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1. Patient‐specific CFD modelling in the thoracic aorta with PC‐MRI–based boundary conditions: A least‐square three‐element Windkessel approach

   https://doi.org/10.1002/cnm.3134  

   Romarowski, Rodrigo M. ; Lefieux, Adrien ; Morganti, Simone ; Veneziani, Alessandro ; Auricchio, Ferdinando ( August 2018 , International Journal for Numerical Methods in Biomedical Engineering)

   The increasing use of computational fluid dynamics for simulating blood flow in clinics demands the identification of appropriate patient‐specific boundary conditions for the customization of the mathematical models. These conditions should ideally be retrieved from measurements. However, finite resolution of devices as well as other practical/ethical reasons prevent the construction of complete data sets necessary to make the mathematical problems well posed. Available data need to be completed by modelling assumptions, whose impact on the final solution has to be carefully addressed. Focusing on aortic vascular districts and related pathologies, we present here a method for efficiently and robustly prescribing phase contrast MRI–based patient‐specific data as boundary conditions at the domain of interest. In particular, for the outlets, the basic idea is to obtain pressure conditions from an appropriate elaboration of available flow rates on the basis of a 3D/0D dimensionally heterogeneous modelling. The key point is that the parameters are obtained by a constrained optimization procedure. The rationale is that pressure conditions have a reduced impact on the numerical solution compared with velocity conditions, yielding a simulation framework less exposed to noise and inconsistency of the data, as well as to the arbitrariness of the underlying modelling assumptions.more »Numerical results confirm the reliability of the approach in comparison with other patient‐specific approaches adopted in the literature.

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2. The effects of clinically‐derived parametric data uncertainty in patient‐specific coronary simulations with deformable walls

   https://doi.org/10.1002/cnm.3351  

   Seo, Jongmin ; Schiavazzi, Daniele E. ; Kahn, Andrew M. ; Marsden, Alison L. ( June 2020 , International Journal for Numerical Methods in Biomedical Engineering)

   Cardiovascular simulations are increasingly used for noninvasive diagnosis of cardiovascular disease, to guide treatment decisions, and in the design of medical devices. Quantitative assessment of the variability of simulation outputs due to input uncertainty is a key step toward further integration of cardiovascular simulations in the clinical workflow. In this study, we present uncertainty quantification in computational models of the coronary circulation to investigate the effect of uncertain parameters, including coronary pressure waveform, intramyocardial pressure, morphometry exponent, and the vascular wall Young's modulus. We employ a left coronary artery model with deformable vessel walls, simulated via an Arbitrary‐Lagrangian‐Eulerian framework for fluid‐structure interaction, with a prescribed inlet pressure and open‐loop lumped parameter network outlet boundary conditions. Stochastic modeling of the uncertain inputs is determined from intra‐coronary catheterization data or gathered from the literature. Uncertainty propagation is performed using several approaches including Monte Carlo, Quasi Monte Carlo sampling, stochastic collocation, and multi‐wavelet stochastic expansion. Variabilities in the quantities of interest, including branch pressure, flow, wall shear stress, and wall deformation are assessed. We find that uncertainty in inlet pressures and intramyocardial pressures significantly affect all resulting QoIs, while uncertainty in elastic modulus only affects the mechanical response of the vascular wall.more »Variability in the morphometry exponent used to distribute the total downstream vascular resistance to the single outlets, has little effect on coronary hemodynamics or wall mechanics. Finally, we compare convergence behaviors of statistics of QoIs using several uncertainty propagation methods on three model benchmark problems and the left coronary simulations. From the simulation results, we conclude that the multi‐wavelet stochastic expansion shows superior accuracy and performance against Quasi Monte Carlo and stochastic collocation methods.

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3. The interaction of vortical flows with red cells in venous valve mimics

   https://doi.org/10.1063/5.0078337  

   Sanchez, Zyrina Alura C. ; Vijayananda, Vignesha ; Virassammy, Devin M. ; Rosenfeld, Liat ; Ramasubramanian, Anand K. ( March 2022 , Biomicrofluidics)

   The motion of cells orthogonal to the direction of main flow is of importance in natural and engineered systems. The lateral movement of red blood cells (RBCs) distal to sudden expansion is considered to influence the formation and progression of thrombosis in venous valves, aortic aneurysms, and blood-circulating devices and is also a determining parameter for cell separation applications in flow-focusing microfluidic devices. Although it is known that the unique geometry of venous valves alters the blood flow patterns and cell distribution in venous valve sinuses, the interactions between fluid flow and RBCs have not been elucidated. Here, using a dilute cell suspension in an in vitro microfluidic model of a venous valve, we quantified the spatial distribution of RBCs by microscopy and image analysis, and using micro-particle image velocimetry and 3D computational fluid dynamics simulations, we analyzed the complex flow patterns. The results show that the local hematocrit in the valve pockets is spatially heterogeneous and is significantly different from the feed hematocrit. Above a threshold shear rate, the inertial separation of streamlines and lift forces contribute to an uneven distribution of RBCs in the vortices, the entrapment of RBCs in the vortices, and non-monotonic wall shear stresses inmore »the valve pockets. Our experimental and computational characterization provides insights into the complex interactions between fluid flow, RBC distribution, and wall shear rates in venous valve mimics, which is of relevance to understanding the pathophysiology of thrombosis and improving cell separation efficiency.

