Maximum Wall Shear Stress Values Research Articles

Hemodynamic-based virtual surgery design of double-patch repair for pulmonary arterioplasty in tetralogy of Fallot

Background and objectiveSurgical correction of pulmonary artery stenosis (PAS) is essential to the prognosis of patients with tetralogy of Fallot (TOF). The double-patch method of pulmonary arterioplasty is usually applied in case of multiple stenosis in TOF patients’ pulmonary artery (PA) and when PAS cannot be relieved by the single-patch method. The surgical planning for the double-patch design remains challenging. The purpose of this study is to investigate the double-patch design with different angulations between the left pulmonary artery (LPA) and the right pulmonary artery (RPA), and to understand postoperative hemodynamic alterations by the application of computer-aided design (CAD) and computational fluid dynamics (CFD) techniques. MethodsThe three-dimensional model of the PA was reconstructed based on preoperative computed tomography imaging data obtained from the patient with TOF. Three postoperative models with different designs of double-patch were created by “virtual surgery” using the CAD technique. Double-Patch 120 Model was created with double patches implanted in the main pulmonary artery (MPA) and the PA bifurcation and without changing the spatial position of PA. The angulation between the LPA and the RPA was defined as θ, which equaled to 120° in Pre-Operative Model and Double-Patch 120 Model. Based on Double-Patch 120 Model, Double-Patch 110 Model and Double-Patch 130 Model were generated with θ equaled to 110° and 130°, respectively. Combined with CFD, the differences of velocity streamlines, wall shear stress (WSS), flow distribution ratio (FDR), and energy loss (EL) were compared to analyze postoperative pulmonary flow characteristics. ResultsThe values of velocity and WSS decreased significantly after virtual surgery. Obvious vortices and swirling flows were observed downstream of the stenosis of RPA and LPA in Pre-Operative Model, while fewer vortices developed along the anterior wall of the expanded lumens of RPA, especially in Double-Patch 110 Model. With the relief of PAS, two relatively higher WSS regions were observed at the posterior walls of RPA and LPA. The maximum WSS values in these regions of Double-Patch 110 Model were lower than those in Double-Patch 120 Model and Double-Patch 130 Model. Furthermore, the FDRs were elevated and the ELs were greatly reduced. It was found that Double-Patch 110 Model with the angulation between the LPA and the RPA equaled to 110° showed relatively better properties of hemodynamics than other models. ConclusionsThe angulation between the LPA and the RPA is an important factor that should be integrated in the double-patch design for TOF repair. Virtual surgery based on patient-specific vascular model and computational hemodynamics can be used to provide assistance for individualized surgical planning of double-patch arterioplasty.

Segmentation of 4D Flow MRI: Comparison between 3D Deep Learning and Velocity-Based Level Sets.

A thoracic aortic aneurysm is an abnormal dilatation of the aorta that can progress and lead to rupture. The decision to conduct surgery is made by considering the maximum diameter, but it is now well known that this metric alone is not completely reliable. The advent of 4D flow magnetic resonance imaging has allowed for the calculation of new biomarkers for the study of aortic diseases, such as wall shear stress. However, the calculation of these biomarkers requires the precise segmentation of the aorta during all phases of the cardiac cycle. The objective of this work was to compare two different methods for automatically segmenting the thoracic aorta in the systolic phase using 4D flow MRI. The first method is based on a level set framework and uses the velocity field in addition to 3D phase contrast magnetic resonance imaging. The second method is a U-Net-like approach that is only applied to magnitude images from 4D flow MRI. The used dataset was composed of 36 exams from different patients, with ground truth data for the systolic phase of the cardiac cycle. The comparison was performed based on selected metrics, such as the Dice similarity coefficient (DSC) and Hausdorf distance (HD), for the whole aorta and also three aortic regions. Wall shear stress was also assessed and the maximum wall shear stress values were used for comparison. The U-Net-based approach provided statistically better results for the 3D segmentation of the aorta, with a DSC of 0.92 ± 0.02 vs. 0.86 ± 0.5 and an HD of 21.49 ± 24.8 mm vs. 35.79 ± 31.33 mm for the whole aorta. The absolute difference between the wall shear stress and ground truth slightly favored the level set method, but not significantly (0.754 ± 1.07 Pa vs. 0.737 ± 0.79 Pa). The results showed that the deep learning-based method should be considered for the segmentation of all time steps in order to evaluate biomarkers based on 4D flow MRI.

Influence of Rigid-Elastic Artery Wall of Carotid and Coronary Stenosis on Hemodynamics.

