Flow in a mechanical bileaflet heart valve at laminar and near-peak systole flow rates: CFD simulations and experiments

Time-accurate, fully 3D numerical simulations and particle image velocity laboratory experiments are carried out for flow through a fully open bileaflet mechanical heart valve under steady (nonpulsatile) inflow conditions. Flows at two different Reynolds numbers, one in the laminar regime and the other turbulent (near-peak systole flow rate), are investigated. A direct numerical simulation is carried out for the laminar flow case while the turbulent flow is investigated with two different unsteady statistical turbulence modeling approaches, unsteady Reynolds-averaged Navier-Stokes (URANS) and detached-eddy simulation (DES) approach. For both the laminar and turbulent cases the computed mean velocity profiles are in good overall agreement with the measurements. For the turbulent simulations, however, the comparisons with the measurements demonstrate clearly the superiority of the DES approach and underscore its potential as a powerful modeling tool of cardiovascular flows at physiological conditions. The study reveals numerous previously unknown features of the flow.     

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.     

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。     

Tomographic PIV in a model of the left ventricle: 3D flow past biological and mechanical heart valves

Left ventricular flow is intrinsically complex, three-dimensional and unsteady. Its features are susceptible to cardiovascular pathology and treatment, in particular to surgical interventions involving the valves (mitral valve replacement). To improve our understanding of intraventricular fluid mechanics and the impact of various types of prosthetic valves thereon, we have developed a custom-designed versatile left ventricular phantom with anatomically realistic moving left ventricular membrane. A biological, a tilting disc and a bileaflet valve (in two different orientations) were mounted in the mitral position and tested under the same settings. To investigate 3D flow within the phantom, a four-view tomographic particle image velocimetry setup has been implemented. The results compare side-by-side the evolution of the 3D flow topology, vortical structures and kinetic energy in the left ventricle domain during the cardiac cycle. Except for the tilting disc valve, all tested prosthetic valves induced a crossed flow path, where the outflow crosses the inflow path, passing under the mitral valve. The biological valve shows a strong jet with a peak velocity about twice as high compared to all mechanical heart valves, which makes it easier to penetrate deeply into the cavity. Accordingly, the peak kinetic energy in the left ventricle in case of the biological valve is about four times higher than the mechanical heart valves. We conclude that the tomographic particle imaging velocimetry setup provides a useful ground truth measurement of flow features and allows a comparison of the effects of different valve types on left ventricular flow patterns.     

Numerical simulation of steady flow in a two-dimensional total artificial heart model.

In this paper, a numerical simulation of steady laminar and turbulent flow in a two-dimensional model for the total artificial heart is presented. A trileaflet polyurethane valve was simulated at the outflow orifice while the inflow orifice had a trileaflet or a flap valve. The finite analytic numerical method was employed to obtain solutions to the governing equations in the Cartesian coordinates. The closure for turbulence model was achieved by employing the k-epsilon-E model. The SIMPLER algorithm was used to solve the problem in primitive variables. The numerical solutions of the simulated model show that regions of relative stasis and trapped vortices were smaller within the ventricular chamber with the flap valve at the inflow orifice than that with the trileaflet valve. The predicted Reynolds stresses distal to the inflow valve within the ventricular chamber were also found to be smaller with the flap valve than with the trileaflet valve. These results also suggest a correlation between high turbulent stresses and the presence of thrombus in the vicinity of the valves in the total artificial hearts. The computed velocity vectors and turbulent stresses were comparable with previously reported in vitro measurements in artificial heart chambers. Analysis of the numerical solutions suggests that geometries similar to the flap valve (or a tilting disk valve) results in a better flow dynamics within the total artificial heart chamber compared to a trileaflet valve.     

In vitro flow dynamics of four prosthetic aortic valves: a comparative analysis

The velocity fields downstream of four prosthetic heart valves were mapped in vitro over the entire cross-section of a model aortic root using laser Doppler anemometry. THe Bj?rk-Shiley 60 degrees convexo-concave tilting disc valve, the Smeloff-Cutter caged ball valve, the St. Jude Medical bileaflet valve, and the Ionescu-Shiley standard bioprosthesis were examined under both steady and pulsatile flows. Velocity profiles under steady flow conditions were a good approximation for pulsatile profiles only during midsystole. The pulsatile flow characteristics of the four valves showed variation in large scale flow structures. Comparison of the valves according to pressure drop, shear stress and maximum velocities are also provided.     

