Near valve flows and potential blood damage during closure of a bileaflet mechanical heart valve

Blood damage and thrombosis are major complications that are commonly seen in patients with implanted mechanical heart valves. For this in vitro study, we isolated the closing phase of a bileaflet mechanical heart valve to study near valve fluid velocities and stresses. By manipulating the valve housing, we gained optical access to a previously inaccessible region of the flow. Laser Doppler velocimetry and particle image velocimetry were used to characterize the flow regime and help to identify the key design characteristics responsible for high shear and rotational flow. Impact of the closing mechanical leaflet with its rigid housing produced the highest fluid stresses observed during the cardiac cycle. Mean velocities as high as 2.4 m/s were observed at the initial valve impact. The velocities measured at the leaflet tip resulted in sustained shear rates in the range of 1500-3500 s(-1), with peak values on the order of 11,000-23,000 s(-1). Using velocity maps, we identified regurgitation zones near the valve tip and through the central orifice of the valve. Entrained flow from the transvalvular jets and flow shed off the leaflet tip during closure combined to generate a dominant vortex posterior to both leaflets after each valve closing cycle. The strength of the peripheral vortex peaked within 2 ms of the initial impact of the leaflet with the housing and rapidly dissipated thereafter, whereas the vortex near the central orifice continued to grow during the rebound phase of the valve. Rebound of the leaflets played a secondary role in sustaining closure-induced vortices.     

Lumped parameter model for computing the minimum pressure during mechanical heart valve closure

The cavitation inception threshold of mechanical heart valves has been shown to be highly variable. This is in part due to the random distribution of the initial and final conditions that characterize leaflet closure. While numerous hypotheses exist explaining the mechanisms of inception, no consistent scaling laws have been developed to describe this phenomenon due to the complex nature of these dynamic conditions. Thus in order to isolate and assess the impact of these varied conditions and mechanisms on inception, a system of ordinary differential equations is developed to describe each system component and solved numerically to predict the minimum pressure generated during valve closure. In addition, an experiment was conducted in a mock circulatory loop using an optically transparent size 29 bileaflet valve over a range of conditions to calibrate and validate this model under physiological conditions. High-speed video and high-response pressure measurements were obtained simultaneously to characterize the relationship between the valve motion, fluid motion, and negative pressure transients during closure. The simulation model was calibrated using data from a single closure cycle and then compared to other experimental flow conditions and to results found in the literature. The simulation showed good agreement with the closing dynamics and with the minimum pressure trends in the current experiment. Additionally, the simulation suggests that the variability observed experimentally (when using dP/dt alone as the primary measure of cavitation inception) is predictable. Overall, results from the current form of this lumped parameter model indicate that it is a good engineering assessment tool.     

Laser assessment of leaflet closing motion in prosthetic heart valves

The dynamics of leaflet motion in heart valve prostheses (HVP), and in particular the closing velocity, is believed to be related to the valve sound and possibly to the phenomenon of valve cavitation. This paper describes a non-intrusive laser sweeping technique enabling the study of leaflet motion. The principle of measurement and the equipment involved are presented, together with the results of two commerially available, 29 mm bileaflet mitral valves, a St. Jude Medical, and an Edwards Duromedic valve. Experiments were carried out in a pulsatile mock flow testing loop designed to mimic physiological pressure waveforms and ventricular contraction. Measurements of heart rate were made in the range 70–120 beats min⁻¹, with a ventricular pressure slope range of 1800–5600 mm Hgs⁻¹ and a cardiac output range of 5.0–7.5 litres min⁻¹. Motion analysis of the measured data focuses on the velocity of the leaflet immediately before closure.     

A three-dimensional computational analysis of fluid-structure interaction in the aortic valve

Numerical analysis of the aortic valve has mainly been focused on the closing behaviour during the diastolic phase rather than the kinematic opening and closing behaviour during the systolic phase of the cardiac cycle. Moreover, the fluid-structure interaction in the aortic valve system is most frequently ignored in numerical modelling. The effect of this interaction on the valve's behaviour during systolic functioning is investigated. The large differences in material properties of fluid and structure and the finite motion of the leaflets complicate blood-valve interaction modelling. This has impeded numerical analyses of valves operating under physiological conditions. A numerical method, known as the Lagrange multiplier based fictitious domain method, is used to describe the large leaflet motion within the computational fluid domain. This method is applied to a three-dimensional finite element model of a stented aortic valve. The model provides both the mechanical behaviour of the valve and the blood flow through it. Results show that during systole the leaflets of the stented valve appear to be moving with the fluid in an essentially kinematical process governed by the fluid motion.     

