School of Mechanical Engineering Seminar
Wednesday, November 18, 2015 at 15:00
Wolfson Building of Mechanical Engineering, Room 206
THE EFFECT OF AORTIC VALVE REPLACEMENT ON THE CORONARY PERFUSION - COMPUTATIONAL FLUID-STRUCTURE INTERACTION MODELING AND ANALYSIS
Shaily Wald Shohat
MSc Student of Prof. Alex Liberzon & Prof. Idit Avrahami
Transcatheter aortic valve implantation (TAVI) is an alternative treatment to conventional surgical aortic valve replacement for patients with aortic stenosis. Patients with severe aortic stenosis suffer also from diastolic dysfunction and reduced coronary flow (perfusion). The coronary perfusion depends on the pressure gradient between the myocardial tissue during diastole and the coronary origin located at the aortic root (sinuses of Valsalva), and thus subjected to changes in diastolic flow field near the closing valve's leaflets. Coronary perfusion can be influenced by the valve size and design as well as diastolic time.
In this study, we examine the impact of replacement valve on the coronary perfusion and on the pressure changes in the aortic root, compared with an intact valve. The numerical models include 2D computational fluid-structure interaction (FSI) simulation of the aortic root including the valve's leaflets and coronary arteries, using the commercial finite-element package of ADINA.
The study considered healthy, stenosed and TAVI valves. Pressure and flow patterns at different cardiac output (flow rate) and heart rates (beats per minute) were studied in details. It is found that aortic valve replacement leads to a significant improve in coronary perfusion pressure as well as in the cardiac cycle time. This could be explained by two potential mechanisms: (1) increase of the pressure gradient across the sinus due to induced diastolic vortical flow patterns, and (2) the high velocity ejection of blood into the aorta is reduced, thus reducing any existing Venturi effect on pressures in the sinus. The results may shed light on the dynamic mechanisms that affect coronary perfusion due to TAVI.
School of Mechanical Engineering Seminar
Wednesday, November 18, 2015 at 15:00
Wolfson Building of Mechanical Engineering, Room 206
THE EFFECT OF AORTIC VALVE REPLACEMENT
ON THE CORONARY PERFUSION - EXPERIMENTAL STUDY
Barak Even Chen
MSc Student of Prof. Alex Liberzon & Prof. Idit Avrahami
Transcatheter aortic valve implantation (TAVI) is an alternative treatment to conventional surgical aortic valve replacement for patients with aortic stenosis. Patients with severe aortic stenosis suffer also from diastolic dysfunction and reduced coronary flow (perfusion). The coronary perfusion depends on the pressure gradient between the myocardial tissue during diastole and the coronary origin located at the aortic root (sinuses of Valsalva), and thus subjected to changes in diastolic flow field near the closing valve's leaflets. Coronary perfusion can be influenced by the valve size and design as well as diastolic time. It is suggested that TAVI improves coronary perfusion pressure and increases coronary flow-rate by two potential mechanisms: (1) increase of the pressure gradient across the sinus due to induced diastolic vortical flow patterns, and (2) the high velocity ejection of blood into the aorta is reduced, thus reducing any existing Venturi effect on pressures in the sinus.
In this experimental study, we examine the impact of replacement valve on the coronary perfusion and on the pressure changes in the aortic root, compared with an intact valve. The method is based on flow visualization in a transparent flexible model of the aortic root, along with the pressure and flowrate measurements to coronary arteries. The flow is driven by hemodynamic pump using pulse duplicator, and contains a synchronized controlled resistance in the coronary arteries.
The study considered healthy, stenosed and TAVI valves. Pressure and flow patterns at different cardiac output (flow rate) and heart rates (beats per minute) were investigated. The experimental results confirm that aortic valve replacement leads to normalization of coronary flow, although at slightly different rate as compared to the reference healthy case.