Role of vortices in cavitation formation in the flow across a mechanical heart valve.

BACKGROUND AND AIM OF THE STUDY: Cavitation occurs during mechanical heart valve closure when the local pressure drops below vapor pressure. The formation of stable gas bubbles may result in gaseous emboli, and secondarily cause transient ischemic attacks or strokes. It is noted that instantaneous valve closure, occluder rebound and high-speed leakage flow generate vortices that promote low-pressure regions in favor of stable bubble formation; however, to date no studies have been conducted for the quantitative measurement and analysis of these vortices. METHODS: A Björk-Shiley Monostrut (BSM) monoleaflet valve was placed in the mitral position of a pulsatile mock circulatory loop. Particle image velocimetry (PIV) and pico coulomb (PCB) pressure measurements were applied. Flow field measurements were carried out at t = -5, -3, -1, -0.5, 0 (valve closure), 0.3, 0.5, 0.75, 1.19, 1.44, 1.69, 1.94, 2, 2.19, 2.54, 2.79, 3.04, 3.29, 3.54, 5 and 10 ms. The vortices were quantitatively analyzed using the Rankine vortex model. RESULTS: A single counter-clockwise vortex was The instantaneous formation of cavitation bubbles at mechanical heart valve (MHV) closure, which subsequently damage blood cells and valve integrity, is a well-known and widely studied phenomenon (1-4). Contributing factors seem to include the water-hammer, squeeze flow and Venturi effects, all of which are short-lived. Both, Dauzat et al. (5) and Sliwka et al. (6) have detected high-intensity transient signals (HITS) with transcranial Doppler ultrasound in the carotid and cerebral arteries of MHV recipients, while Deklunder (7) observed clinical occurrences of cerebral gas emboli that were not seen with bioprosthetic valves. These detected over the major orifice, while a pair of counter-rotating vortices was found over the minor orifice. Velocity profiles were consistent with Rankine vortices. The vortex strength and magnitude of the pressure drop peaked shortly after initial occluder-housing impact and rapidly decreased after 0.5 ms, indicating viscous dissipation, with a less significant contribution from the occluder rebound effect. The maximum pressure drop was on the order of magnitude of 40 mmHg. CONCLUSION: Detailed PIV measurements and quantitative analysis of the BSM mechanical heart valve revealed large-scale vortex formation immediately after valve closure. Of note, the vortices were typical of a Rankine vortex and the maximum pressure change at the vortex center was only 40 mmHg. These data support the conclusion that vortex formation alone cannot generate the magnitude of pressure drop required for cavitation bubble formation.

Cavitation behavior observed in three monoleaflet mechanical heart valves under accelerated testing conditions.

Accelerated testing provides a substantial amount of data on mechanical heart valve durability in a short period of time, but such conditions may not accurately reflect in vivo performance. Cavitation, which occurs during mechanical heart valve closure when local flow field pressure decreases below vapor pressure, is thought to play a role in valve damage under accelerated conditions. The underlying flow dynamics and mechanisms behind cavitation bubble formation are poorly understood. Under physiologic conditions, random perivalvular cavitation is difficult to capture. We applied accelerated testing at a pulse rate of 600 bpm and transvalvular pressure of 120 mm Hg, with synchronized videographs and high-frequency pressure measurements, to study cavitation of the Medtronic Hall Standard (MHS), Medtronic Hall D-16 (MHD), and Omni Carbon (OC) valves. Results showed cavitation bubbles between 340 and 360 micros after leaflet/housing impact of the MHS, MHD, and OC valves, intensified by significant leaflet rebound. Squeeze flow, Venturi, and water hammer effects each contributed to cavitation, depending on valve design.

Squeeze flow measurements in mechanical heart valves.

