Investigation of the effects of miniscrew-assisted rapid palatal expansion on airflow in the upper airway of an adult patient with obstructive sleep apnea syndrome using computational fluid-structure interaction analysis / 대한치과교정학회지

OBJECTIVE: The objective of this study was to investigate the effects of miniscrew-assisted rapid palatal expansion (MARPE) on changes in airflow in the upper airway (UA) of an adult patient with obstructive sleep apnea syndrome (OSAS) using computational fluid-structure interaction analysis. METHODS: Three-dimensional UA models fabricated from cone beam computed tomography images obtained before (T0) and after (T1) MARPE in an adult patient with OSAS were used for computational fluid dynamics with fluid-structure interaction analysis. Seven and nine cross-sectional planes (interplane distance of 10 mm) in the nasal cavity (NC) and pharynx, respectively, were set along UA. Changes in the cross-sectional area and changes in airflow velocity and pressure, node displacement, and total resistance at maximum inspiration (MI), rest, and maximum expiration (ME) were investigated at each plane after MARPE. RESULTS: The cross-sectional areas at most planes in NC and the upper half of the pharynx were significantly increased at T1. Moreover, airflow velocity decreased in the anterior NC at MI and ME and in the nasopharynx and oropharynx at MI. The decrease in velocity was greater in NC than in the pharynx. The airflow pressure in the anterior NC and entire pharynx exhibited a decrease at T1. The amount of node displacement in NC and the pharynx was insignificant at both T0 and T1. Absolute values for the total resistance at MI, rest, and ME were lower at T1 than at T0. CONCLUSIONS: MARPE improves airflow and decreases resistance in UA; therefore, it may be an effective treatment modality for adult patients with moderate OSAS.

Influences of Geometric Configurations of Bypass Grafts on Hemodynamics in End-to-Side Anastomosis

BACKGROUND: Although considerable efforts have been made to improve the graft patency in coronary artery bypass surgery, the role of biomechanical factors remains underrecognized. The aim of this study is to investigate the influences of geometric configurations of the bypass graft on hemodynamic characteristics in relation to anastomosis. MATERIALS AND METHODS: The Numerical analysis focuses on understanding the flow patterns for different values of inlet and distal diameters and graft angles. The Blood flow field is treated as a two-dimensional incompressible laminar flow. A finite volume method is adopted for discretization of the governing equations. The Carreau model is employed as a constitutive equation for blood. In an attempt to obtain the optimal aorto-coronary bypass conditions, the blood flow characteristics are analyzed using in vitro models of the end-to-side anastomotic angles of 45degrees, 60degrees and 90degrees. To find the optimal graft configurations, the mass flow rates at the outlets of the four models are compared quantitatively. RESULTS: This study finds that Model 3, whose bypass diameter is the same as the inlet diameter of the stenosed coronary artery, delivers the largest amount of blood and the least pressure drop along the arteries. CONCLUSION: Biomechanical factors are speculated to contribute to the graft patency in coronary artery bypass grafting.

Development of the Unsteady Capillary Tube Viscometer and Viscosity Measurement of Blood Analogue Fluid

The purpose of the present study is to measure the viscosity of liquid in the capillary tube viscometer using the unsteady flow concept. The capillary tube viscometer is consisted of a small cylindrical reservoir, capillary tubes, and the mass flow rate measuring system interfaced with computer. Two capillary tubes with 1.152 and 3.002 mm (inner diameter) are used to determine the diameter effects on the viscosity measurements. The instantaneous shear rate and gravitational driving force in the capillary tube are determined by measuring the mass flow rate through the capillary tube instantaneously. The measured viscosities of water and aqueous Separan solution as the blood analogue fluid are in good agreement with the reported experimental data.

