Abstract
Paravalvular leaks (PVLs) may lead to hemolysis. In vitro shear stress forces above 300 Pa cause erythrocyte destruction. PVL channel dimensions may determine magnitude of shear stress forces that affect erythrocytes; however, this has not been tested. It remains unclear how different properties of PVL channels contribute to presence of hemolysis. A model of a left ventricle was created based on data from computer tomography with Slicer software PVLs of various shapes and sizes were introduced. Blood flow was simulated using ANSYS Fluent software. The following variables were examined: wall shear stress, shear stress in fluid, volume of PVL channel with shear stress exceeding 300 Pa, and duration of exposure of erythrocytes to shear stress values above 300 Pa. In all models, shear stress forces exceeded 300 Pa. Shear stress increased with blood flow rates and cross-sectional areas of any PVL. There was no linear relationship between cross-sectional area of a PVL and volume of a PVL channel with shear stress > 300 Pa. Blood flow through mitral PVLs is associated with shear stress above 300 Pa. Cross-sectional area of a PVL does not correlate with volume of a PVL channel with shear stress > 300 Pa and duration of exposure of erythrocytes to shear stress > 300 Pa.
Highlights
Paravalvular leaks (PVLs) following surgical valve replacement are relatively common
Pathogenesis of hemolysis in patients with PVLs appears to be multifactorial, and current data indicate that several factors may be important such as: shear stress, turbulent pattern of blood flow, fluctuations of blood pressure between cardiac chambers connected by a PVL, interactions of erythrocytes with prosthetic material, and even defects of cellular membranes of erythrocytes [4,5]
We present a simplified model of the left ventricle, which was created based on data obtained from a cardiac computer tomography with contrast
Summary
Paravalvular leaks (PVLs) following surgical valve replacement are relatively common. Pathogenesis of hemolysis in patients with PVLs appears to be multifactorial, and current data indicate that several factors may be important such as: shear stress, turbulent pattern of blood flow, fluctuations of blood pressure between cardiac chambers connected by a PVL, interactions of erythrocytes with prosthetic material, and even defects of cellular membranes of erythrocytes [4,5]. One of these factors, namely shear stress distribution in the PVL channel, can currently be precisely determined using specialized computer software and principles of computational fluid dynamics (CFD). PVL models of various shapes and sizes were placed around the mitral annulus, and blood flow patterns through the PVL channels were assessed
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