Abstract

In this paper, the characteristics of pulsatile flow past a silicone-based artificial stenotic aortic valve under varied heart rates have been studied using particle image velocimetry (PIV). Pulsatile flow waveforms were generated by a closed-loop cardiovascular flow simulator. Phase-locked PIV was employed to quantify the average and turbulent flow field information. Pressure gradient waveforms were recorded to evaluate the severity of the stenosis. Results suggest that as the heart rate increases, the peak pressure gradient across the stenotic aortic valve increases significantly under the same cardiac output. Under the same cardiac output, the aortic valve area (AVA) estimated using Gorlin equation decreases as the heart rate increases, while the trend is reversed using Hakki equation estimation. PIV results suggest that the peak systolic jet velocity downstream of the valve increases as the heart rate increases, implying a longer pressure recovery distance as heart rate increases. While the turbulence at peak systole is higher under the slower heart rate, the faster heart rate contributes to higher turbulence during the late systole and early diastole phases. Based on the comparison with no-valve cases, the differences in turbulence kinetic energy (TKE) was mainly related to the dynamics of leaflets under different heart rates. Overall, the results obtained in this study demonstrate that the hemodynamics of a stenotic aortic valve is complex, and the assessment of AS could be significantly affected by the pulsating rate of the flow.

References

References
1.
Nkomo
,
V. T.
,
Gardin
,
J. M.
,
Skelton
,
T. N.
,
Gottdiener
,
J. S.
,
Scott
,
C. G.
, and
Enriquez-Sarano
,
M.
,
2006
, “
Burden of Valvular Heart Diseases: A Population-Based Study
,”
Lancet
,
368
(
9540
), pp.
1005
1011
.10.1016/S0140-6736(06)69208-8
2.
Otto
,
C. M.
,
Burwash
,
I. G.
,
Legget
,
M. E.
,
Munt
,
B. I.
,
Fujioka
,
M.
,
Healy
,
N. L.
,
Kraft
,
C. D.
,
Miyake-Hull
,
C. Y.
, and
Schwaegler
,
R. G.
,
1997
, “
Prospective Study of Asymptomatic Valvular Aortic Stenosis
,”
Circulation
,
95
(
9
), pp.
2262
2270
.10.1161/01.CIR.95.9.2262
3.
Soler-Soler
,
J.
, and
Galve
,
E.
,
2000
, “
Worldwide Perspective of Valve Disease
,”
Heart
,
83
(
6
), pp.
721
725
.10.1136/heart.83.6.721
4.
Falk
,
E.
,
1991
, “
Coronary Thrombosis: Pathogenesis and Clinical Manifestations
,”
Am. J. Cardiol.
,
68
(
7
), pp.
B28
B35
.10.1016/0002-9149(91)90382-U
5.
Czarny
,
M. J.
, and
Resar
,
J. R.
,
2014
, “
Diagnosis and Management of Valvular Aortic Stenosis
,”
Clin. Med. Insights Cardiol.
,
8s1
, p.
S15716
.10.4137/CMC.S15716
6.
Carabello
,
B. A.
, and
Paulus
,
W. J.
,
2009
, “
Aortic Stenosis
,”
Lancet
,
373
(
9667
), pp.
956
966
.10.1016/S0140-6736(09)60211-7
7.
Rosenhek
,
R.
,
2004
, “
Mild and Moderate Aortic Stenosis Natural History and Risk Stratification by Echocardiography
,”
Eur. Heart J.
,
25
(
3
), pp.
199
205
.10.1016/j.ehj.2003.12.002
8.
Pereira
,
J. J.
,
Balaban
,
K.
,
Lauer
,
M. S.
,
Lytle
,
B.
,
Thomas
,
J. D.
, and
Garcia
,
M. J.
,
2005
, “
Aortic Valve Replacement in Patients With Mild or Moderate Aortic Stenosis and Coronary Bypass Surgery
,”
Am. J. Med.
,
118
(
7
), pp.
735
742
.10.1016/j.amjmed.2005.01.072
9.
Varadarajan
,
P.
,
Kapoor
,
N.
,
Bansal
,
R. C.
, and
Pai
,
R. G.
,
2006
, “
Clinical Profile and Natural History of 453 Nonsurgically Managed Patients With Severe Aortic Stenosis
,”
Ann. Thorac. Surg.
,
82
(
6
), pp.
2111
2115
.10.1016/j.athoracsur.2006.07.048
10.
Chen
,
Y.
, and
Luo
,
H.
,
2018
, “
A Computational Study of the Three-Dimensional Fluid–Structure Interaction of Aortic Valve
,”
J. Fluids Struct.
,
80
, pp.
