known to be detrimental to blood elements. Flow fields are characterized by: (1) complex systolic flows, with rotating structures and slow reverse flow pattern, and (2) two strong diastolic leakage jets accompanied by fast reverse flow at the hinge bottom. Elevated shear stresses, up to 1920 dyn/cm2 during systole and 6115 dyn/cm2 during diastole, are reported. This study underscores the need to conduct three-dimensional simulations throughout the cardiac cycle to fully characterize the complexity and thromboembolic potential of the hinge flows

Flow Residence Time and Regions of Intraluminal Thrombus Deposition in Intracranial Aneurysms

Thrombus formation in intracranial aneurysms, while sometimes stabilizing lesion growth, can present additional risk of thrombo-embolism. The role of hemodynamics in the progression of aneurysmal disease can be elucidated by patient-specific computational modeling. In our previous work, patient-specific computational fluid dynamics (CFD) models were constructed from MRI data for three patients who had fusiform basilar aneurysms that were thrombus-free and then proceeded to develop intraluminal thrombus. In this study, we investigated the effect of increased flow residence time (RT) by modeling passive scalar advection in the same aneurysmal geometries. Non-Newtonian pulsatile flow simulations were carried out in base-line geometries and a new postprocessing technique, referred to as “virtual ink” and based on the passive scalar distribution maps, was used to visualize the flow and estimate the flow RT. The virtual ink technique clearly depicted regions of flow separation. The flow RT at different locations adjacent to aneurysmal walls was calculated as the time the virtual ink scalar remained above a threshold value. The RT values obtained in different areas were then correlated with the location of intra-aneurysmal thrombus observed at a follow-up MR study. For each patient, the wall shear stress (WSS) distribution was also obtained from CFD simulations and correlated with thrombus location. The correlation analysis determined a significant relationship between regions where CFD predicted either an increased RT or low WSS and the regions where thrombus deposition was observed to occur in vivo. A model including both low WSS and increased RT predicted thrombus-prone regions significantly better than the models with RT or WSS alone

Device Thrombogenicity Emulation: A Novel Method for Optimizing Mechanical Circulatory Support Device Thromboresistance

Mechanical circulatory support (MCS) devices provide both short and long term hemodynamic support for advanced heart failure patients. Unfortunately these devices remain plagued by thromboembolic complications associated with chronic platelet activation – mandating complex, lifelong anticoagulation therapy. To address the unmet need for enhancing the thromboresistance of these devices to extend their long term use, we developed a universal predictive methodology entitled Device Thrombogenicity Emulation (DTE) that facilitates optimizing the thrombogenic performance of any MCS device – ideally to a level that may obviate the need for mandatory anticoagulation