High-speed squeeze flow during mechanical valve closure is often thought to cause cavitation, either between the leaflet tip and flat contact area in the valve housing, seating lip, or strut flat seat stop, depending on design. These sites have been difficult to measure within the housing, limiting earlier research to study of squeeze flow outside the housing or with computational fluid dynamics. We directly measured squeeze flow velocity with laser Doppler velocimetry at its site of occurrence within the St. Jude Medical (SJM), Omnicarbon (OC), and Medtronic Hall Standard (MHS) 29 mm valves in a mock circulation loop. Quartz glass provided an observation window to facilitate laser penetration. Our results showed increasing squeeze flow velocity at higher heart rates: 2.39-3.44 m/s for SJM, 3.07-4.33 m/s for OC, and 3.87-5.33 m/s for MHS. Strobe lighting technique captured the images of cavitation formation. Because these results were obtained in a mock circulation loop, one can assume this may occur in vivo resulting in valve damage, hemolysis, and thromboembolism. However, velocities of this magnitude alone cannot produce the pressure drop required for cavitation, and the applicability of the Bernoulli equation under these circumstances requires further investigation.

Shear stress investigation across mechanical heart valve.

The particle image velocimetry technique was used to study the shear field across a transparent mechanical heart valve model in one cardiac cycle. Shear stress was continuously increased until peak systole and high turbulent stress was observed at the orifice of the central channel and also around the occluder trailing tips. The peak Reynolds shear stress was up to 500 N/m at peak systole, which was higher than the normal threshold for hemolysis.

The effect of tip angle on cavitation potential during closure of a bileaflet prosthesis model.

BACKGROUND AND AIM OF THE STUDY: Mechanical heart valve (MHV) cavitation has been widely investigated by negative pressure transient (NPT) measurements. Whilst NPT is believed to be the cause of cavitation as the valve occluder approaches its fully closed position, some valves are also more prone to cavitation initiation. The study aim was to determine the effect of tip angle on the occluder trailing edge for the MHV closure flow field and cavitation potential. METHODS: Three pairs of 1:1 transparent bileaflet models, with different tip angles (30 degrees, 60 degrees and 90 degrees), were used in a pulsatile mock loop. Particle image velocimetry (PIV) and micro-tip pressure catheters were applied respectively for the closure flow and transient pressure investigations. A mechanism was designed to enable triggering when the valve occluder approached its closing position. RESULTS: The transient pressure showed two maximum pressure drops, the magnitudes of which differed with various angle designs. A series of flow fields with continuously narrowing gap channels was captured. Different flow features were demonstrated for the three valve models. CONCLUSION: The tip angle design on the occluder trailing edge affected both the NPT magnitude and MHV closure flow field. The 60 degrees and 30 degrees valves had higher vorticity and fluid deceleration rate within the squeeze flow and occluder sudden stop respectively, which correlated with their larger pressure drops for the first and second NPT peaks.

Leukocyte-endothelium interaction: measurement by laser tweezers force spectroscopy.

Leukocyte adhesion to vascular endothelium is an initial step of many inflammatory diseases. Although the atomic force microscopy (AFM) measurements of leukocyte-endothelial interaction have been recently introduced. with cell adhesion force unbinding curves (CAFUC). We obtained pico-Newton force in the initial interaction between a single living THP-1 cell and HUVEC monolayer using a custom-built laser tweezers (LT) system. The measured quantities included the non-linear force-distance relationship, and the effect of yielding in cell detachment. It is possible to introduce a time scale into the LT cell-detachment experiments for further exploration and more detailed information on the viscoelastic properties of living cells.

Particle image velocimetry study of pulsatile flow in bi-leaflet mechanical heart valves with image compensation method.