332
349
.10.1016/j.jfluidstructs.2018.04.009
11.
Chen
,
Y.
, and
Luo
,
H.
,
2020
, “
Pressure Distribution Over the Leaflets and Effect of Bending Stiffness on Fluid–Structure Interaction of the Aortic Valve
,”
J. Fluid Mech.
,
883
, p. A52.10.1017/jfm.2019.904
12.
Falahatpisheh
,
A.
, and
Kheradvar
,
A.
,
2012
, “
High-Speed Particle Image Velocimetry to Assess Cardiac Fluid Dynamics In Vitro: From Performance to Validation
,”
Eur. J. Mech.—B
,
35
, pp.
2
8
.10.1016/j.euromechflu.2012.01.019
13.
Knapp
,
Y.
, and
Bertrand
,
E.
,
2005
, “
Particle Imaging Velocimetry Measurements in a Heart Simulator
,”
J. Vis.
,
8
(
3
), pp.
217
224
.10.1007/BF03181499
14.
Stamatopoulos
,
C.
,
Mathioulakis
,
D. S.
,
Papaharilaou
,
Y.
, and
Katsamouris
,
A.
,
2011
, “
Experimental Unsteady Flow Study in a Patient-Specific Abdominal Aortic Aneurysm Model
,”
Exp. Fluids
,
50
(
6
), pp.
1695
1709
.10.1007/s00348-010-1034-6
15.
Yu
,
S. C. M.
,
2000
, “
Steady and Pulsatile Flow Studies in Abdominal Aortic Aneurysm Models Using Particle Image Velocimetry
,”
Int. J. Heat Fluid Flow
,
21
(
1
), pp.
74
83
.
16.
Lim
,
W. L.
,
Chew
,
Y. T.
,
Chew
,
T. C.
, and
Low
,
H. T.
,
1998
, “
Steady Flow Dynamics of Prosthetic Aortic Heart Valves: A Comparative Evaluation With PIV Techniques
,”
J. Biomech.
,
31
(
5
), pp.
411
421
.10.1016/S0021-9290(98)00026-8
17.
Leo
,
H. L.
,
Dasi
,
L. P.
,
Carberry
,
J.
,
Simon
,
H. A.
, and
Yoganathan
,
A. P.
,
2006
, “
Fluid Dynamic Assessment of Three Polymeric Heart Valves Using Particle Image Velocimetry
,”
Ann. Biomed. Eng.
,
34
(
6
), pp.
936
952
.10.1007/s10439-006-9117-5
18.
Saikrishnan
,
N.
,
Yap
,
C.-H.
,
Milligan
,
N. C.
,
Vasilyev
,
N. V.
, and
Yoganathan
,
A. P.
,
2012
, “
In Vitro Characterization of Bicuspid Aortic Valve Hemodynamics Using Particle Image Velocimetry
,”
Ann. Biomed. Eng.
,
40
(
8
), pp.
1760
1775
.10.1007/s10439-012-0527-2
19.
Dasi
,
L. P.
,
Ge
,
L.
,
Simon
,
H. A.
,
Sotiropoulos
,
F.
, and
Yoganathan
,
A. P.
,
2007
, “
Vorticity Dynamics of a Bileaflet Mechanical Heart Valve in an Axisymmetric Aorta
,”
Phys. Fluids
,
19
(
6
), p.
067105
.10.1063/1.2743261
20.
Ge
,
L.
,
Leo
,
H.-L.
,
Sotiropoulos
,
F.
, and
Yoganathan
,
A. P.
,
2005
, “
Flow in a Mechanical Bileaflet Heart Valve at Laminar and Near-Peak Systole Flow Rates: CFD Simulations and Experiments
,”
ASME J. Biomech. Eng.
,
127
(
5
), pp.
782
797
.10.1115/1.1993665
21.
Hatle
,
L.
,
Angelsen
,
B. A.
, and
Tromsdal
,
A.
,
1980
, “
Non-Invasive Assessment of Aortic Stenosis by Doppler Ultrasound
,”
Heart
,
43
(
3
), pp.
284
292
.10.1136/hrt.43.3.284
22.
Pibarot
,
P.
, and
Dumesnil
,
J. G.
,
2012
, “
Improving Assessment of Aortic Stenosis
,”
J. Am. Coll. Cardiol.
,
60
(
3
), pp.
169
180
.10.1016/j.jacc.2011.11.078
23.
Moraes
,
A. B.
,
de
,
O.
,
Stähli
,
B. E.
,
Arsenault
,
B. J.
,
Busseuil
,
D.
,
Merlet
,
N.
