Validation and Extension of a Fluid–Structure Interaction Model of the Healthy Aortic Valve

PurposeThe understanding of the optimum function of the healthy aortic valve is essential in interpreting the effect of pathologies in the region, and in devising effective treatments to restore the physiological functions. Still, there is no consensus on the operating mechanism that regulates the valve opening and closing dynamics. The aim of this study is to develop a numerical model that can support a better comprehension of the valve function and serve as a reference to identify the changes produced by specific pathologies and treatments.MethodsA numerical model was developed and adapted to accurately replicate the conditions of a previous in vitro investigation into aortic valve dynamics, performed by means of particle image velocimetry (PIV). The resulting velocity fields of the two analyses were qualitatively and quantitatively compared to validate the numerical model. In order to simulate more physiological operating conditions, this was then modified to overcome the main limitations of the experimental setup, such as the presence of a supporting stent and the non-physiological properties of the fluid and vessels.ResultsThe velocity fields of the initial model resulted in good agreement with those obtained from the PIV, with similar flow structures and about 90% of the computed velocities after valve opening within the standard deviation of the equivalent velocity measurements of the in vitro model. Once the experimental limitations were removed from the model, the valve opening dynamics changed substantially, with the leaflets opening into the sinuses to a much greater extent, enlarging the effective orifice area by 11%, and reducing greatly the vortical structures previously observed in proximity of the Valsalva sinuses wall.ConclusionsThe study suggests a new operating mechanism for the healthy aortic valve leaflets considerably different from what reported in the literature to date and largely more efficient in terms of hydrodynamic performance. This work also confirms the crucial role that numerical approaches, complemented with experimental findings, can play in overcoming some of the limitations inherent in experimental techniques, supporting the full understanding of complex physiological phenomena.

[1]  I. C. Howard,et al.  On the opening mechanism of the aortic valve: some observations from simulations , 2003, Journal of medical engineering & technology.

[2]  M. Sacks,et al.  Biaxial mechanical properties of the natural and glutaraldehyde treated aortic valve cusp--Part I: Experimental results. , 2000, Journal of biomechanical engineering.

[3]  Stefanie Reese,et al.  Multi-scale modelling of textile reinforced artificial tubular aortic heart valves , 2017 .

[4]  R GORLIN,et al.  Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. , 1951, American heart journal.

[5]  R. Haut Biomechanics of Soft Tissue , 2002 .

[6]  Gaetano Burriesci,et al.  Hemodynamics in the Valsalva sinuses after transcatheter aortic valve implantation (TAVI). , 2013, The Journal of heart valve disease.

[7]  Govinda Balan Kalyana Sundaram,et al.  Aortic valve dynamics using a fluid structure interaction model--The physiology of opening and closing. , 2015, Journal of biomechanics.

[8]  van Aa Anton Steenhoven,et al.  Model studies of the closing behaviour of the aortic valve , 1979, Journal of Fluid Mechanics.

[9]  Idit Avrahami,et al.  A numerical study of the hemodynamic effect of the aortic valve on coronary flow , 2018, Biomechanics and modeling in mechanobiology.

[10]  J Vierendeels,et al.  Validation of a Fluid–Structure Interaction Model of a Heart Valve using the Dynamic Mesh Method in Fluent , 2004, Computer methods in biomechanics and biomedical engineering.

[11]  Akram Joda,et al.  Multiphysics simulation of the effect of leaflet thickness inhomogeneity and material anisotropy on the stress-strain distribution on the aortic valve. , 2016, Journal of biomechanics.

[12]  B J Bellhouse,et al.  Fluid mechanics of the aortic valve. , 1969, British heart journal.

[13]  Komarakshi R Balakrishnan,et al.  Dynamic analysis of the aortic valve using a finite element model. , 2002, The Annals of thoracic surgery.

[14]  T. Schmitz-Rode,et al.  The geometry of the aortic root in health, at valve disease and after valve replacement. , 1990, Journal of biomechanics.

[15]  J. Guccione,et al.  Computational cardiovascular mechanics , 2010 .

[16]  W. M. Swanson,et al.  Dimensions and Geometric Relationships of the Human Aortic Value as a Function of Pressure , 1974, Circulation research.

[17]  Laura R. Croft,et al.  Computational Modeling of Aortic Heart Valves , 2010 .

[18]  Hélène A. Simon,et al.  FLUID MECHANICS OF ARTIFICIAL HEART VALVES , 2009, Clinical and experimental pharmacology & physiology.

[19]  I. C. Howard,et al.  A three-dimensional analysis of a bioprosthetic heart valve. , 1991, Journal of biomechanics.

[20]  Michel R Labrosse,et al.  Aortic root dilatation may alter the dimensions of the valve leaflets. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[21]  B. Bellhouse,et al.  Fluid Mechanics of the Aortic Root with Application to Coronary Flow , 1968, Nature.

[22]  G. Holzapfel SECTION 10.11 – Biomechanics of Soft Tissue , 2001 .

[23]  A. Yoganathan,et al.  Heart valve function: a biomechanical perspective , 2008, Philosophical Transactions of the Royal Society B: Biological Sciences.

[24]  David E. Schmidt,et al.  On the biomechanics of heart valve function. , 2009, Journal of biomechanics.

[25]  B J Bellhouse,et al.  Instantaneous velocity measurement in major blood vessels: its value in the study of normal and abnormal circulation. , 1969, British heart journal.