Particle Image Velocimetry (PIV) is an important technique in studying blood flow in heart valves. Previous PIV studies of flow around prosthetic heart valves had different research concentrations, and thus never provided the physical flow field pictures in a complete heart cycle, which compromised their pertinence for a better understanding of the valvular mechanism. In this study, a digital PIV (DPIV) investigation was carried out with improved accuracy, to analyse the pulsatile flow field around the bi-leaflet mechanical heart valve (MHV) in a complete heart cycle. For this purpose a pulsatile flow test rig was constructed to provide the necessary in vitro test environment, and the flow field around a St. Jude size 29 bi-leaflet MHV and a similar MHV model were studied under a simulated physiological pressure waveform with flow rate of 5.2 l/min and pulse rate at 72 beats/min. A phase-locking method was applied to gate the dynamic process of valve leaflet motions. A special image-processing program was applied to eliminate optical distortion caused by the difference in refractive indexes between the blood analogue fluid and the test section. Results clearly showed that, due to the presence of the two leaflets, the valvular flow conduit was partitioned into three flow channels. In the opening process, flow in the two side channels was first to develop under the presence of the forward pressure gradient. The flow in the central channel was developed much later at about the mid-stage of the opening process. Forward flows in all three channels were observed at the late stage of the opening process. At the early closing process, a backward flow developed first in the central channel. Under the influence of the reverse pressure gradient, the flow in the central channel first appeared to be disturbed, which was then transformed into backward flow. The backward flow in the central channel was found to be the main driving factor for the leaflet rotation in the valve closing process. After the valve was fully closed, local flow activities in the proximity of the valve region persisted for a certain time before slowly dying out. In both the valve opening and closing processes, maximum velocity always appeared near the leaflet trailing edges. The flow field features revealed in the present paper improved our understanding of valve motion mechanism under physiological conditions, and this knowledge is very helpful in designing the new generation of MHVs.

Computational hemodynamics of an implanted coronary stent based on three-dimensional cine angiography reconstruction.

Coronary stents are supportive wire meshes that keep narrow coronary arteries patent, reducing the risk of restenosis. Despite the common use of coronary stents, approximately 20-35% of them fail due to restenosis. Flow phenomena adjacent to the stent may contribute to restenosis. Three-dimensional computational fluid dynamics (CFD) and reconstruction based on biplane cine angiography were used to assess coronary geometry and volumetric blood flows. A patient-specific left anterior descending (LAD) artery was reconstructed from single-plane x-ray imaging. With corresponding electrocardiographic signals, images from the same time phase were selected from the angiograms for dynamic three-dimensional reconstruction. The resultant three-dimensional LAD artery at end-diastole was adopted for detailed analysis. Both the geometries and flow fields, based on a computational model from CAE software (ANSYS and CATIA) and full three-dimensional Navier-Stroke equations in the CFD-ACE+ software, respectively, changed dramatically after stent placement. Flow fields showed a complex three-dimensional spiral motion due to arterial tortuosity. The corresponding wall shear stresses, pressure gradient, and flow field all varied significantly after stent placement. Combined angiography and CFD techniques allow more detailed investigation of flow patterns in various segments. The implanted stent(s) may be quantitatively studied from the proposed hemodynamic modeling approach.

An experimental study of steady flow patterns of a new trileaflet mechanical aortic valve.

Hemodynamic research shows that thrombosis formation is closely tied to flow field turbulent stress. Design limitations cause flow separation at leaflet edges and the annular valve base, vortex mixing downstream, and high turbulent shear stress. The trileaflet design opens like a physiologic valve with central flow. Leaflet curvature approximates a completely circular orifice, maximizing effective flow area of the open valve. Semicircular aortic sinuses downstream of the valve allow vortex formation to help leaflet closure. The new trileaflet design was hemodynamically evaluated via digital particle image velocimetry and laser-Doppler anemometry. Measurements were made during peak flow of the fully open valve, immediately downstream of the valve, and compared with the 27-mm St. Jude Medical (SJM) bileaflet valve. The trileaflet valve central flow produces sufficient pressure to inhibit separation shear layers. Absence of downstream turbulent wake eddies indicates smooth, physiologic blood flow. In contrast, SJM produces strong turbulence because of unsteady separated shear layers where the jet flow meets the aortic sinus wall, resulting in higher turbulent shear stresses detrimental to blood cells. The trileaflet valve simulates the physiologic valve better than previous designs, produces smoother flow, and allows large scale recirculation in the aortic sinuses to help valve closure.

On the closing sounds of a mechanical heart valve.

