Three-dimensional visualization of velocity fields downstream of six mechanical aortic valves in a pulsatile flow model

Velocity fields downstream of 27 mm Bj?rk-Shiley Standard, Bj?rk-Shiley Convex-Concave, Bj?rk-Shiley Monostrut, Hall-Kaster (Medtronic-Hall), St. Jude Medical and Starr-Edwards Silastic Ball aortic valves were studied in a pulsatile mock circulation. Stroke volume was 70 cm3 and frequency 71 min-1 and 88 min-1. Fluid velocity was measured by a catheter mounted hot-film anemometer probe in a glycerol water mixture one and two diameters downstream of the aortic valve. Velocity fields were dynamically visualized by a three-dimensional technique and revealed qualitative independence of frequency. All profiles were flat in the acceleration phase of systole. From peak systole and throughout the systolic deceleration phase profiles characteristic of the individual valves appeared. The pivoting and tilting disc valves caused a skewed velocity profile with highest velocities downstream of the major orifice and lowest velocities downstream of the minor orifice. The differences between the three investigated Bj?rk-Shiley valves were remarkable. The St. Jude Medical valve generated velocity peaks downstream of the two major orifices and the central slit, and lower velocities in the hinge areas. A rather flat profile with central hollowing was seen downstream of the Starr-Edwards Ball valve. All velocity profiles were more or less dampened two diameters downstream.     

Mechanical aspects of the development of artificial heart valves

The development of an antithrombogenic coating permits a hybrid design for artificial heart valves. A substrate material optimized for its application is coated to meet the electrochemical requirements of improved hemocompatibility. But future progress in artificial heart valves requires an improvement in design as well as of the material. The basis of both aspects is the determination of such fundamental mechanical properties as the elasticity and plasticity of the valve ring and the deformation and fraction behaviour of the occluder. Analytical and numerical calculations of various different models result in different requirements for the substrate of ring and occluder. A combination of high elastic temper and low resistance to flow requires a ring material with a Young's modulus of 40 GPa or more, and a 0.2% proof stress to (Young's modulus)2/3 ratio of 0.3 MPa1/3. The best occluder materials should have a Young's modulus of more than 50 GPa and a flexural strength of at least 800 MPa. On the basis of these criteria, a heart valve consisting of a TiA15Fe2,5 ring and occluders made partially stabilized zirconia is introduced.     

A patient with four artificial heart valves after ergotamine therapy

A 67-year-old female was evaluated in the out-patient clinic because of shortness of breath on exertion and regular spells of fever. She had been taking ergotamine tartrate to treat migraine for more than 30 years. The patient had undergone aortic-valve replacement for aortic insufficiency three years before. On echocardiographic evaluation, severe retraction and insufficiency of the remaining native heart valves was demonstrated. Endocarditis and carcinoid syndrome were excluded. The mitral, tricuspid and pulmonary valves were all replaced by a mechanical valvular prosthesis. Pathological-anatomical evaluation of the three replaced valves and the aortic valve replaced three years earlier disclosed identical findings, compatible with long-term ergotamine use. Nine months after surgery, a sick sinus syndrome developed necessitating implantation of a DDDR pacemaker with a right atrial and a coronary sinus lead. Functional class according to the New York Heart Association improved from class III to I. After stopping the ergotamine, the fever disappeared. However, the migraine spells reoccurred which are now being treated with paracetamol.     

Vascular-nervous relationships in the valves of the heart]

Method of silver nitrate impregnation was used in order to study 50 preparations of not-changed atrioventricular valves of the heart of domestic bulls and 30 preparations of the same valves of adult humans. It has been shown that in heart valves there are certain relationships between striated muscle fibres, blood vessels and nerve elements. The nerve structures of the valves are represented by nerve bundles of different thickness. In their composition there are comparatively thin non-myelinated and thicker myelinated fibres. Towards the free edge of cusps the nerve bundles become thinner and the nerve trunks give off separate thin nerve fibres disposed along the vessels of a capillary type and in some places getting around them. In certain portions of cusps the nerve bundles, some of which have zigzag sinuosity, cross blood vessels in different directions. In man the major mass of blood vessels and nerve elements are disposed near the base of the valve cusps, accompanying the muscle fibre bundles penetrating from the base side. In the bull heart valves an amount of blood vessels and nerve elements is found in considerable portions of the cusps not connected with muscle fibres.     