Cardiovascular system abnormalities can result in serious health complications. By using the fluid-structure interaction (FSI) procedure, a comprehensive realistic approach can be employed to accurately investigate blood flow coupled with arterial wall response. The hemodynamics was investigated in both the coronary and carotid arteries based on the arterial wall response. The hemodynamics was estimated based on the numerical simulation of a comprehensive three-dimensional non-Newtonian blood flow model in elastic and rigid arteries. For stenotic right coronary artery (RCA), it was found that the maximum value of wall shear stress (WSS) for the FSI case is higher than the rigid wall. On the other hand, for the stenotic carotid artery (CA), it was found that the maximum value of WSS for the FSI case is lower than the rigid wall. Moreover, at the peak systole of the cardiac cycle (0.38 s), the maximum percentage of arterial wall deformation was found to be 1.9%. On the other hand, for the stenotic carotid artery, the maximum percentage of arterial wall deformation was found to be 0.46%. A comparison between FSI results and those obtained by rigid wall arteries is carried out. Findings indicate slight differences in results for large-diameter arteries such as the carotid artery. Accordingly, the rigid wall assumption is plausible in flow modeling for relatively large diameters such as the carotid artery. Additionally, the FSI approach is essential in flow modeling in small diameters.

P068 Computational fluid dynamic study in Obstructive Sleep Apnea patients

Abstract Introduction Obstructive sleep apnea (OSA) is a common disorder which may need surgery to widen the airway. However, the success rate of surgery is variable. Thus, it is necessary to predict the outcome of the surgery preoperatively. The purpose of this study is to evaluate the mechanical parameter of upper airway airflow in OSA patients using computational fluid dynamics (CFD) method. Method We conducted a study on the patients with snoring, underwent the full night polysomnograpny (PSG) and paranasal sinus computed tomography(CT). The patients with past history of previous trauma or surgery were excluded. Three-demensional reconstructions of the upper airway were created in the medical imaging software Mimics 16.0 using paranasal CT. The reconstructions extended from nasopharynx to hypopharynx. Steady-state, turbulent, inspiratory airflow simulations were conducted in Fluent 17.0 with following boundary conditions The mechanical parameters (wall shear stress, pressure, plane velocity) were calculated in the three levels of nasopharynx, retropalatal, retrolingual area. Results The maximum wall shear stress values were shown at the retropalatal plane in all patients. There is a tendency for the wall shear stress value of the retropalatal area to increase as the AHI increases. The maximum velocity values were shown at the retropalatal plane in all patients. The maximum pressure values were shown at the nasopharynx plane in all patients. Conclusion the maximum wall shear stress values were shown at the retropalatal plane and the wall shear stress value of the retropalatal area increased as the AHI increased. Thus, the palatal surgery might help the OSA patients.

Ultrasound Based Computational Fluid Dynamics Assessment of Brachial Artery Wall Shear Stress in Preeclamptic Pregnancy.

Preeclampsia (PE) is a pregnancy complication of abnormally elevated blood pressure and organ damage where endothelial function is impaired. Wall shear stress (WSS) strongly effects endothelial cell morphology and function but in PE the WSS values are unknown. WSS calculations from ultrasound inaccurately assume cylindrical arteries and patient specific computational fluid dynamics (CFD) typically require time-consuming 3D imaging such as CT or MRI. Two-dimensional (2D) B-mode ultrasound images were lofted together to create simplified three-dimensional (3D) geometries of the brachial artery (BA) that incorporate artery curvature and non-circular cross sections. This process was efficient and on average took 120±10 s. Patient specific CFD was then performed to quantify BA WSS for a small cohort of PE (n=5) and normotensive pregnant patients (n=5) and compared against WSS calculations assuming a cylindrical artery. For several WSS metrics (time averaged WSS (TAWSS), peak systolic WSS, oscillatory shear index (OSI), OSI/TAWSS and relative residence time) CFD on the simplified arterial geometries calculated large spatial differences in WSS that assuming a cylindrical artery cannot calculate. Bland-Altman and intra-class correlation (ICC) analyses found assuming a cylindrical artery both underestimated (p<0.05) and had poor agreement (ICC<0.5) with the maximum WSS values from CFD. WSS values that were abnormal compared to the normotensive patients (OSI=0.014±0.026) appear related to the pregnancy complications fetal growth restriction (n=2, OSI=0.14, 0.25) and gestational diabetes (n=1, OSI=0.23). Creating 3D artery geometries from 2D ultrasound images can be used for CFD simulations to calculate WSS from ultrasound without assuming cylindrical arteries. This approach requires minimal time for both medical imaging and CFD analysis.

Wall Shear Stress and T1 Contrast Ratio Are Associated With Embolic Signals During Carotid Exposure in Endarterectomy.