Hemodynamic Analysis of Coronary Circulation in Angulated Coronary Stenosis Following Stenting

The present study in angulated coronary stenosis used human in vivo hemodynamic parameters and computed simulation, both qualitatively and qualitatively, to evaluate the influence of flow velocity and wall shear stress (WSS) on coronary atherosclerosis, the changes of hemodynamic indices following coronary stenting, and their effect on evolving in-stent restenosis. Initial and follow-up coronary angiographies in patients with angulated coronary stenosis were performed (n=60). The optimal degree of coronary stenting for angulated coronary stenosis had two models, the less than 50% angle changed group (model 1, n=33) and the more than 50% angle changed group (model 2, n=27). This angle change was based on the percentage change of vascular angle between pre- and post-intracoronary stenting. The flow-velocity wave obtained from in vivo intracoronary Doppler study data was used for in vitro numerical simulation. Spatial and temporal patterns of the flow-velocity vector and recirculation area were drawn throughout the selected segment of coronary models. WSS of pre- and post-intracoronary stenting was calculated from three-dimensional computer simulation. As results, follow-up coronary angiogram demonstrated significant difference in the percentage of diameter stenosis between the two groups (group 1: 40.3 +/- 30.2 vs. group 2: 25.5 +/- 22.5%, p < 0.05). Negative shear area on 3D simulation, which is consistent with the re-circulation area of flow vector, was noted on the inner wall of the post-stenotic area before stenting. The negative WSS disappeared after stenting. High spatial and temporal WSS before stenting fell within the range of physiologic WSS after stenting. This finding was more prominent in model 2 (p < 0.01). The present study suggests that hemodynamic forces exerted by pulsatile coronary circulation, termed WSS, might affect the evolution of atherosclerosis within the angulated vascular curvature. Moreover, geometric characteristics, such as the angular difference between pre- and post- intracoronary stenting might define optimal rheologic properties for vascular repair after stenting.

Hemodynamic Effects on Atherosclerosis-Prone Coronary Artery: Wall Shear Stress / Rate Distribution and Impedance Phase Angle in Coronary and Aortic Circulation

The objective of the present study was to evaluate the hemodynamic characteristics of an atherosclerosis-prone coronary artery compared to the aorta. We describe three- dimensional spatial patterns of wall shear stress (WSS) according to the impedance phase angle in pulsatile coronary and aorta models using in vivo hemodynamic parameters and computed numerical simulations both qualitatively and quantitatively. Angiography of coronary arteries and aortas were done to obtain a standard model of vascular geometry. Simultaneously to the physiologic studies, flow-velocity and pressure profiles from in vivo data of the intravascular Doppler and pressure wire studies allowed us to include in vitro numerical simulations. Hemodynamic variables, such as flow-velocity, pressure and WSS in the coronary and aorta models were calculated taking into account the effects of vessel compliance and phase angle between pressure and flow waveforms. We found that there were spatial fluctuations of WSS and in the recirculation areas at the curved outer wall surface of the coronary artery. The mean WSS of the calculated negative phase angle increased in the coronary artery model over that in the aorta model and the phase angle effect was most prominent on the calculated amplitude of WSS of the coronary artery. This study suggests that the rheologic property of coronary circulation, such as the fluctuation of WSS/WSR induces several hemodynamic characteristics. A separation of flow-velocity, a difference in phase between pressure conductance and blood flow and prominent temporal and/or spatial oscillatory fluctuations of the shear forces as a function of pulsatile flow might be important factors in atherogenesis and progression of atherosclerosis.

Fundamental Study for Simulation of Blood Cell Motion in a Blood Vessel

PURPOSE: The objective of this study is to investigate the blood cell motion in human capillary by applying the boundary singularity method. METHODS: A particle motion of spherical shape falling in a vertical tube filled with Newtonian fluid is studied by using the boundary singularity method and the experiment. RESULTS AND CONCLUSION: As the eccentric ratio increases up to 0.6, the rotational velocity increases almost linearly and the falling velocity remains constant. However, as the eccentric ratio exceeds 0.6, the rotational velocity increases rapidly and the falling velocity decreases. As the tube radius increases, falling velocity increases and approaches the stokes velocity and the rotational velocity decreases.