In the 1994 Replacement Heart Valve Guidance of the U.S. Food and Drug Administration (FDA), in-vitro testing is required to evaluate the potential for cavitation damage of a mechanical heart valve (MHV). To fulfill this requirement, the stroboscopic high-speed imaging method is commonly used to visualize cavitation bubbles at the instant of valve closure. The procedure is expensive; it is also limited because not every cavitation event is detected, thus leaving the possibility of missing the whole cavitation process. As an alternative, some researchers have suggested an acoustic cavitation-detection method, based on the observation that cavitation noise has a broadband spectrum. In practice, however, it is difficult to differentiate between cavitation noise and the valve closing sound, which may also contain high-frequency components. In the present study, the frequency characteristics of the closing sound in air of a Björk-Shiley Convexo-Concave (BSCC) valve are investigated. The occluder closing speed is used as a control parameter, which is measured via a laser sweeping technique. It is found that for the BSCC valve tested, the distribution of the sound energy over its frequency domain changes at different valve closing speeds, but the cut-off frequency remains unchanged at 123.32 +/- 6.12 kHz. The resonant frequencies of the occluder are also identified from the valve closing sound.

Statistical correlation between transient pressure drop and cavitation at closure of a mechanical heart valve.

Cavitation on a mechanical heart valve (MHV) is attributable to transient regional pressure drop at the instant of valve closure. As a cavitation bubble collapses, it emits shock waves, which have the characteristics of high frequency oscillations (HFO) on a pressure time trace. The potential for such HFO bursts to cause material damage on an MHV can be measured by the cavitation impulse I, which is defined as the area under the trace of the HFO bursts. In the present study, experiments were conducted on a bileaflet MHV in a durability tester, operated at pulse rates from 300-1,000 bpm. In each case, the transient pressure near an occluder was monitored for 60,000 beats via a transducer. The peak pressure drop Pm and the corresponding cavitation impulse I obtained for the 60,000 beat sequence are found to resemble sample records of two stationary stochastic processes, each of which follows a log normal distribution. Their first order probability density functions are estimated from the records. The correlation is investigated between I and Pm associated with each beat, which is found to be of statistical significance.

The closing behavior of mechanical aortic heart valve prostheses.

Mechanical artificial heart valves rely on reverse flow to close their leaflets. This mechanism creates regurgitation and water hammer effects that may form cavitations, damage blood cells, and cause thromboembolism. This study analyzes closing mechanisms of monoleaflet (Medtronic Hall 27), bileaflet (Carbo-Medics 27; St. Jude Medical 27; Duromedics 29), and trileaflet valves in a circulatory mock loop, including an aortic root with three sinuses. Downstream flow field velocity was measured via digital particle image velocimetry (DPIV). A high speed camera (PIVCAM 10-30 CCD video camera) tracked leaflet movement at 1000 frames/s. All valves open in 40-50 msec, but monoleaflet and bileaflet valves close in much less time (< 35 msec) than the trileaflet valve (>75 msec). During acceleration phase of systole, the monoleaflet forms a major and minor flow, the bileaflet has three jet flows, and the trileaflet produces a single central flow like physiologic valves. In deceleration phase, the aortic sinus vortices hinder monoleaflet and bileaflet valve closure until reverse flows and high negative transvalvular pressure push the leaflets rapidly for a hard closure. Conversely, the vortices help close the trileaflet valve more softly, probably causing less damage, lessening back flow, and providing a washing effect that may prevent thrombosis formation.

Statistical characteristics of mechanical heart valve cavitation in accelerated testing.

BACKGROUND AND AIM OF THE STUDY: Cavitation damage has been observed on mechanical heart valves (MHVs) undergoing accelerated testing. Cavitation itself can be modeled as a stochastic process, as it varies from beat to beat of the testing machine. This in-vitro study was undertaken to investigate the statistical characteristics of MHV cavitation. METHODS: A 25-mm St. Jude Medical bileaflet MHV (SJM 25) was tested in an accelerated tester at various pulse rates, ranging from 300 to 1,000 bpm, with stepwise increments of 100 bpm. A miniature pressure transducer was placed near a leaflet tip on the inflow side of the valve, to monitor regional transient pressure fluctuations at instants of valve closure. The pressure trace associated with each beat was passed through a 70 kHz high-pass digital filter to extract the high-frequency oscillation (HFO) components resulting from the collapse of cavitation bubbles. Three intensity-related measures were calculated for each HFO burst: its time span; its local root-mean-square (LRMS) value; and the area enveloped by the absolute value of the HFO pressure trace and the time axis, referred to as cavitation impulse. These were treated as stochastic processes, of which the first-order probability density functions (PDFs) were estimated for each test rate. RESULTS: Both the LRMS value and cavitation impulse were log-normal distributed, and the time span was normal distributed. These distribution laws were consistent at different test rates. CONCLUSION: The present investigation was directed at understanding MHV cavitation as a stochastic process. The results provide a basis for establishing further the statistical relationship between cavitation intensity and time-evolving cavitation damage on MHV surfaces. These data are required to assess and compare the performance of MHVs of different designs.