,
Gebhard
,
C.
,
Fortier
,
A.
,
Rhainds
,
D.
,
Dubé
,
M.-P.
,
Guertin
,
M.-C.
,
Asgar
,
A.
,
Rhéaume
,
E.
, and
Tardif
,
J.-C.
,
2016
, “
Resting Heart Rate as a Predictor of Aortic Valve Stenosis Progression
,”
Int. J. Cardiol.
,
204
, pp.
149
151
.10.1016/j.ijcard.2015.11.166
24.
Lou
,
Z.
, and
Yang
,
W.-J.
,
1993
, “
A Computer Simulation of the Non-Newtonian Blood Flow at the Aortic Bifurcation
,”
J. Biomech.
,
26
(
1
), pp.
37
49
.10.1016/0021-9290(93)90611-H
25.
Caballero
,
A. D.
, and
Laín
,
S.
,
2015
, “
Numerical Simulation of Non-Newtonian Blood Flow Dynamics in Human Thoracic Aorta
,”
Comput. Methods Biomech. Biomed. Eng.
,
18
(
11
), pp.
1200
1216
.10.1080/10255842.2014.887698
26.
Buchmann
,
N. A.
,
Atkinson
,
C.
,
Jeremy
,
M. C.
, and
Soria
,
J.
,
2011
, “
Tomographic Particle Image Velocimetry Investigation of the Flow in a Modeled Human Carotid Artery Bifurcation
,”
Exp. Fluids
,
50
(
4
), pp.
1131
1151
.10.1007/s00348-011-1042-1
27.
Forliti
,
D. J.
,
Strykowski
,
P. J.
, and
Debatin
,
K.
,
2000
, “
Bias and Precision Errors of Digital Particle Image Velocimetry
,”
Exp. Fluids
,
28
(
5
), pp.
436
447
.10.1007/s003480050403
28.
Hasan
,
A.
,
Ragaert
,
K.
,
Swieszkowski
,
W.
,
Selimović
,
S.
,
Paul
,
A.
,
Camci-Unal
,
G.
,
Mofrad
,
M. R. K.
, and
Khademhosseini
,
A.
,
2014
, “
Biomechanical Properties of Native and Tissue Engineered Heart Valve Constructs
,”
J. Biomech.
,
47
(
9
), pp.
1949
1963
.10.1016/j.jbiomech.2013.09.023
29.
Chandra
,
S.
,
Rajamannan
,
N. M.
, and
Sucosky
,
P.
,
2012
, “
Computational Assessment of Bicuspid Aortic Valve Wall-Shear Stress: Implications for Calcific Aortic Valve Disease
,”
Biomech. Model. Mechanobiol.
,
11
(
7
), pp.
1085
1096
.10.1007/s10237-012-0375-x
30.
Nishimura
,
R. A.
,
Otto
,
C. M.
,
Bonow
,
R. O.
,
Carabello
,
B. A.
,
Erwin
,
J. P.
,
Guyton
,
R. A.
,
O'Gara
,
P. T.
,
Ruiz
,
C. E.
,
Skubas
,
N. J.
,
Sorajja
,
P.
,
Sundt
,
T. M.
, and
Thomas
,
J. D.
,
and American College of Cardiology/American Heart Association Task Force on Practice Guidelines
,
2014
, “
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
,”
J. Am. Coll. Cardiol.
,
63
(
22
), pp.
2438
2488
.10.1016/j.jacc.2014.02.537
31.
Chung
,
C. S.
,
Karamanoglu
,
M.
, and
Kovács
,
S. J.
,
2004
, “
Duration of Diastole and Its Phases as a Function of Heart Rate During Supine Bicycle Exercise
,”
Am. J. Physiol.-Heart Circ. Physiol.
,
287
(
5
), pp.
H2003
H2008
.10.1152/ajpheart.00404.2004
32.
Sarnari
,
R.
,
Kamal
,
R. Y.
,
Friedberg
,
M. K.
, and
Silverman
,
N. H.
,
2009
, “
Doppler Assessment of the Ratio of the Systolic to Diastolic Duration in Normal Children: Relation to Heart Rate, Age and Body Surface Area
,”
J. Am. Soc. Echocardiogr.
,
22
(
8
), pp.
928
932
.10.1016/j.echo.2009.05.004
33.
Womersley
,
J. R.
,
1955
, “
Method for the Calculation of Velocity, Rate of Flow and Viscous Drag in Arteries When the Pressure Gradient is Known
,”
J. Physiol.
,
127
(
3
), pp.
553
563
.10.1113/jphysiol.1955.sp005276
34.