Fundamental Study for Simulation of Blood Cell Motion in a Blood Vessel

PURPOSE: The objective of this study is to investigate the blood cell motion in human capillary by applying the boundary singularity method. METHODS: A particle motion of spherical shape falling in a vertical tube filled with Newtonian fluid is studied by using the boundary singularity method and the experiment. RESULTS AND CONCLUSION: As the eccentric ratio increases up to 0.6, the rotational velocity increases almost linearly and the falling velocity remains constant. However, as the eccentric ratio exceeds 0.6, the rotational velocity increases rapidly and the falling velocity decreases. As the tube radius increases, falling velocity increases and approaches the stokes velocity and the rotational velocity decreases.

Morphological Changes of the Endothelial Cell under the Influence of the Hemodynamic Stresses

PURPOSE: The objective of this study is to investigate the effects of hemodynamics on morphological changes of human endothelial cells. METHODS: The changes under the laminar flow condition are investigated by the in-vitro experiment and computer simulation. Micrographs of the endothelial cells in the laminar flow chamber are taken as a function of the exposed time. Idealized geometric shapes of the cells whose shapes are changing with the exposed time due to the flow stresses are portrayed by the computer simulation. Drag force on the cell due to the pressure and shear stress is calculated for two constraining conditions, that is, the cell changes its shape keeping its initial volume or initial surface area. RESULTS AND CONCLUSION: The drag force of the cell which keeps constant volume is smaller than that of the cell which keeps constant surface area.

Morphological Changes of the Endothelial Cell under the Influence of the Hemodynamic Stresses

PURPOSE: The objective of this study is to investigate the effects of hemodynamics on morphological changes of human endothelial cells. METHODS: The changes under the laminar flow condition are investigated by the in-vitro experiment and computer simulation. Micrographs of the endothelial cells in the laminar flow chamber are taken as a function of the exposed time. Idealized geometric shapes of the cells whose shapes are changing with the exposed time due to the flow stresses are portrayed by the computer simulation. Drag force on the cell due to the pressure and shear stress is calculated for two constraining conditions, that is, the cell changes its shape keeping its initial volume or initial surface area. RESULTS AND CONCLUSION: The drag force of the cell which keeps constant volume is smaller than that of the cell which keeps constant surface area.

Visualization of Pulsatile Flow of the Blood Substitute Fluids Using the Particle Image Velocimetry

PURPOSE: The objective of the present study is to investigate the steady and pulsatile flow phenomena of the blood substitute fluids in the circular and bifurcated vessels numerically and experimentally. METHODS: The particle image velocimetry (PIV) is adopted to visualize the flow fields in the circular and bifurcated vessels. In order to analyse the complex flow phenomena of the blood substitute fluids in the bifurcated vessel, the constitutive equations which are suitable to describe the rheological properties of the non-Newtonian fluids are determined and the steady and unsteady momentum equations are solved by the finite volume prediction. RESULTS AND CONCLUSION: Velocity vectors of the steady flow in the bifurcated tube obtained by the PIV system are in good agreement with those obtained by the numerical analysis. The experimental and numerical results show the recirculation zone in the outer wall distal to bifurcation.

Modelling of Elastic Blood Vessel under the Pulsatile Flow

PURPOSE: Characteristics of pulsatile flow in 3-dimensional arterial geometry and elastic vessel wall should be investigated in order to understand the physiological blood flow in human body. In this study, the modelling of the physiological blood flow in the elastic blood vessel is proposed. METHODS: The finite volume predictions are used to analyse the pulsatile flow characteristics in the elastic blood vessel. RESULTS AND CONCLUSION: Variations of the pressure and the velocity waveforms are obtained using the proposed modelling. The magnitudes of the pressure waveforms in the elastic blood vessel model are bigger than those of the rigid blood vessel model.

Analysis of Hemodynamic Characteristics in End-to-Side Anastomoses with Miller Cuff

The hemodynamic characteristics of the cuff end-to-side anastomosis model are investigated using by the finite volume predictions. The flow rates and the impedance indices through of the cuff anastomosis model are compared with those of the anastomosis model without the cuff. Blood flow increased through the cuff anastomosis model than the standard anastomosis model. The impedance index decreased with the increase of flow rate. The impedance index at a given flow rate is reduced by the increase of anastomosis angle and further reduced by the addition of the cuff. The results suggest that the cuff anastomosis model should be applied for the low Reynolds number flow and/or the small artery anastomosis model.