Bubble observation and transient pressure signals in mechanical heart valve cavitation study.

BACKGROUND AND AIMS OF THE STUDY: Cavitation in the mechanical heart valve (MHV) was first detected in Edwards-Duromedics (ED) clinical explants. Early studies indicated that the pitted surface of the valve leaflet was due to cavitation phenomena occurring during valve closing. Cavitation is seen as the transient appearance of bubbles on the MHV surface on valve closure. The cavitation bubbles occur due to abrupt pressure changes in the vicinity of the valve on valve closing. Hence, analysis of the recorded field pressure can provide useful information relating to cavitation potential. In the present study, MHV cavitation potential was evaluated by counting bubble appearance probability and measuring bubble-size using an image-processing method. A simple and reliable technique using wavelet packet analysis (WPA) to evaluate cavitation potential was also investigated. METHODS: A single-valve, pneumatic-driven burst tester system with adjustable pressure control unit, was used to simulate the closing process in the heart mitral valve at three driving pressures: 200, 500 and 1,000 mmHg, using three valve models. A triggering and imaging system was developed within the burst tester system to capture images of cavitation bubbles at predetermined time delays on valve closing. Transient pressure signals were recorded on both sides of the MHV occluder, using a high-frequency piezoelectric pressure transducer and a physiological pressure transducer. The pictures recorded were analyzed using image processing software to determine bubble appearance probability and bubble size. WPA was applied to the transient closing pressure signals to evaluate cavitation potential. RESULTS: Cavitation intensity index (Cii) and bubble size-based cavitation index (BS-Ci) were measured by analyzing images captured at different time delays on valve closing at different driving pressures. WPA was used to analyze transient pressure signals at the inflow side of the MHV occluder at valve closure to calculate the WPA-based cavitation index (WPA-Ci). The three methods showed a similar trend for cavitation potential in the valves tested. CONCLUSION: In the present study, two new approaches to evaluate MHV cavitation were investigated, namely WPA and BS-Ci. The results obtained produced a similar trend to that seen with an earlier method based on counting the probability that cavitation bubbles occur. As cavitation is primarily a function of the transient pressure within the vicinity of the closing valve occluder, the WPA method can be an effective method for future investigation of cavitation potential of mechanical heart valves.

Numerical simulation of opening process in a bileaflet mechanical heart valve under pulsatile flow condition.

BACKGROUND AND AIM OF THE STUDY: Most previous computational fluid dynamics (CFD) studies of blood flow in mechanical heart valves (MHVs) have not efficiently addressed the important features of moving leaflet and blood-leaflet interaction. Herein, computationally efficient approaches were developed to study these features and to obtain better insight into the pulsatile flow field in bileaflet MHVs. METHODS: A simple and effective method to track the moving boundary was proposed, and an efficient method for calculating the blood-leaflet interaction applied. In this way, a CFD code was developed to study the pulsatile flow field around bileaflet MHVs. The CFD code was parallelized on a supercomputer to reduce turn-around time in the simulation. The solver was then used to study the opening process in a St. Jude Medical (SJM) size 29 bileaflet MHV. RESULTS: CFD results showed that, in the opening process, the flow field was consistently partitioned into two side channels and a central channel due to the presence of the two leaflets. In the flow field near the surface of the two leaflets, the fluid velocity followed the local surface velocity of the leaflets, thus showing a strong blood-leaflet interaction effect. Throughout the valve-opening process, peak velocities were always observed near the tips of the valve leaflet. The CFD simulation showed that the opening process took approximately 0.044 s, which compared well with experimental findings. CONCLUSION: The new computational approaches were efficient and able to address the moving leaflet and blood-leaflet interaction. The flow field in the opening process of a SJM 29 bileaflet MHV was successfully simulated using the developed solver.

