Effects of pannus formation on the flow around a bileaflet mechanical heart valve.

Abstract

Some patients with a bileaflet mechanical heart valve (BMHV) show significant increases in the transvalvular pressure drop and abnormal leaflet motion due to a pannus (an abnormal fibrovascular tissue) formed on the ventricular side, even in the absence of physical contact between the pannus and leaflets. We investigate the effects of the pannus shape (circular or semi-circular ring), implantation location and height on the leaflet motion, flow structure and transvalvular pressure drop using numerical simulations. The valve model considered resembles a 25 mm masters HP valve. The mean systolic pressure drop is significantly increased with increasing pannus height, irrespective of its implantation orientation. Near the peak inflow rate, the flow behind the pannus becomes highly turbulent, and the transvalvular pressure drop is markedly increased by the pannus. At the end of valve opening and the start of valve closing, oscillatory motions of the leaflets occur due to periodic shedding of vortex rings behind the pannus, and their amplitudes become large with increasing pannus height. When the pannus shape is asymmetric (e.g., a semi-circular ring) and its height reaches about 0.1D (D (= 25 mm) is the diameter of an aorta), abnormal leaflet motions occur: two leaflets move asymmetrically, and valve closing is delayed in time or incomplete, which increases the regurgitation volume. The peak energy loss coefficients due to panni are obtained from simulation data and compared with those predicted by a one-dimensional model. The comparison indicates that the one-dimensional model is applicable for the BMHV with and without pannus.