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4. Patient–Specific Immersed Finite Element–Difference Model of Transcatheter Aortic Valve Replacement

   https://doi.org/10.1007/s10439-022-03047-3  

   Brown, Jordan A. ; Lee, Jae H. ; Smith, Margaret Anne ; Wells, David R. ; Barrett, Aaron ; Puelz, Charles ; Vavalle, John P. ; Griffith, Boyce E. ( January 2023 , Annals of Biomedical Engineering)

   Abstract Transcatheter aortic valve replacement (TAVR) first received FDA approval for high-risk surgical patients in 2011 and has been approved for low-risk surgical patients since 2019. It is now the most common type of aortic valve replacement, and its use continues to accelerate. Computer modeling and simulation (CM&S) is a tool to aid in TAVR device design, regulatory approval, and indication in patient-specific care. This study introduces a computational fluid-structure interaction (FSI) model of TAVR with Medtronic’s CoreValve Evolut R device using the immersed finite element-difference (IFED) method. We perform dynamic simulations of crimping and deployment of the Evolut R, as well as device behavior across the cardiac cycle in a patient-specific aortic root anatomy reconstructed from computed tomography (CT) image data. These IFED simulations, which incorporate biomechanics models fit to experimental tensile test data, automatically capture the contact within the device and between the self-expanding stent and native anatomy. Further, we apply realistic driving and loading conditions based on clinical measurements of human ventricular and aortic pressures and flow rates to demonstrate that our Evolut R model supports a physiological diastolic pressure load and provides informative clinical performance predictions.
5. Deep phenotyping of cardiac function in heart transplant patients using cardiovascular system models

   https://doi.org/10.1113/JP279393  

   Colunga, Amanda L. ; Kim, Karam G. ; Woodall, N. Payton ; Dardas, Todd F. ; Gennari, John H. ; Olufsen, Mette S. ; Carlson, Brian E. ( June 2020 , The Journal of Physiology)

   Right heart catheterization data from clinical records of heart transplant patients are used to identify patient‐specific models of the cardiovascular system.

   These patient‐specific cardiovascular models represent a snapshot of cardiovascular function at a given post‐transplant recovery time point.

   This approach is used to describe cardiac function in 10 heart transplant patients, five of which had multiple right heart catheterizations allowing an assessment of cardiac function over time.

   These patient‐specific models are used to predict cardiovascular function in the form of right and left ventricular pressure‐volume loops and ventricular power, an important metric in the clinical assessment of cardiac function.

   Outcomes for the longitudinally tracked patients show that our approach was able to identify the one patient from the group of five that exhibited post‐transplant cardiovascular complications.

   Heart transplant patients are followed with periodic right heart catheterizations (RHCs) to identify post‐transplant complications and guide treatment. Post‐transplant positive outcomes are associated with a steady reduction of right ventricular and pulmonary arterial pressures, toward normal levels of right‐side pressure (about 20 mmHg) measured by RHC. This study shows that more information about patient progression is obtained by combining standard RHC measures with mechanistic computational cardiovascular system models. The purpose of this study is twofold: to understandmore »how cardiovascular system models can be used to represent a patient's cardiovascular state, and to use these models to track post‐transplant recovery and outcome. To obtain reliable parameter estimates comparable within and across datasets, we use sensitivity analysis, parameter subset selection, and optimization to determine patient‐specific mechanistic parameters that can be reliably extracted from the RHC data. Patient‐specific models are identified for 10 patients from their first post‐transplant RHC, and longitudinal analysis is carried out for five patients. Results of the sensitivity analysis and subset selection show that we can reliably estimate seven non‐measurable quantities; namely, ventricular diastolic relaxation, systemic resistance, pulmonary venous elastance, pulmonary resistance, pulmonary arterial elastance, pulmonary valve resistance and systemic arterial elastance. Changes in parameters and predicted cardiovascular function post‐transplant are used to evaluate the cardiovascular state during recovery of five patients. Of these five patients, only one showed inconsistent trends during recovery in ventricular pressure–volume relationships and power output. At the four‐year post‐transplant time point this patient exhibited biventricular failure along with graft dysfunction while the remaining four exhibited no cardiovascular complications.

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