Prediction of Turbulent Shear Stresses through Dysfunctional Bileaflet Mechanical Heart Valves using Computational Fluid Dynamics

There are more than 300,000 heart valves implanted annually worldwide with about 50% of them being mechanical valves. The heart valve replacement is often a common treatment for severe valvular disease. However, valves may dysfunction leading to adverse hemodynamic conditions. The current computational study investigated the flow around a bileaflet mechanical heart valve at different leaflet dysfunction levels of 0%, 50%, and 100%, and documented the relevant flow characteristics such as vortical structures and turbulent shear stresses. Studying the flow characteristics through these valves during their normal operation and dysfunction can lead to better understanding of their performance, possibly improved designs, and help identify conditions that may increase the potential risk of blood cell damage. Results suggested that maximum flow velocities increased with dysfunction from 2.05 to 4.49 ms-1 which were accompanied by growing eddies and velocity fluctuations. These fluctuations led to higher turbulent shear stresses from 90 to 800 N.m-2 as dysfunctionality increased. These stress values exceeded the thresholds corresponding to elevated risk of hemolysis and platelet activation. The regions of elevated stresses were concentrated around and downstream of the functional leaflet where high jet velocity and stronger helical structures existed

Numerical Modeling of Pulse Wave Propagation in a Stenosed Artery using Two-Way Coupled Fluid Structure Interaction (FSI)

As the heart beats, it creates fluctuation in blood pressure leading to a pulse wave that propagates by displacing the arterial wall. These waves travel through the arterial tree and carry information about the medium that they propagate through as well as information of the geometry of the arterial tree. Pulse wave velocity (PWV) can be used as a non-invasive diagnostic tool to study the functioning of cardiovascular system. A stenosis in an artery can dampen the pulse wave leading to changes in the propagating pulse. Hence, PWV analysis can be performed to detect a stenosed region in arteries. This paper presents a numerical study of pulse wave propagation in a stenosed artery by means of two-way coupled fluid structure interaction (FSI). The computational model was validated by the comparison of the simulated PWV results with theoretical values for a healthy artery. Propagation of the pulse waves in the stenosed artery was compared with healthy case using spatiotemporal maps of wall displacements. The analysis for PWV showed significance differences between the healthy and stenosed arteries including damping of propagating waves and generation of high wall displacements downstream the stenosis caused by flow instabilities. This approach can be used to develop patient-specific models that are capable of predicting PWV signatures associated with stenosis changes. The knowledge gained from these models may increase utility of this approach for managing patients at risk of stenosis occurrence

Fluid Dynamics Modeling and Sound Analysis of a Bileaflet Mechanical Heart Valve

Cardiovascular disease (CVD) is one of the main causes of death in the world. Some CVD involve severe heart valve disease that require valve replacement. There are more than 300,000 heart valves implanted worldwide, and about 85,000 heart valve replacements in the US. Approximately half of these valves are mechanical. Artificial valves may dysfunction leading to adverse hemodynamic conditions. Understanding the normal and abnormal valve function is important as it help improve valve designs. Modeling of heart valve hemodynamics using computational fluid dynamics (CFD) provides a comprehensive analysis of flow, which can potentially help explain clinical observations and support therapeutic decision-making. This detailed information might not be accessible with in-vivo measurements. On the other hand, finite element analysis (FEA), is an efficient way to analyze the interactions of blood flow with blood vessel and tissue layers. In this project both CFD and FEA simulations were performed to investigate the flow-induced sound generation and propagation of sound waves through a tissue-like material. This method is based on mapping the transient pressure (force) fluctuations on the vessel wall and solving for the structural vibrations in the frequency domain. These vibrations would then be detected as sound on the epidermal surface. Advantages of the methods used in the current study include: (a) capability of providing accurate solution with a faster solution time; (b) inclusion of the fluid–structure interaction between blood flow and the arterial wall; and (c) accurately capturing some of the spectral features of the velocity fluctuation measured over the epidermal surface

The Influence of the Aortic Root Geometry on Flow Characteristics of a Bileaflet Mechanical Heart Valve

Bileaflet mechanical heart valves have one of the most successful valve designs for more than 30 years. These valves are often used for aortic valve replacement, where the geometry of the aortic root sinuses may vary due to valvular disease and affect valve performance. Common geometrical sinus changes may be due to valve stenosis and insufficiency. In the current study, the effect of these geometrical changes on the mean flow and velocity fluctuations downstream of the valve and aortic sinuses were investigated. The study focused on the fully-open leaflet position where blood velocities are close to their maximum. Simulation results were validated using previous experimental laser Doppler anemometry (LDA) measurements. Results showed that as the stenosis and insufficiency increased there were more flow separation and increased local mean velocity downstream of the leaflets. In addition, the detected elevated velocity fluctuations were associated with higher Reynolds shear stresses levels, which may increase the chances of blood damage and platelet activation and may lead to increased risk of blood clot formation

Is there any association between contrast-induced nephropathy and serum uric acid levels?