A detailed fluid mechanics study of tilting disk mechanical heart valve closure and the implications to blood damage

Hemolysis and thrombosis are among the most detrimental effects associated with mechanical heart valves. The strength and structure of the flows generated by the closure of mechanical heart valves can be correlated with the extent of blood damage. In this in vitro study, a tilting disk mechanical heart valve has been modified to measure the flow created within the valve housing during the closing phase. This is the first study to focus on the region just upstream of the mitral valve occluder during this part of the cardiac cycle, where cavitation is known to occur and blood damage is most severe. Closure of the tilting disk valve was studied in a "single shot" chamber driven by a pneumatic pump. Laser Doppler velocimetry was used to measure all three velocity components over a 30 ms period encompassing the initial valve impact and rebound. An acrylic window placed in the housing enabled us to make flow measurements as close as 200 microm away from the closed occluder. Velocity profiles reveal the development of an atrial vortex on the major orifice side of the valve shed off the tip of the leaflet. The vortex strength makes this region susceptible to cavitation. Mean and maximum axial velocities as high as 7 ms and 20 ms were recorded, respectively. At closure, peak wall shear rates of 80,000 s(-1) were calculated close to the valve tip. The region of the flow examined here has been identified as a likely location of hemolysis and thrombosis in tilting disk valves. The results of this first comprehensive study measuring the flow within the housing of a tilting disk valve may be helpful in minimizing the extent of blood damage through the combined efforts of experimental and computational fluid dynamics to improve mechanical heart valve designs.     

Numerical simulation of the dynamics of a bileaflet prosthetic heart valve using a fluid-structure interaction approach

The main purpose of this study is to reproduce in silico the dynamics of a bileaflet mechanical heart valve (MHV; St Jude Hemodynamic Plus, 27mm characteristic size) by means of a fully implicit fluid-structure interaction (FSI) method, and experimentally validate the results using an ultrafast cinematographic technique. The computational model was constructed to realistically reproduce the boundary condition (72 beats per minute (bpm), cardiac output 4.5l/min) and the geometry of the experimental setup, including the valve housing and the hinge configuration. The simulation was carried out coupling a commercial computational fluid dynamics (CFD) package based on finite-volume method with user-defined code for solving the structural domain, and exploiting the parallel performance of the whole numerical setup. Outputs are leaflets excursion from opening to closure and the fluid dynamics through the valve. Results put in evidence a favorable comparison between the computed and the experimental data: the model captures the main features of the leaflet motion during the systole. The use of parallel computing drastically limited the computational costs, showing a linear scaling on 16 processors (despite the massive use of user-defined subroutines to manage the FSI process). The favorable agreement obtained between in vitro and in silico results of the leaflet displacements confirms the consistency of the numerical method used, and candidates the application of FSI models to become a major tool to optimize the MHV design and eventually provides useful information to surgeons.     

Bioprosthetic heart valve leaflet motion monitored by dual camera stereo photogrammetry

Dual camera stereo photogrammetry (DCSP) was applied to investigate the leaflet motion of bioprosthetic heart valves (BHVs) in a physiologic pulse flow loop (PFL). A 25-mm bovine pericardial valve was installed in the aortic valve position of the PFL, which was operated at a pulse rate of 70 beats/min and a cardiac output of 5 l/min. The systolic/diastolic aortic pressure was maintained at 120/80 mmHg to mimic the physiologic load experienced by the aortic valve. The leaflet of the test valve was marked with 80 India ink dots to form a fan-shaped matrix. From the acquired image sequences, 3-D coordinates of the marker matrix were derived and hence the surface contour, local mean and Gaussian curvatures at each opening and closing phase during one cardiac cycle were reconstructed. It is generally believed that the long-term failure rate of BHV is related to the uneven distribution of mechanical stresses occurring in the leaflet material during opening and closing. Unfortunately, a quantitative analysis of the leaflet motion under physiological conditions has not been reported. The newly developed technique permits frame-by-frame mapping of the leaflet surface, which is essential for dynamic analysis of stress-strain behavior in BHV.     