Numerical models for the simulation of flexible artificial heart valves: part I--computational methods

A numerical model of the coupled motion of a flexing surface in a high Reynolds number flow is presented for the simulation of flexible polyurethane heart valves in the aortic position. This is achieved by matching a Lagrangian dynamic leaflet model with a panel method based flow solver. The two models are coupled via the time-dependent pressure field using the unsteady Bernoulli equation. Incorporation of sub-cycling in the dynamic model equations and fast pre conditioning techniques in the panel method solver yields efficient convergence and near real-time simulations of valve motion. The generality of dynamic model allows different material properties and/or geometries to be studied easily and interactively. This interactivity is realized by embedding the models within a design environment created using the software IRIS Explorer. Two flow domains are developed, an infinite domain and an internal domain using conformal mapping theory. In addition bending stress on the valve is computed using a simple stress model based on spline and circle equation techniques.     

Numerical simulation of flow in mechanical heart valves: grid resolution and the assumption of flow symmetry

A numerical method is developed for simulating unsteady, 3-D, laminar flow through a bileaflet mechanical heart valve with the leaflets fixed. The method employs a dual-time-stepping artificial-compressibility approach together with overset (Chimera) grids and is second-order accurate in space and time. Calculations are carried out for the full 3-D valve geometry under steady inflow conditions on meshes with a total number of nodes ranging from 4 x 10(5) to 1.6 x 10(6). The computed results show that downstream of the leaflets the flow is dominated by two pairs of counter-rotating vortices, which originate on either side of the central orifice in the aortic sinus and rotate such that the common flow of each pair is directed away from the aortic wall. These vortices intensify with Reynolds number, and at a Reynolds number of approximately 1200 their complex interaction leads to the onset of unsteady flow and the break of symmetry with respect to both geometric planes of symmetry. Our results show the highly 3-D structure of the flow; question the validity of computationally expedient assumptions of flow symmetry; and demonstrate the need for highly resolved, fully 3-D simulations if computational fluid dynamics is to accurately predict the flow in prosthetic mechanical heart valves.     

Study of the velocity and strain fields in the flow through prosthetic heart valves

A comparative experimental study of the velocity field and the strain field produced down-stream of biological and mechanical artificial valves is presented. In order to determine the spatial and temporal distributions of these fields, a phase-locked stereoscopic particle image velocimetry (or 3D-PIV) technique was implemented. Emphasis was placed on the identification of the fundamental differences between the extensional and the shear components of the strain tensor. The analysis of the characteristic flows reveal that the strains in every direction may reach high values at different times during the cardiac cycle. It was found that elevated strain levels persist throughout the cardiac cycle as a result of all these contributions. Finally, it is suggested that the frequency with which the strain variations occur at particular instants and locations could be associated to the cumulative damage process of the blood constituents and should be taken into account in the overall assessment of existing valve types, as well as in future design efforts.     

Estimation of turbulent shear stresses in pulsatile flow immediately downstream of two artificial aortic valves in vitro

Measuring turbulent shear stresses is of major importance in artificial heart valve evaluation. Bi- and unidirectional fluid velocity measurements enable calculation of Reynolds shear stress ( ) and Reynolds normal stress ( ). τ is important due to the relation to hemolysis and thrombus formation, but σ is the only obtainable parameter in vivo. Therefore, determination of a correlation factor between τ and σ is pertinent.

In a pulsatile flow model, laser Doppler (LDA) and hot-film (HFA) anemometry were used for simultaneous bi- and unidirectional fluid velocity measurements downstream of a Hall Kaster and a Hancock Porcine aortic valve. Velocities were registered in two flow field locations and at four cardiac outputs. The velocity signals were subjected to analog signal processing prior to digital turbulence analysis, as a basis for calculation of τ and σ.

A correlation factor of 0.5 with a correlation coefficient of 0.97 was found between the maximum Reynolds shear stress and Reynolds normal stress, implying . In vitro estimation of turbulent shear stresses downstream of artificial aortic valves, based on the axial velocity component alone, seems possible.     

Spread of excitation through the heart upon electrical stimulation of the atrioventricular valves]

Experiments were conducted on the isolated hearts of rabbits and dogs. Synchronous recording of the electrical activity of the right auricle, the right ventricle, and tricuspid valve demonstrated the existence of definite functional associations between the auricular, ventricular and valvular depolarization. The spread of excitation in the heart in electrical stimulation of the atrio-ventricular valves was investigated. The impulses from the heterotopic excitation focus localized in these valves could be conducted to the other parts of the heart and thus lead to cardiac arrhythmias.     