Pulsatile flow past aortic valve bioprostheses in a model human aorta

Pulsatile flow development past tissue valve prostheses in a model human aorta has been studied using qualitative flow visualization and quantitative laser-Doppler techniques. Experiments were conducted both in steady and physiological pulsatile flow situations and the measurements included the pressure drop across the valve, the instantaneous flow rate as well as the velocity profiles and turbulent stresses downstream to the valves. Our study shows that the velocity profiles with pericardial valves are closer to those measured past natural aortic valves. The porcine valves with a smaller valve opening area produce a narrower and stronger jet downstream from the valve with relatively larger turbulent axial stresses in the boundary of the jet. Our study suggests that the pericardial valves with turbulent stresses comparable to those of caged ball and tilting disc valves are preferable from a hemodynamic point of view.     

Comparative in vitro study of bileaflet and tilting disk valve behavior in the pulmonary position

A study of mechanical heart valve behavior in the pulmonary position as a function of pulmonary vascular resistance is reported for the St. Jude Medical bileaflet (SJMB) valve and the MedicalCV Omnicarbon (OTD) tilting disk valve. Tests were conducted in a pulmonic mock circulatory system and impedance was varied in terms of system pulmonary vascular resistance (PVR). An impedance spectrum was found using instantaneous pulmonary artery pressure and flow rate curves. Both valves fully opened and closed at and above a nominal PVR of 3.0 mmHg/L/min. The SJMB valve was prone to leaflet bounce at closure, but otherwise completely closed, at settings above and below this nominal setting. At PVR values at and below 2.0 mmHg/L/min, the SJMB valve exhibited two types of leaflet aberrant behavior: single leaflet only closure while the other leaflet fluttered, and incomplete closure where both leaflets flutter but neither remain fully closed. The OTD valve fully opened and closed to a PVR value of 1.6 mmHg/L/min. At lower values, the valve did not close. Valves designed for the left heart can show aberrant behavior under normal conditions as pulmonary valves.     

Probing the effect of morphology on lymphatic valve dynamic function

The lymphatic system is vital to the circulatory and immune systems, performing a range of important functions such as transport of interstitial fluid, fatty acid, and immune cells. Lymphatic vessels are composed of contractile walls and lymphatic valves, allowing them to pump lymph against adverse pressure gradients and to prevent backflow. Despite the importance of the lymphatic system, the contribution of mechanical and geometric changes of lymphatic valves and vessels in pathologies of lymphatic dysfunction, such as lymphedema, is not well understood. We develop a fully coupled fluid–solid, three-dimensional computational model to interrogate the various parameters thought to influence valve behavior and the consequences of these changes to overall lymphatic function. A lattice Boltzmann model is used to simulate the lymph, while a lattice spring model is used to model the mechanics of lymphatic valves. Lymphatic valve functions such as enabling lymph flow and preventing backflow under varied lymphatic valve geometries and mechanical properties are investigated to provide an understanding of the function of lymphatic vessels and valves. The simulations indicate that lymphatic valve function is optimized when valves are of low aspect ratio and bending stiffness, so long as these parameters are maintained at high enough values to allow for proper valve closing. This suggests that valve stiffening could have a profound effect on overall lymphatic pumping performance. Furthermore, dynamic valve simulations showed that this model captures the delayed response of lymphatic valves to dynamic flow conditions, which is an essential feature of valve operation. Thus, our model enhances our understanding of how lymphatic pathologies, specifically those exhibiting abnormal valve morphologies such as has been suggested to occur in cases of primary lymphedema, can lead to lymphatic dysfunctions.     

In vitro pulsatile flow velocity and shear stress measurements in the vicinity of mechanical mitral heart valve prostheses

A three beam laser Doppler anemometer system was used to study the flow fields created by various types of mitral heart valve prostheses under physiological pulsatile flow conditions. The prosthetic valves studied were: Beall caged disc valve, Bjork-Shiley tilting disc valve, Medtronic-Hall tilting disc valve and St. Jude bileaflet valve. The results indicate that all four prosthetic valve designs studied create very disturbed flow fields with elevated turbulent shear stresses and regions of flow separation and/or stagnation. The observed elevated turbulent shear stresses could cause sublethal and/or lethal damage to red cells and platelets. The regions of flow separation and/or stagnation, could lead to thrombus formation and/or tissue overgrowth on the valve structure, as observed on clinically recovered prosthetic valves.     