Sudden interruption of leaflet opening by ventricular contractions: a mechanism of mitral regurgitation.

The motion of both mitral cusps and the presence of valvular regurgitation during ventricular contractions were investigated in seven experiments on dogs in which radiopaque markers had been sutured to the cusps and the valve annulus 1-32 wk before the studies. Cineangiograms of the left ventricle were obtained during ventricular ectopic beats, interposed throughout the cardiac cycle (20-99% of cycle length) and during induced variations in the P-R interval (0-200 ms). Mitral regurgitation was observed only during a) weak, early ectopic beats (peak pressure below 34 mmHg) which were incapable of closing the cusps and b) when ventricular contractions suddenly interrupted normal leaflet motion toward the ventricle, during three well-defined periods of diastole (diastolic valve opening, diastolic rebound, and atrial opening). Valve closure following sudden reversal of cusp opening was slow and the leaflets often did not arrive simultaneously at their closed positions. These findings suggest that sudden interruption of leaflet opening by ventricular contractions is an important mechanism of transient mitral regurgitation in the normal heart.     

Motion of both mitral valve leaflets: a cineroentgenographic study in intact dogs.

Motion and position of both mitral leaflets were studied in five normal dogs 1-11 wk after radiopaque markers were sutured on the valve cusps and on the mitral annulus. Cinefluorograms and cineangiograms (100-120 frames/s) of left atrium and left ventricle were used to study cusp motion and intraventricular flow patterns, and to detect mitral regurgitation during sinus rhythm (42-184 beats/min) and during isolated atrial or ventricular contractions. Time-motion of both leaflets was similar throughout diastole with the exception of delayed posterior cusp opening. Peak opening and closing speeds, opening and closing times, and time of complete closure, measured from the Q wave of the ECG, were not significantly affected by the variations in heart rate. Diastolic leaflet closure began immediately after opening, while the ventricular cavity was small, and was caused by flow eddies behind the cusps. Isolated ventricular contractions closed the valve leaflets completely and symmetric valve closure was ensured by the different rates of leaflet edge approximation. In contrast, atrial closure was slow, partial, and of very short duration.     

Collagen fibers reduce stresses and stabilize motion of aortic valve leaflets during systole

The effect of collagen fibers on the mechanics and hemodynamics of a trileaflet aortic valve contained in a rigid aortic root is investigated in a numerical analysis of the systolic phase. Collagen fibers are known to reduce stresses in the leaflets during diastole, but their role during systole has not been investigated in detail yet. It is demonstrated that also during systole these fibers substantially reduce stresses in the leaflets and provide smoother opening and closing. Compared to isotropic leaflets, collagen reinforcement reduces the fluttering motion of the leaflets. Due to the exponential stress-strain behavior of collagen, the fibers have little influence on the initial phase of the valve opening, which occurs at low strains, and therefore have little impact on the transvalvular pressure drop.     

A fully coupled fluid-structure interaction model of the secondary lymphatic valve

Abstract

The secondary lymphatic valve is a bi-leaflet structure frequent throughout collecting vessels that serves to prevent retrograde flow of lymph. Despite its vital function in lymph flow and apparent importance in disease development, the lymphatic valve and its associated fluid dynamics have been largely understudied. The goal of this work was to construct a physiologically relevant computational model of an idealized rat mesenteric lymphatic valve using fully coupled fluid-structure interactions to investigate the relationship between three-dimensional flow patterns and stress/deformation within the valve leaflets. The minimum valve resistance to flow, which has been shown to be an important parameter in effective lymphatic pumping, was computed as 268?g/mm⁴?s. Hysteretic behavior of the lymphatic valve was confirmed by comparing resistance values for a given transvalvular pressure drop during opening and closing. Furthermore, eddy structures were present within the sinus adjacent to the valve leaflets in what appear to be areas of vortical flow; the eddy structures were characterized by non-zero velocity values (up to ～4?mm/s) in response to an applied unsteady transvalvular pressure. These modeling capabilities present a useful platform for investigating the complex interplay between soft tissue motion and fluid dynamics of lymphatic valves and contribute to the breadth of knowledge regarding the importance of biomechanics in lymphatic system function.     

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.     