[26]  Emiliano Votta,et al.  Impact of modeling fluid-structure interaction in the computational analysis of aortic root biomechanics. , 2013, Medical engineering & physics.

[27]  A. Ducci,et al.  Physiological vortices in the sinuses of Valsalva: An in vitro approach for bio-prosthetic valves , 2016, Journal of biomechanics.

[28]  I. Borazjani Fluid–structure interaction, immersed boundary-finite element method simulations of bio-prosthetic heart valves , 2013 .

[29]  Wei Sun,et al.  Fluid Simulation of a Transcatheter Aortic Valve Deployment into a Patient-Specific Aortic Root , 2011 .

[30]  Jan Engvall,et al.  Flow patterns in the aortic root and the aorta studied with time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging: implications for aortic valve-sparing surgery. , 2004, The Journal of thoracic and cardiovascular surgery.

[31]  Fotis Sotiropoulos,et al.  Flow in Prosthetic Heart Valves: State-of-the-Art and Future Directions , 2005, Annals of Biomedical Engineering.

[32]  Arash Kheradvar,et al.  High-speed particle image velocimetry to assess cardiac fluid dynamics in vitro: From performance to validation , 2012 .

[33]  Francesco Migliavacca,et al.  Study on the Accuracy of Structural and FSI Heart Valves Simulations , 2018, Cardiovascular Engineering and Technology.

[34]  Adrian Ranga,et al.  Computational simulations of the aortic valve validated by imaging data: evaluation of valve-sparing techniques. , 2006, Interactive cardiovascular and thoracic surgery.

[35]  Rosaire Mongrain,et al.  Therapeutic Vascular Compliance Change May Cause Significant Variation in Coronary Perfusion: A Numerical Study , 2012, Comput. Math. Methods Medicine.

[36]  A. Ducci,et al.  Transcatheter aortic valves produce unphysiological flows which may contribute to thromboembolic events: An in-vitro study , 2016, Journal of biomechanics.

[37]  Kris Dumont,et al.  Experimental and numerical modeling of heart valve dynamics , 2004 .

[38]  A. Yoganathan,et al.  Experimental measurement of dynamic fluid shear stress on the aortic surface of the aortic valve leaflet , 2011, Biomechanics and Modeling in Mechanobiology.

[39]  U. Morbiducci,et al.  The combined role of sinuses of Valsalva and flow pulsatility improves energy loss of the aortic valve. , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[40]  A. Yoganathan,et al.  Experimental measurement of dynamic fluid shear stress on the ventricular surface of the aortic valve leaflet , 2011, Biomechanics and Modeling in Mechanobiology.

[41]  Rosaire Mongrain,et al.  The effect of aortic wall and aortic leaflet stiffening on coronary hemodynamic: a fluid–structure interaction study , 2013, Medical & Biological Engineering & Computing.

[42]  Nicolas Aquelet,et al.  Initialisation of volume fraction in fluid/structure interaction problem , 2005 .

[43]  M. Sacks,et al.  Biaxial mechanical properties of the native and glutaraldehyde-treated aortic valve cusp: Part II--A structural constitutive model. , 2000, Journal of biomechanical engineering.

[44]  Hélène A. Simon,et al.  Vorticity dynamics of a bileaflet mechanical heart valve in an axisymmetric aorta , 2007 .

[45]  Eli J Weinberg,et al.  Transient, Three-dimensional, Multiscale Simulations of the Human Aortic Valve , 2007, Cardiovascular engineering.

[46]  I. Shbeeb,et al.  The aortic valve , 1984, Diseases of the colon and rectum.

[47]  S. Bozkurt,et al.  Design, Analysis and Testing of a Novel Mitral Valve for Transcatheter Implantation , 2017, Annals of Biomedical Engineering.

[48]  I. C. Howard,et al.  An approach to the simulation of fluid-structure interaction in the aortic valve. , 2006, Journal of biomechanics.

[49]  Wei Sun,et al.  Fluid–Structure Interaction Study of Transcatheter Aortic Valve Dynamics Using Smoothed Particle Hydrodynamics , 2016, Cardiovascular engineering and technology.

[50]  Valérie Deplano,et al.  Validation of a numerical 3-D fluid-structure interaction model for a prosthetic valve based on experimental PIV measurements. , 2009, Medical engineering & physics.

[51]  C. Scheffer,et al.  Experimental validation of the fluid–structure interaction simulation of a bioprosthetic aortic heart valve , 2013, Australasian Physical & Engineering Sciences in Medicine.

[52]  Lakshmi Prasad Dasi,et al.  Coronary Flow Impacts Aortic Leaflet Mechanics and Aortic Sinus Hemodynamics , 2015, Annals of Biomedical Engineering.

[53]  Ajit P Yoganathan,et al.  Fluid mechanics of heart valves. , 2004, Annual review of biomedical engineering.

[54]  Peter Oshkai,et al.  The influence of the aortic root geometry on flow characteristics of a prosthetic heart valve. , 2015, Journal of biomechanical engineering.

[55]  Wei Sun,et al.  Computational Fluid Dynamics Assessment Associated with Transcatheter Heart Valve Prostheses: A Position Paper of the ISO Working Group , 2018, Cardiovascular engineering and technology.

[56]  Ghassan S Kassab,et al.  A rate-insensitive linear viscoelastic model for soft tissues. , 2007, Biomaterials.