Numerical and experimental investigations of pulsatile blood flow pattern through a dysfunctional mechanical heart valve

Around 250,000 heart valve replacements are performed every year around the world. Due their higher durability, approximately 2/3 of these replacements use mechanical prosthetic heart valves (mainly bileaflet valves). Although very efficient, these valves can be subject to valve leaflet malfunctions. These malfunctions are usually the consequence of pannus ingrowth and/or thrombus formation and represent serious and potentially fatal complications. Hence, it is important to investigate the flow field downstream of a dysfunctional mechanical heart valve to better understand its impact on blood components (red blood cells, platelets and coagulation factors) and to improve the current diagnosis techniques. Therefore, the objective of this study will be to numerically and experimentally investigate the pulsatile turbulent flow downstream of a dysfunctional bileaflet mechanical heart valve in terms of velocity field, vortex formation and potential negative effect on blood components. The results show that the flow downstream of a dysfunctional valve was characterized by abnormally elevated velocities and shear stresses as well as large scale vortices. These characteristics can predispose to blood components damage. Furthermore, valve malfunction led to an underestimation of maximal transvalvular pressure gradient, using Doppler echocardiography, when compared to numerical results. This could be explained by the shifting of the maximal velocity towards the normally functioning leaflet. As a consequence, clinicians should try, when possible, to check the maximal velocity position not only at the central orifice but also through the lateral orifices. Finding the maximal velocity in the lateral orifice could be an indication of valve dysfunction.     

Dynamic modelling of prosthetic chorded mitral valves using the immersed boundary method

Current artificial heart valves either have limited lifespan or require the recipient to be on permanent anticoagulation therapy. In this paper, effort is made to assess a newly developed bileaflet valve prosthesis made of synthetic flexible leaflet materials, whose geometry and material properties are based on those of the native mitral valve, with a view to providing superior options for mitral valve replacement. Computational analysis is employed to evaluate the geometric and material design of the valve, by investigation of its mechanical behaviour and unsteady flow characteristics. The immersed boundary (IB) method is used for the dynamic modelling of the large deformation of the valve leaflets and the fluid-structure interactions. The IB simulation is first validated for the aortic prosthesis subjected to a hydrostatic loading. The predicted displacement fields by IB are compared with those obtained using ANSYS, as well as with experimental measurements. Good quantitative agreement is obtained. Moreover, known failure regions of aortic prostheses are identified. The dynamic behaviour of the valve designs is then simulated under four physiological pulsatile flows. Experimental pressure gradients for opening and closure of the valves are in good agreement with IB predictions for all flow rates for both aortic and mitral designs. Importantly, the simulations predicted improved physiological haemodynamics for the novel mitral design. Limitation of the current IB model is also discussed. We conclude that the IB model can be developed to be an extremely effective dynamic simulation tool to aid prosthesis design.     

Device Thrombogenicity Emulator (DTE) − Design optimization methodology for cardiovascular devices: A study in two bileaflet MHV designs

Patients who receive prosthetic heart valve (PHV) implants require mandatory anticoagulation medication after implantation due to the thrombogenic potential of the valve. Optimization of PHV designs may facilitate reduction of flow-induced thrombogenicity and reduce or eliminate the need for post-implant anticoagulants. We present a methodology entitled Device Thrombogenicty Emulator (DTE) for optimizing the thrombo-resistance performance of PHV by combining numerical and experimental approaches. Two bileaflet mechanical heart valves (MHV) designs, St. Jude Medical (SJM) and ATS, were investigated by studying the effect of distinct flow phases on platelet activation. Transient turbulent and direct numerical simulations (DNS) were conducted, and stress loading histories experienced by the platelets were calculated along flow trajectories. The numerical simulations indicated distinct design dependent differences between the two valves. The stress loading waveforms extracted from the numerical simulations were programmed into a hemodynamic shearing device (HSD), emulating the flow conditions past the valves in distinct ‘hot-spot’ flow regions that are implicated in MHV thrombogenicity. The resultant platelet activity was measured with a modified prothrombinase assay, and was found to be significantly higher in the SJM valve, mostly during the regurgitation phase. The experimental results were in excellent agreement with the calculated platelet activation potential. This establishes the utility of the DTE methodology for serving as a test bed for evaluating design modifications for achieving better thrombogenic performance for such devices.     