Analysis of Hemodynamic Characteristics in Anastomotic Sites of Femoral Artery Implantation

The objective of the present study is to obtain information on the hemodynamic characteristics in the anastomotic sites of femoral artery through the vascular implantation. Three dimensional steady and physiological blood flows in the femoral artery are simulated using the finite volume method. The geometrical shape of the anastomotic sites is made based on the vascular anatomy of a white rabbit. Wall shear stress distributions in the anastomotic sites for the physiological flow are compared with those for steady flow. Blood flow phenomena in the anastomotic sites of the femoral artery are discussed extensively.

Effect of Physical Vibration on Blood Viscosity

The objective of the current study is to investigate the effect of physical vibration on blood viscosity. The "capillary tube viscometer concept" is applied to measure blood viscosity. Blood viscosity can be measured at the minimum shear rate of 12 s(-1) by the capillary tube viscometer. To examine the effect of physical vibration on blood viscosity, the vibrations are produced by contact with an electronic speaker. The frequencies of vibration are varied from 0 to 1000 Hz. The experimental results show that blood viscosity can be effectively reduced by applying vibration. Blood viscosity decreases as much as 10~12 % by applying vibration.

Computed numerical analysis of the biomechanical effects on coronary atherogenesis using human hemodynamic and dimensional variables

The objectives of this investigation were to evaluate biomechanical factors in the atherosclerotic process using human in vivo hemodynamic parameters and computed numerical simulation qualitatively and quantitatively. The three-dimensional spatial patterns of steady and pulsatile flows in the left coronary artery were simulated, using a finite volume method. Coronary angiogram and Doppler ultrasound measurement of the proximal left coronary flow velocity were performed in humans. Inlet wave velocity distribution obtained from in vivo data of the intravascular Doppler study allowed for input of in vitro numerical simulation. Hemodynamic variables, such as flow velocity, pressure and shear stress of the left anterior descending coronary bifurcation site were calculated. We found that there were spatial fluctuation of flow-velocity and recirculation areas at the curved outer wall of the left anterior descending coronary artery, which were due to the differences of flow-velocity and shear stress, especially during the declaration phase of pulsatile flow. This study suggests that rheologic properties may be a part of the atherogenic process in the coronary bifurcated and curved areas.

Experimental Study on Representation of Flow on the Bifurcated Carotid Arterial Phantoms Using Magnetic Resonance Angiography

PURPOSE: A common finding of carotid artery on magnetic resonance angiograms(MRAs) is a signal dropout along the posterior wall of carotid bulb due to reverse flow. The purpose of this study is to evaluate variable flow patterns on bifurcated carotid arterial phantoms using steady-state flow. MATERIALS AND METHODS: We designed phantoms of a bifurcated carotid artery with acrylic materials. Flow patterns were evaluated with axial and coronal imaging of MRA(2D-TOF, 3D-TOF), color Doppler imaging, and computational fluid dynamics (CFD) within the phantoms constructed of an automated closed-type circulatory system filled with 4% sugar solution. These findings were compared with findings obtained from normal volunteers. RESULTS: Axial 3D-TOF MRA images exhibited closer resemblance to the contour of the inner wall of phantoms when compared to coronal 2D-TOF MRA imaging. However, 2D-TOF MRA showed good contrast difference of signal intensities between forward flow area and reverse flow area. Dark zones with reduced signal intensities due to reversed flow were separated from the outer wall of the internal and external carotid arteries by a thin layer of forward flow along the wall on the source slice image of MRA. The general hemodynamics of the phantoms on MRA were identical to hemodynamics on color Doppler imaging and CFD. The results obtained with the phantoms matched the findings on normal volunteers. CONCLUSION: Although representations of bifurcated carotid arterial phantoms on axial 3D-TOF MRA were excellent if ideally desinged, the zone of reversed flow could be a significant factor in creating distorted image when the zone of reversed flow contacted directly with curved or deformed arterial wall.