Numerical Models for the Simulation of Flexible Artificial Heart Valves: Part II - Valve Studies

Abstract

Using a coupled Lagrangian dynamic leaflet model and an unsteady potential flow solver the motion of a polyurethane type heart valve is simulated in the aortic position. The simulations incorporate two flow domains; the first comprises only the leaflets which are embedded within an unsteady flow of infinite expanse, and the second incorporates the influence of the aortic geometry via a conformal mapping. Simulations are performed for a cardiac output of 51itres/min and a beat period of 72 b.p.m. corresponding to a typical aortic pulse. Resulting valve motions are computed for various leaflet bending stiffnesses in both flow domains. In addition both the bending stress and strain and their time rate of change are evaluated. Valve motion displays the characteristic rapid opening, stable opening and slow closing phases as detailed in the literature. The computed stress values along the leaflet surface are of the order of those found experimentally.     

Comparison of the hemodynamic and thrombogenic performance of two bileaflet mechanical heart valves using a CFD/FSI model

The hemodynamic and the thrombogenic performance of two commercially available bileaflet mechanical heart valves (MHVs)--the ATS Open Pivot Valve (ATS) and the St. Jude Regent Valve (SJM), was compared using a state of the art computational fluid dynamics-fluid structure interaction (CFD-FSI) methodology. A transient simulation of the ATS and SJM valves was conducted in a three-dimensional model geometry of a straight conduit with sudden expansion distal the valves, including the valve housing and detailed hinge geometry. An aortic flow waveform (60 beats/min, cardiac output 4 l/min) was applied at the inlet. The FSI formulation utilized a fully implicit coupling procedure using a separate solver for the fluid problem (FLUENT) and for the structural problem. Valve leaflet excursion and pressure differences were calculated, as well as shear stress on the leaflets and accumulated shear stress on particles released during both forward and backward flow phases through the open and closed valve, respectively. In contrast to the SJM, the ATS valve opened to less than maximal opening angle. Nevertheless, maximal and mean pressure gradients and velocity patterns through the valve orifices were comparable. Platelet stress accumulation during forward flow indicated that no platelets experienced a stress accumulation higher than 35 dyne x s/cm2, the threshold for platelet activation (Hellums criterion). However, during the regurgitation flow phase, 0.81% of the platelets in the SJM valve experienced a stress accumulation higher than 35 dyne x s/cm2, compared with 0.63% for the ATS valve. The numerical results indicate that the designs of the ATS and SJM valves, which differ mostly in their hinge mechanism, lead to different potential for platelet activation, especially during the regurgitation phase. This numerical methodology can be used to assess the effects of design parameters on the flow induced thrombogenic potential of blood recirculating devices.     

Dynamics of flow in a mechanical heart valve: the role of leaflet inertia and leaflet compliance

In this work, we examine the dynamics of fluid flow in a mechanical heart valve when the solid inertia and leaflet compliance are important. The fluid is incompressible and Newtonian, and the leaflet is an incompressible neo-Hookean material. In the case of an inertialess leaflet, we find that the maximum valve opening angle and the time that the valve remains closed increase as the shear modulus of the leaflet decreases. More importantly, the regurgitant volume decreases with decreasing shear modulus. When we examined the forces exerted on the leaflet, we found that the downward motion of the leaflet is initiated by a vertical force exerted on its right side and, later on, by a vertical force exerted on the top side of the leaflet. In the case of solid inertia, we find that the maximum valve opening angle and the regurgitant volume are larger than in the case of an inertialess leaflet. These results highlight the importance of solid compliance in the dynamics of blood flow in a mechanical heart valve. More importantly, they indicate that mechanical heart valves with compliant leaflets may have smaller regurgitant volumes and smaller shear stresses than the ones with rigid leaflets.     

Computational model of aortic valve surgical repair using grafted pericardium

Aortic valve reconstruction using leaflet grafts made from autologous pericardium is an effective surgical treatment for some forms of aortic regurgitation. Despite favorable outcomes in the hands of skilled surgeons, the procedure is underutilized because of the difficulty of sizing grafts to effectively seal with the native leaflets. Difficulty is largely due to the complex geometry and function of the valve and the lower distensibility of the graft material relative to native leaflet tissue. We used a structural finite element model to explore how a pericardial leaflet graft of various sizes interacts with two native leaflets when the valve is closed and loaded. Native leaflets and pericardium are described by anisotropic, hyperelastic constitutive laws, and we model all three leaflets explicitly and resolve leaflet contact in order to simulate repair strategies that are asymmetrical with respect to valve geometry and leaflet properties. We ran simulations with pericardial leaflet grafts of various widths (increase of 0%, 7%, 14%, 21% and 27%) and heights (increase of 0%, 13%, 27% and 40%) relative to the native leaflets. Effectiveness of valve closure was quantified based on the overlap between coapting leaflets. Results showed that graft width and height must both be increased to achieve proper valve closure, and that a graft 21% wider and 27% higher than the native leaflet creates a seal similar to a valve with three normal leaflets. Experimental validation in excised porcine aortas (n=9) corroborates the results of simulations.     

