Blood flow velocity prediction in aorto-iliac stent grafts using computational fluid dynamics and Taguchi method.

Covered Endovascular Reconstruction of Aortic Bifurcation (CERAB) is a new technique to treat extensive aortoiliac occlusive disease with covered expandable stent grafts to rebuild the aortoiliac bifurcation. Post stenting Doppler ultrasound (DUS) measurement of maximum peak systolic velocity (PSVmax) in the stented segment is widely used to determine patency and for follow up surveillance due to the portability, affordability and ease of use. Anecdotally, changes in hemodynamics created by CERAB can lead to falsely high PSVmax requiring CT angiography (CTA) for further assessment. Therefore, the importance of DUS would be enhanced with a proposed PSVmax prediction tool to ascertain whether PSVmax falls within the acceptable range of prediction. We have developed a prediction tool based on idealized models of aortoiliac bifurcations with various infra-renal PSV (PSVin), iliac to aortic area ratios (R) and aortoiliac bifurcation angles (α). Taguchi method with orthogonal arrays (OA) was utilized to minimize the number of Computational Fluid Dynamics (CFD) simulations performed under physiologically realistic conditions. Analysis of Variance (ANOVA) and Multiple Linear Regression (MLR) analyses were performed to assess Goodness of fit and to predict PSVmax. PSVin and R were found to contribute 94.06% and 3.36% respectively to PSVmax. The Goodness of fit based on adjusted R2 improved from 99.1% to 99.9% based on linear and exponential functions. The PSVmax predictor based on the exponential model was evaluated with sixteen patient specific cases with a mean prediction error of 9.9% and standard deviation of 6.4%. Eleven out of sixteen cases (69%) in our current retrospective studies would have avoided CTA if the proposed predictor was used to screen out DUS measured PSVmax with prediction error greater than 15%. The predictor therefore has the potential to be used as a clinical tool to detect PSVmax more accurately post aortoiliac stenting and might reduce diagnostic errors and avoid unnecessary expense and risk from CTA follow-up imaging.

Numerical simulation of pharyngeal airflow applied to obstructive sleep apnea: effect of the nasal cavity in anatomically accurate airway models.

Repetitive brief episodes of soft-tissue collapse within the upper airway during sleep characterize obstructive sleep apnea (OSA), an extremely common and disabling disorder. Failure to maintain the patency of the upper airway is caused by the combination of sleep-related loss of compensatory dilator muscle activity and aerodynamic forces promoting closure. The prediction of soft-tissue movement in patient-specific airway 3D mechanical models is emerging as a useful contribution to clinical understanding and decision making. Such modeling requires reliable estimations of the pharyngeal wall pressure forces. While nasal obstruction has been recognized as a risk factor for OSA, the need to include the nasal cavity in upper-airway models for OSA studies requires consideration, as it is most often omitted because of its complex shape. A quantitative analysis of the flow conditions generated by the nasal cavity and the sinuses during inspiration upstream of the pharynx is presented. Results show that adequate velocity boundary conditions and simple artificial extensions of the flow domain can reproduce the essential effects of the nasal cavity on the pharyngeal flow field. Therefore, the overall complexity and computational cost of accurate flow predictions can be reduced.

Effect of the velopharynx on intraluminal pressures in reconstructed pharynges derived from individuals with and without sleep apnea.

The most collapsible part of the upper airway in the majority of individuals is the velopharynx which is the segment positioned behind the soft palate. As such it is an important morphological region for consideration in elucidating the pathogenesis of obstructive sleep apnea (OSA). This study compared steady flow properties during inspiration in the pharynges of nine male subjects with OSA and nine body-mass index (BMI)- and age-matched control male subjects without OSA. The k-ωSST turbulence model was used to simulate the flow field in subject-specific pharyngeal geometric models reconstructed from anatomical optical coherence tomography (aOCT) data. While analysis of the geometry of reconstructed pharynges revealed narrowing at velopharyngeal level in subjects with OSA, it was not possible to clearly distinguish them from subjects without OSA on the basis of pharyngeal size and shape alone. By contrast, flow simulations demonstrated that pressure fields within the narrowed airway segments were sensitive to small differences in geometry and could lead to significantly different intraluminal pressure characteristics between subjects. The ratio between velopharyngeal and total pharyngeal pressure drops emerged as a relevant flow-based criterion by which subjects with OSA could be differentiated from those without.

Experimental validation of quasi-one-dimensional and two-dimensional steady glottal flow models.

Physical modelling of phonation requires a mechanical description of the vocal fold coupled to a description of the flow within the glottis. In this study, an in-vitro set-up, allowing to reproduce flow conditions comparable to those of human glottal flow is used to systematically verify and discuss the relevance of the pressure and flow-rate predictions of several laminar flow models. The obtained results show that all the considered flow models underestimate the measured flow-rates and that flow-rates predicted with the one-dimensional model are most accurate. On the contrary, flow models based on boundary-layer theory and on the two-dimensional numerical resolution of Navier-Stokes equations yield most accurate pressure predictions. The influence of flow separation on the predictions is discussed since these two models can estimate relevant flow separation positions whereas this phenomenon is treated in a simplified ad-hoc way in the one-dimensional flow modelling. Laminar flow models appear to be unsuitable to describe the flow downstream of the glottal constriction. Therefore, the use of flow models taking into account three-dimensional effects as well as turbulence is motivated.

Validation of theoretical models of phonation threshold pressure with data from a vocal fold mechanical replica.

This paper analyzes the capability of a mucosal wave model of the vocal fold to predict values of phonation threshold lung pressure. Equations derived from the model are fitted to pressure data collected from a mechanical replica of the vocal folds. The results show that a recent extension of the model to include an arbitrary delay of the mucosal wave in its travel along the glottal channel provides a better approximation to the data than the original version of the model, which assumed a small delay. They also show that modeling the vocal tract as a simple inertive load, as has been proposed in recent analytical studies of phonation, fails to capture the effect of the vocal tract on the phonation threshold pressure with reasonable accuracy.

Theoretical simulation and experimental validation of inverse quasi-one-dimensional steady and unsteady glottal flow models.

In physical modeling of phonation, the pressure drop along the glottal constriction is classically assessed with the glottal geometry and the subglottal pressure as known input parameters. Application of physical modeling to study phonation abnormalities and pathologies requires input parameters related to in vivo measurable quantities commonly corresponding to the physical model output parameters. Therefore, the current research presents the inversion of some popular simplified flow models in order to estimate the subglottal pressure, the glottal constriction area, or the separation coefficient inherent to the simplified flow modeling for steady and unsteady flow conditions. The inverse models are firstly validated against direct simulations and secondly against in vitro measurements performed for different configurations of rigid vocal fold replicas mounted in a suitable experimental setup. The influence of the pressure corrections related to viscosity and flow unsteadiness on the flow modeling is quantified. The inversion of one-dimensional glottal flow models including the major viscous effects can predict the main flow quantities with respect to the in vitro measurements. However, the inverse model accuracy is strongly dependent on the pertinence of the direct flow modeling. The choice of the separation coefficient is preponderant to obtain pressure predictions relevant to the experimental data.