新型机械心脏瓣膜的研究

目前临床使用的各种机械心脏瓣膜的主要问题是血栓栓塞和与抗凝治疗有关的出血,其缺陷在于瓣膜开启时,碟片和支架将瓣膜的整个血流通道分隔成三至四个较小的血流通道。在这种受阻隔的血流通宫,形成容易诱发血栓的高剪应力区、紊流和滞流区。我们研制的两种机械心脏瓣膜在瓣膜开启时,没有任何支架和碟片分隔瓣膜的血流通道,使血流与天然心脏瓣膜中的相类似,可减少对血液的危害,从而可减少换瓣病人对抗凝治疗的依赖程度。     

Three-dimensional visualization of coated vesicle formation in fibroblasts

Fibroblasts apparently ingest low density lipoproteins (LDL) by a selective mechanism of receptor-mediated endocytosis involving the formation of coated vesicles from the plasma membrane. However, it is not known exactly how coated vesicles collect LDL receptors and pinch off from the plasma membrane. In this report, the quick-freeze, deep- etch, rotary-replication method has been applied to fibroblasts; it displays with unusual clarity the coats that appear under the plasma membrane at the start of receptor-mediated endocytosis. These coats appear to be polygonal networks of 7-nm strands or struts arranged into 30-nm polygons, most of which are hexagons but some of which are 5- and 7-sided rings. The proportion of pentagons in each network increases as the coated area of the plasma membrane puckers up from its planar configuration (where the network is mostly hexagons) to its most sharply curved condition as a pinched-off coated vesicle. Coats around the smallest vesicles (which are icosahedrons of hexagons and pentagons) appear only slightly different from "empty coats" purified from homogenized brain, which are less symmetrical baskets containing more pentagons than hexagons. A search for structural intermediates in this coat transformation allows a test of T. Kanaseki and K. Kadota's (1969. J. Cell Biol. 42:202--220.) original idea that an internal rearrangement in this basketwork from hexagons to pentagons could "power" coated vesicle formation. The most noteworthy variations in the typical hexagonal honeycomb are focal juxtapositions of 5- and 7-sided polygons at points of partial contraction and curvature in the basketwork. These appear to precede complete contraction into individual pentagons completely surrounded by hexagons, which is the pattern that characterizes the final spherical baskets around coated vesicles.     

Modeling technique of prosthetic heart valves

This paper demonstrates a modeling technique of prosthetic heart valves. In the modeling, a pumping cycle is divided into four phases, in which the state of the valve and flow is different. The pressure-flow relation across the valve is formulated separately in each phase. This technique is developed to build a mathematical model used in the real time estimation of the hemodynamic state under artificial heart pumping. The model built by this technique is simple enough for saving the computational time in the real time estimation. The model is described by the first-order ordinary differential equation with 12 parameters. These parameters can be uniquely determined beforehand from in-vitro experimental data. It is shown that the model can adapt, with sufficient accuracy, to a change in the practical pumping condition and the viscosity of the fluid in their practical range, and is also demonstrated that the estimated backflow volume by model agrees closely with the actual one.     

Functional analysis of bioprosthetic heart valves

Glutaraldehyde-treated bovine pericardium is used successfully as bioprosthetic material in the manufacturing of heart valves leaflets. The mechanical properties of bovine pericardial aortic valve leaflets seem to influence its mechanical behaviour and the failure mechanisms. In this study the effect of orthotropy on tricuspid bioprosthetic aortic valve was analysed, using a three-dimensional finite element model, during the entire cardiac cycle. Multiaxial tensile tests were also performed to determine the anisotropy of pericardium. Seven different models of the same valve were analysed using different values of mechanical characteristics from one leaflet to another, considering pericardium as an orthotropic material. The results showed that even a small difference between values along the two axes of orthotropy can negatively influence leaflets performance as regard both displacement and stress distribution. Leaflets of bovine pericardium bioprostheses could be manufactured to be similar to natural human heart valves reproducing their well-known anisotropy. In this way it could be possible to improve the manufacturing process, durability and function of pericardial bioprosthetic valves.