Stalder
,
A. F.
,
Frydrychowicz
,
A.
,
Russe
,
M. F.
,
Korvink
,
J. G.
,
Hennig
,
J.
,
Li
,
K.
, and
Markl
,
M.
,
2011
, “
Assessment of Flow Instabilities in the Healthy Aorta Using Flow-Sensitive MRI
,”
J. Magn. Reson. Imaging
,
33
(
4
), pp.
839
846
.10.1002/jmri.22512
35.
Farag
,
E. S.
,
van Ooij
,
P.
,
Planken
,
R. N.
,
Dukker
,
K. C. P.
,
de Heer
,
F.
,
Bouma
,
B. J.
,
Robbers‐Visser
,
D.
,
Groenink
,
M.
,
Nederveen
,
A. J.
,
de Mol
,
B. A. J. M.
,
Kluin
,
J.
, and
Boekholdt
,
S. M.
,
2018
, “
Aortic Valve Stenosis and Aortic Diameters Determine the Extent of Increased Wall Shear Stress in Bicuspid Aortic Valve Disease
,”
J. Magn. Reson. Imaging
,
48
(
2
), pp.
522
530
.10.1002/jmri.25956
36.
Bahlmann
,
E.
,
Cramariuc
,
D.
,
Gerdts
,
E.
,
Gohlke-Baerwolf
,
C.
,
Nienaber
,
C. A.
,
Eriksen
,
E.
,
Wachtell
,
K.
,
Chambers
,
J.
,
Kuck
,
K. H.
, and
Ray
,
S.
,
2010
, “
Impact of Pressure Recovery on Echocardiographic Assessment of Asymptomatic Aortic Stenosis: A SEAS Substudy
,”
JACC Cardiovasc. Imaging
,
3
(
6
), pp.
555
562
.10.1016/j.jcmg.2009.11.019
37.
Stein
,
P. D.
, and
Sabbah
,
H. N.
,
1974
, “
Measured Turbulence and Its Effect on Thrombus Formation
,”
Circ. Res.
,
35
(
4
), pp.
608
614
.10.1161/01.RES.35.4.608
38.
Ha
,
H.
,
Ziegler
,
M.
,
Welander
,
M.
,
Bjarnegård
,
N.
,
Carlhäll
,
C.-J.
,
Lindenberger
,
M.
,
Länne
,
T.
,
Ebbers
,
T.
, and
Dyverfeldt
,
P.
,
2018
, “
Age-Related Vascular Changes Affect Turbulence in Aortic Blood Flow
,”
Front. Physiol.
,
9
,
36
.10.3389/fphys.2018.00036
39.
Gorlin
,
R.
, and
Gorlin
,
S. G.
,
1951
, “
Hydraulic Formula for Calculation of the Area of the Stenotic Mitral Valve, Other Cardiac Valves, and Central Circulatory Shunts—I
,”
Am. Heart J.
,
41
(
1
), pp.
1
29
.10.1016/0002-8703(51)90002-6
40.
Reddy
,
Y. N. V.
, and
Nishimura
,
R. A.
,
2018
, “
Evaluating the Severity of Aortic Stenosis: A Re-Look at Our Current ‘Gold Standard’ Measurements
,”
Eur. Heart J.
,
39
(
28
), pp.
2656
2658
.10.1093/eurheartj/ehy224
41.
Hakki
,
A. H.
,
Iskandrian
,
A. S.
,
Bemis
,
C. E.
,
Kimbiris
,
D.
,
Mintz
,
G. S.
,
Segal
,
B. L.
, and
Brice
,
C.
,
1981
, “
A Simplified Valve Formula for the Calculation of Stenotic Cardiac Valve Areas
,”
Circulation
,
63
(
5
), pp.
1050
1055
.10.1161/01.CIR.63.5.1050
42.
Burwash
,
I. G.
,
Dickinson
,
A.
,
Teskey
,
R. J.
,
Tam
,
J. W.
, and
Chan
,
K. L.
,
2000
, “
Aortic Valve Area Discrepancy by Gorlin Equation and Doppler Echocardiography Continuity Equation: Relationship to Flow in Patients With Valvular Aortic Stenosis
,”
Can. J. Cardiol.
,
16
(
8
), pp.
985
992
. https://pubmed.ncbi.nlm.nih.gov/10978934/
43.
Magne
,
J.
,
Lancellotti
,
P.
, and
Piérard
,
L. A.
,
2014
, “
Exercise Testing in Asymptomatic Severe Aortic Stenosis
,”
JACC Cardiovasc. Imaging
,
7
(
2
), pp.
188
199
.10.1016/j.jcmg.2013.08.011
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