Design of a system for the accelerated loading of heart valve prostheses

In this paper an equipment is described for the loading of heart valve prostheses under physiological pressure conditions at a frequency of 10 Hz. The system consists essentially of two reservoirs between which a housing is mounted for holding the valve prosthesis. The reservoirs are partly filled with liquid. The physiological pressure variation across the valve is obtained by pressure control within the two reservoirs. A phase difference between the pressures in the two reservoirs compensates for the mass-inertia effects which normally occur at these high frequencies. The system without a valve has been analysed on the basis of simplified relationships between pressure and flow. The predicted values for the phase difference between the flow and the pressure curves within the valve housing, have been verified experimentally for various values of phase difference and amplitude ratios of the pressure variations within the reservoirs. The agreement between theory and experiment is fair. For the system with a valve the experimentally observed patterns closely resemble the theoretically predicted ones. From experiments with a Bj?rk-Shiley ( 21ABP ) and a Hancock (242-A21) valve prosthesis it is concluded that the valves open and close completely and that the pressure and flow patterns around the valves mimic the essential features of the in-vivo signals.     

A comparative computational study of blood flow through prosthetic heart valves using the finite element method

The steady flow of blood through three common types of prosthetic heart valves was simulated numerically using the finite element method. The velocity, pressure and stress fields were obtained for the disk-type, tilting-disk and ball-type prosthetic heart valves in aortic position, for increasing Reynolds numbers up to 900, 1500 and 2000 respectively. Computer graphics of calculated velocities are presented, showing in detail the accelerated flow, recirculation and stagnation areas developed in the prosthesis. Maximum wall shear stresses were found at 0.5, 1.4, and 1.2 diameters from the sewing ring downstream for the disk, tilting-disk and ball valves being the values of 55, 18 and 33 dyn cm-2 respectively. In the vicinity of the occluder, maximum shear stresses of 38, 30 and 47 dyn cm-2 respectively were computed. The flow characteristics and performance for each valve are compared, the results are presented in terms of energy loss and maximum shear stress. The velocity and stress fields are compared with in vitro evaluations found in the literature.     

The central axis prosthetic cardiac valve: an in vitro study of pressure drop assessment under steady-state flow conditions

In this work, a new mechanical prosthetic heart valve, the central axis valve, is presented. This new prosthesis has been tested in vitro, and compared with four other common prosthetic cardiac valves (Starr-Edwards 6120, Bjork-Shiley monostrut, Medtronic-Hall, and St Jude Medical valves). All valves studied have the same orifice diameter of 22 mm. The prostheses were installed inside a transparent mitral test chamber, which enables pressure drop measurement to be made under steady-state flow conditions using a blood analogue fluid. Pressure drop loss is one important factor affecting the overall performance of a prosthetic heart valve. Steady-state flow tests are essential to predict certain flow characteristics and pressure gradient loss before more complicated, expensive, and difficult-to-interpret pulsatile flow tests are conducted. All experiments were performed in vitro and at steady volumetric flow rates of 10 to 30 l/min. The Starr-Edwards SE 6120 showed the highest values for pressure drop. The St Jude Medical valve offers the minimum resistance to flow. The central axis valve comes second to the Starr-Edwards valve for this type of measurement. The new valve is promising. A complete valve evaluation programme, covering initial conceptional design through to clinical use, is in progress. Materials for the fabrication of the new valve are also under consideration.     