Introduction: During the recent years, several studies have investigated that hyperuricemia is associated with greater incidence of contrast induced nephropathy (CIN). Most of them are in acute conditions like primary percutaneous coronary interventions. This study aimed to assess the relationship between high serum uric acid and incidence of acute kidney injury in patients undergoing elective angiography and angioplasty. Methods: This prospective study was conducted on 211 patients who were admitted to hospital for elective coronary angiography or angioplasty. The researchers measured serum creatinine and uric acid on admission and repeated creatinine measurement in 48 hours and seven days after the procedure. According to serum uric acid, the patients were divided into two groups; group 1 with normal uric acid and group 2 with hyperuricemia which was defined as uric acid more than 6 mg/dL in women and 7 mg/dL in men. CIN is defined as an increased creatinine level of more than 0.5 mg/dL or 25% from the baseline in 48 hours after the intervention. Results: In total, 211 patients with mean age of 60.58 years were enrolled in the study. Of these, 87 (41.2%) patients were in the high uric acid group and 124 (58.8%) were in the normal uric acid group. CIN was occurred in 16 patients (7.5%). Seven out of 16 (8.04%) were in the high uric acid and nine (7.2%) were in the normal uric acid group. There were no significant differences between the two groups (P =0.831). Conclusion: The frequency of CIN development was not different in the patients with hyperuricemia

Buckling Analysis Of A Functionally Graded Implant Model For Treatment Of Bone Fractures: A Numerical Study

In orthopedics, the current internal fixations often use screws or intramedullary rods that obstruct bone material. In this paper, an internal implant was modelled as a hollow cylindrical sector made of a functionally graded material (FGM), which will hold bone in place with less obstruction of bone surface. Functionally graded implant was considered as an inhomogeneous composite structure, with continuously compositional variation from a ceramic at the outer diameter to a metal at the inner diameter. The buckling behavior of the implant was numerically analyzed using a finite element analysis software (ANSYS), and the structural stability of the implant was assessed. The buckling critical loads were calculated for different fixation lengths, cross sectional areas, and different sector angles. These critical loads were then compared with the critical loads of an FGM hollow cylinder with the same cross sectional area. Results showed that the critical load of the hollow cylindrical sector was ∼ 63%, ∼ 70%, and ∼ 73% of the hollow cylinder for different fixation lengths, cross sectional areas, and sector angles, respectively. Further investigations are warranted to study the relation between the composition profile and the implant stability, which can lead to batter internal fixation solutions

Body Acoustics for the Non-Invasive Diagnosis of Medical Conditions

In the past few decades, many non-invasive monitoring methods have been developed based on body acoustics to investigate a wide range of medical conditions, including cardiovascular diseases, respiratory problems, nervous system disorders, and gastrointestinal tract diseases. Recent advances in sensing technologies and computational resources have given a further boost to the interest in the development of acoustic-based diagnostic solutions. In these methods, the acoustic signals are usually recorded by acoustic sensors, such as microphones and accelerometers, and are analyzed using various signal processing, machine learning, and computational methods. This paper reviews the advances in these areas to shed light on the state-of-the-art, evaluate the major challenges, and discuss future directions. This review suggests that rigorous data analysis and physiological understandings can eventually convert these acoustic-based research investigations into novel health monitoring and point-of-care solutions

The Influence Of The Aortic Root Geometry On Flow Characteristics Of A Bileaflet Mechanical Heart Valve

Bileaflet mechanical heart valves have one of the most successful valve designs for more than 30 years. These valves are often used for aortic valve replacement, where the geometry of the aortic root sinuses may vary due to valvular disease and affect valve performance. Common geometrical sinus changes may be due to valve stenosis and insufficiency. In the current study, the effect of these geometrical changes on the mean flow and velocity fluctuations downstream of the valve and aortic sinuses were investigated. The study focused on the fully-open leaflet position where blood velocities are close to their maximum. Simulation results were validated using previous experimental laser Doppler anemometry (LDA) measurements. Results showed that as the stenosis and insufficiency increased there were more flow separation and increased local mean velocity downstream of the leaflets. In addition, the detected elevated velocity fluctuations were associated with higher Reynolds shear stresses levels, which may increase the chances of blood damage and platelet activation and may lead to increased risk of blood clot formation