Dynamic impact stress analysis of a bileaflet mechanical heart valve.

BACKGROUND AND AIMS OF THE STUDY: Mechanical heart valves (MHV) are widely used to replace dysfunctional and failed heart valves. The bileaflet MHV is very popular due to its superior hemodynamics. At present, bileaflet MHVs account for about two-thirds of the prosthetic heart valve market. Since their introduction in 1977, the hemodynamics of bileaflet prostheses has been extensively studied. New technologies used to develop MHV include better design concepts, materials, manufacturing processes, and post-design verification. The study aim was to investigate the dynamic impact stress of a newly designed bileaflet MHV under normal physiological conditions. METHODS: Pro/Engineer was used to generate a 3-D model of the designed valve. ANSYS 5.5 and LS-DYNA were used to calculate stress and deformation of the valve. Due to symmetry, a one-half orifice and one leaflet were modeled using the eight-noded hexahedral elements. When valve leaflets are in the fully closed position, the static contact stress between leaflet and orifice was predicated under typical heart valve closing pressure of 80 mmHg. To study the dynamic effects of the closing valve, LS-DYNA was used to simulate leaflet motion. Typical physiological pressure waveform was employed to initiate this leaflet motion. Two types of valve were investigated: Test valve A (size 19, flat leaflet); and test valve B (size 19, tapered leaflet 1.5 degrees, with the same thickness at pivot as valve A). The non-invasive laser sweeping technique was used to measure leaflet closing velocity in a mock flow test rig. The closing velocity of test valve A was compared by experimental and computed results. The corresponding dynamic contact stress on the leaflet was obtained for different modes of loading, simulated under angular velocity, acceleration, and especially under representative pressure waveform. RESULTS: The experimental closing velocity of test valve A was 1.07 +/- 0.05 m/s; the computed value was 1.130 m/s. During full closure, the leaflets showed a slight rebound, and this was also seen experimentally. For test valve B, the computed closing velocity was 1.039 m/s. In the dynamic impact analysis, the physiological pressure waveform was obtained at a normal heart rate of 70 beats/min from the mock flow test rig. Dynamic stress and displacement of the model valve were calculated as the valve was closing. The time step of calculation was determined by the wave propagation velocity and element size. With an interhinge distance of 4.966 mm based on the geometric design of the valve, maximum dynamic von Mises stress appeared near the hinge of the leaflet (26.92 MPa for valve A; 22.36 MPa for valve B). By varying the position of the hinge/pivoting axis (+/- 10%), an optimized valve geometry could be obtained based on minimal impact stress on the valve leaflet. CONCLUSION: Based on closing velocity comparison of valve A, the calculated model and loading conditions were seen to be reasonable. Computational accuracy was satisfied. The tapering feature of the leaflet is designed especially for minimal impact stress at the leaflet contact areas upon impact with the inner walls of the BMHV. These points provide an optimum structure design for the Nanyang Technological University BMHV.

Bioprosthetic heart valve leaflet deformation monitored by double-pulse stereo photogrammetry.

A double-pulse stereo photogrammetry technique has been developed for the dynamic assessment of the leaflet deformation of bioprosthetic heart valves under simulated physiological conditions. By using a specially designed triggering technique, which takes the advantage of the field transfer mechanisms of the charge coupled device camera, two consecutive images separated by a time interval as short as 5 ms were captured. This made it possible to investigate the realistic leaflet deformation during the valve opening and closing processes which typically last 25-45 ms. This technique was applied to assess a newly developed pericardial valve leaflet in a physiological pulse flow loop. Quantitative leaflet deformations of the valve opening and closing were generated from sequences of digital images. The results can later be applied to finite element analysis of bioprosthetic heart valve leaflet stress and strain during a complete cardiac cycle.