Direct numerical simulation of a 2D-stented aortic heart valve at physiological flow rates

We study the nonlinear interaction of an aortic heart valve, composed of hyperelastic corrugated leaflets of finite density attached to a stented vessel under physiological flow conditions. In our numerical simulations, we use a 2D idealised representation of this arrangement. Blood flow is caused by a time-varying pressure gradient that mimics that of the aortic valve and corresponds to a peak Reynolds number equal to 4050. Here, we fully account for the shear-thinning behaviour of the blood and large deformations and contact between the leaflets by solving the momentum and mass balances for blood and leaflets. The mixed finite element/Galerkin method along with linear discontinuous Lagrange multipliers for coupling the fluid and elastic domains is adopted. Moreover, a series of challenging numerical issues such as the finite length of the computational domain and the conditions that should be imposed on its inflow/outflow boundaries, the accurate time integration of the parabolic and hyperbolic momentum equations, the contact between the leaflets and the non-conforming mesh refinement in part of the domain are successfully resolved. Calculations for the velocity and the shear stress fields of the blood reveal that boundary layers appear on both sides of a leaflet. The one along the ventricular side transfers blood with high momentum from the core region of the vessel to the annulus or the sinusoidal expansion, causing the continuous development of flow instabilities. At peak systole, vortices are convected in the flow direction along the annulus of the vessel, whereas during the closure stage of the valve, an extremely large vortex develops in each half of the flow domain.     

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.     

Particle Image Velocimetry Study of Pulsatile Flow in Bi-leaflet Mechanical Heart Valves with Image Compensation Method

Particle Image Velocimetry (PIV) is an important technique in studying blood flow in heart valves. Previous PIV studies of flow around prosthetic heart valves had different research concentrations, and thus never provided the physical flow field pictures in a complete heart cycle, which compromised their pertinence for a better understanding of the valvular mechanism. In this study, a digital PIV (DPIV) investigation was carried out with improved accuracy, to analyse the pulsatile flow field around the bi-leaflet mechanical heart valve (MHV) in a complete heart cycle. For this purpose a pulsatile flow test rig was constructed to provide the necessary in vitro test environment, and the flow field around a St. Jude size 29 bi-leaflet MHV and a similar MHV model were studied under a simulated physiological pressure waveform with flow rate of 5.2 l/min and pulse rate at 72 beats/min. A phase-locking method was applied to gate the dynamic process of valve leaflet motions. A special image-processing program was applied to eliminate optical distortion caused by the difference in refractive indexes between the blood analogue fluid and the test section. Results clearly showed that, due to the presence of the two leaflets, the valvular flow conduit was partitioned into three flow channels. In the opening process, flow in the two side channels was first to develop under the presence of the forward pressure gradient. The flow in the central channel was developed much later at about the mid-stage of the opening process. Forward flows in all three channels were observed at the late stage of the opening process. At the early closing process, a backward flow developed first in the central channel. Under the influence of the reverse pressure gradient, the flow in the central channel first appeared to be disturbed, which was then transformed into backward flow. The backward flow in the central channel was found to be the main driving factor for the leaflet rotation in the valve closing process. After the valve was fully closed, local flow activities in the proximity of the valve region persisted for a certain time before slowly dying out. In both the valve opening and closing processes, maximum velocity always appeared near the leaflet trailing edges. The flow field features revealed in the present paper improved our understanding of valve motion mechanism under physiological conditions, and this knowledge is very helpful in designing the new generation of MHVs.     

An in vitro comparative study of St. Jude Medical and Edwards-Duromedics bileaflet valves using laser anemometry

An in vitro comparative study of St. Jude (SJ) and Edwards-Duromedics (DM) Bileaflet valves was performed under steady and physiological pulsatile flow conditions in an axisymmetric chamber using Laser Doppler Anemometry (LDA). LDA measurements were conducted in two different orientations; in the first orientation, the LDA traverse was perpendicular and, in the second orientation, parallel to the tilt axis of the leaflets. The axial velocities were measured in both orientations at two different locations distal to the valves. The velocity profiles at peak systole show the presence of stronger vortex in the sinus region for flow past SJ valve in the first orientation compared to the DM valve. Velocity profile distal to the SJ valve in second orientation was relatively flat where as for the DM valve, a jet-like flow was present. The differences found in the velocity profiles between the two valves can be attributed to the differences in geometry with thicker leaflets, smaller angle of leaflets opening and the presence of the leaflet curvature for the DM valve. The results obtained in this study do not show any fluid dynamic advantages due to the curved leaflet geometry of the DM valve.