Enhanced Assessment of Aortic Stenosis using Computational Modelling

Lead Research Organisation: Swansea University
Department Name: College of Engineering

Abstract

The aortic valve ensures uni-directional flow during the cardiac cycle, by allowing the stroke volume to be ejected from the left ventricle into the aorta during systole, and by preventing backflow from the aorta into the left ventricle in diastole. There are two main reasons for valve malfunction, 1) regurgitation (retrograde flow) and 2) stenosis (flow obstruction), which are often combined to different extents in patients. Degenerative (age-related) aortic stenosis (AS) is the most prevalent cardiovascular disease in developed countries after coronary artery disease and hypertension and is curable by open heart surgery (aortic valve replacement or, more rarely, repair).Germane to all these clinical problems is the accuracy with which the severity of AS is assessed in clinical practice. From a fluid dynamics perspective, the ideal method for quantifying AS would be to measure the energy 'loss' caused by the high-velocity flow jet across a narrow, irregular orifice and in particular by the turbulent area downstream where the jet expands. However, accurate measurement of the energy 'loss' and correlating this with clinical outcomes is fraught with difficulties. Clinicians therefore rely on two well-tested, but nevertheless imperfect, measures of AS severity: pressure gradients (PG) and effective orifice area (EOA):1) PG is a good measure for the energy loss and can be measured invasively, by passing across the aortic valve using a catheter connected to a pressure gauge or wire. The drawbacks of PG is that the procedure is invasive and that PG is flow-dependent, which requires it to be indexed when used as an assessment criteria. 2) The EOA is an alternative measure for AS severity that distinguishes between smooth and sharp constrictions. It represents the cross-sectional area of the vena contracta just downstream of the valve. The EOA is less flow dependent than PGs and considered a good measure for the energy loss caused by the stenosis. Furthermore, non-invasive fast Doppler measurements are used to determine EOA, which makes this quantity the preferred one in clinical practice. However, some major assumptions are made for the calculation of EOA, i.e. the flow jet is axisymmetric with a uniform profile and is considered flow independent. These assumptions can be questioned for the distinct three-dimensional geometry of the aortic valve, the asymmetry of many diseased valves and the incompressible turbulent flow. Hence, the aim of the proposed work is to elucidate the effect of these assumptions using computational models. Hence, this research initiative will aim to use three-dimensional heart valve models for a better assessment of stenosed aortic valves. The valve geometries will be extracted from echocardiographic data alongside the measured flow for boundary conditions. The influence of the turbulent expansion area on the jet will be evaluated using rigid opened valves or fluid-structure interaction models. The turbulence models (URANS) will be validated using echocardiographic data on the flow and pressure field. The shape, profile and direction of the flow jet through the valve are then analysed and linked to the transvalvular pressure gradients. Current clinical assessment criteria, related to the flow and pressure field, will be re-evaluated based on the modelling results.

Publications

10 25 50
 
Description The interactions between a flexible structure like a heart valve and the blood is very difficult to capture. This project identified a way of coupling an efficient fluid flow solver to a solid mechanics solver. Test cases were run to demonstrate and validate the simulation codes.
Exploitation Route The project mainly delivered on the development of methodology for fluid structure interaction. Hence industries where these type of problems play a role (civil, aerospace, medical engineering) could take the technology and ideas forward.
Sectors Aerospace, Defence and Marine,Healthcare,Manufacturing, including Industrial Biotechology

 
Description The research has trained the post-doc in computational modelling which has led to a job as a Research Officer in Algal Bioenergy Modelling as part of a bigger european project. The researcher is still using the skills gained during the post-doc on a daily basis.
First Year Of Impact 2011
Sector Energy
Impact Types Societal

 
Description NISCHR
Amount £57,000 (GBP)
Funding ID HS/10/13 
Organisation Health and Care Research Wales 
Sector Public
Country United Kingdom
Start 04/2011 
End 03/2014
 
Title FSI solver 
Description A software was developed to efficiently calculate FSI problems for heart valves. The code was integrated with existing meshing and fluid dynamics softwares developed in house. 
Type Of Technology Software 
Year Produced 2011 
Impact Only some preliminary tests were run on the final code after which funding ran out. The code has been idle since waiting for a project where it can be developed further and used.