Structural analysis of the natural aortic valve in dynamics: From unpressurized to physiologically loaded

A novel finite element model of the natural aortic valve was developed implementing anisotropic hyperelastic material properties for the leaflets and aortic tissues, and starting from the unpressurized geometry. Static pressurization of the aortic root, silicone rubber moulds and published data helped to establish the model parameters, while high-speed video recording of the leaflet motion in a left-heart simulator allowed for comparisons with simulations. The model was discretized with brick elements and loaded with time-varying pressure using an explicit commercial solver. The aortic valve model produced a competent valve whose dynamic behavior (geometric orifice area vs. time) closely matched that observed in the experiment. In both cases, the aortic valve took approximately 30 ms to open to an 800 mm² orifice and remained completely or more than half open for almost 200 ms, after which it closed within 30–50 ms. The highest values of stress were along the leaflet attachment line and near the commissure during diastole. Von Mises stress in the leaflet belly reached 600–750 kPa from early to mid-diastole. While the model using the unpressurized geometry as initial configuration was specially designed to satisfy the requirements of continuum mechanics for large deformations of hyperelastic materials, it also clearly demonstrated that dry models can be adequate to analyze valve dynamics. Although improvements are still needed, the advanced modeling and validation techniques used herein contribute toward improved and quantified accuracy over earlier simplified models.     

Cavitation phenomena in mechanical heart valves: the role of squeeze flow velocity and contact area on cavitation initiation between two impinging rods

In this study, the closing dynamics of two impinging rods were experimentally analyzed to simulate the cavitation phenomena associated with mechanical heart valve closure. The purpose of this study was to investigate the cavitation phenomena with respect to squeeze flow between two impinging surfaces and the parameter that influences cavitation inception. High-speed flow imaging was employed to visualize and identify regions of cavitation. The images obtained favored squeeze flow as an important mechanism in cavitation inception. A correlation study of the effects of impact velocities, contact areas and squeeze flow velocity on cavitation inception showed that increasing impact velocities results in an increase in the risk of cavitation. It was also shown that for similar impact velocities, regions near the point of impact were found to cavitate later for those with smaller contact areas. It was found that the decrease in contact areas and squeeze flow velocities would delay the onset and reduce the intensity of cavitation. It is also interesting to note that the squeeze flow velocity alone does not provide an indication if cavitation inception will occur. This is corroborated by the wide range of published critical squeeze flow velocity required for cavitation inception. It should be noted that the temporal acceleration of fluid, often neglected in the literature, can also play an important role on cavitation inception for unsteady flow phenomenon. This is especially true in mechanical heart valves, where for the same leaflet closing velocity, valves with a seat stop were observed to cavitate earlier. Based on these results, important inferences may be made to the design of mechanical heart valves with regards to cavitation inception.     

Computational modeling of the mechanical behavior of the cerebrospinal fluid system

A computational fluid dynamics (CFD) model of the cerebrospinal fluid system was constructed based on a simplified geometry of the brain ventricles and their connecting pathways. The flow is driven by a prescribed sinusoidal motion of the third ventricle lateral walls, with all other boundaries being rigid. The pressure propagation between the third and lateral ventricles was examined and compared to data obtained from a similar geometry with a stenosed aqueduct. It could be shown that the pressure amplitude in the lateral ventricles increases in the presence of aqueduct stenosis. No difference in phase shift between the motion of the third ventricle walls and the pressure in the lateral ventricles because of the aqueduct stenosis could be observed. It is deduced that CFD can be used to analyze the pressure propagation and its phase shift relative to the ventricle wall motion. It is further deduced that only models that take into account the coupling between ventricles, which feature a representation of the original geometry that is as accurate as possible and which represent the ventricle boundary motion realistically, should be used to make quantitative statements on flow and pressure in the ventricular space.