Background and Purpose- The frictional force because of blood flow may dislodge masses present on the surface of a plaque. Such frictional force is calculated as wall shear stress (WSS) using computational fluid dynamics. The aims of the present study were to determine whether, in addition to carotid plaque intensity on T1-weighted magnetic resonance (MR) imaging, WSS calculated using computational fluid dynamics analysis for carotid arteries is associated with development of an embolism during exposure of carotid arteries during carotid endarterectomy. Methods- One hundred patients with internal carotid artery stenosis (≥70%) underwent carotid plaque imaging with MR, and 54 patients with a vulnerable plaque (intraplaque hemorrhage or lipid/necrotic core) displayed as a high-intensity lesion underwent additional cervical 3-dimensional MR angiography. The maximum value of WSS within the most severe stenotic segment of the internal carotid artery was calculated using MR angiography. Transcranial Doppler monitoring of microembolic signals (MES) in the ipsilateral middle cerebral artery was performed during carotid endarterectomy. Results- Although none of the 46 patients with a nonvulnerable carotid plaque had MES during exposure of carotid arteries, 24 of the 54 patients with a vulnerable carotid plaque (44%) had MES. Logistic regression analysis showed that higher plaque intensity ( P=0.0107) and higher WSS ( P=0.0029) were significantly associated with the development of MES. When both cutoff points of plaque intensity and WSS in the receiver operating characteristic curves for predicting development of MES were combined, specificity (from 63% to 93%) and positive predictive value (from 66% to 90%) became greater than those for plaque intensity alone. Conclusions- In addition to carotid plaque intensity on T1-weighted MR imaging, WSS calculated using computational fluid dynamics analysis for carotid arteries is associated with development of an embolism during exposure of carotid arteries during carotid endarterectomy.

The ratio of diameters between the target artery and the bypass modifies hemodynamic parameters related to intimal hyperplasia in the distal end-to-side anastomosis.

Hemodynamics in the distal end-to-side anastomosis is related to early development of intimal hyperplasia and bypass failure. In this study we investigated the effect of diameter ratios between the target artery and the bypass at three different angles of the connection. The pulsatile flow field was visualized using particle image velocimetry in transparent models with three different angles of the connection (25°, 45°, 60°) and the diameter ratio between the bypass and the target artery was 4.6 mm : 6 mm, 6 mm : 6 mm, and 7.5 mm : 6 mm. Six parameters including location and oscillation of the stagnation point, local energy dissipation, wall shear stress (WSS), oscillatory shear index, spatial and temporal gradient of WSS and their distribution in the target artery were calculated from the flow field. In the wider bypass, the stagnation point oscillated in a greater range and was located more proximal to the anastomosis. Energy dissipation was minimal in a wider bypass with a more acute angle. The maximum WSS values were tree times greater in a narrow bypass and concentrated in a smaller circular region at the floor of the anastomosis. The oscillatory shear index increased with wider bypass and more acute angle. The maximum of spatial gradient of WSS concentrated around the floor and toe of the anastomosis and decreased with more acute angle and wider bypass, the temporal gradient of WSS was stretched more towards the side wall. Greater bypass to target vessel ratio and more acute anastomosis angle promote hemodynamics known to reduce formation of intimal hyperplasia.

Abstract 12763: Adolescents With Type 1 Diabetes Show Early Hemodynamic and Vascular Changes Unrelated to Standard Glucose and Lipid Markers

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality in patients with type 1 diabetes (T1D). There is increasing evidence that maladaptive changes in vascular properties occur early in adolescence. Wall shear stress (WSS) plays crucial role in mechanotransduction and tissue remodeling. However, changes in aortic WSS and vascular properties in T1D adolescents and their associations with T1D biomarkers have yet to be determined. Hypothesis: We hypothesized that non-invasively MRI derived WSS and vascular markers of stiffness will be altered in T1D adolescents. Methods: Fourteen adolescents with T1D and 25 age-matched controls underwent prospective phase-contrast MRI (PC-MRI). Segmented cross sectional planes were selected above the sinotubular junction, transverse to the descending aorta. Maximum WSS values were computed from time specific generated shear fields. Aortic strain (AoS), distensibility (Ds), and stiffness index β (SI) were computed using vessel areas and pulse pressure. All measured hemodynamic and vascular markers were correlated with standard T1D biomarkers: A1C hemoglobin, cholesterol, LDL, HDL, and triglyceride levels. The significance between reported median values was assessed using Wilcoxon Ranked sum method and single linear regression analysis using Spearman rho. Results: Subjects with T1D showed significantly increased maximum WSS (dyne/cm2) in both ascending aorta (11.1 vs. 9.02, p = 0.0065) and descending aorta (13.7 vs. 12.3, p = 0.0166). Furthermore, AoS and Ds (mmHg-1) were both decreased in T1D group in ascending aorta (AoS: 25.1 vs. 29.7, p = 0.0352; Ds: 0.49 vs. 0.71, p = 0.0151) and descending aorta (AoS: 20.1 vs. 26.5, p = 0.0002; Ds: 0.41 vs. 0.66, p = 0.0082). Inversely, SI was higher in T1D group in both vessel segments (0.030 vs. 0.018, p = 0.0021 and 0.034 vs. 0.020, p = 0.0017). There were no significant correlations between PC-MRI derived vascular metrics and collected biomarkers. Conclusions: T1D adolescents show early aortic stiffness and altered WSS. Neither WSS nor stiffness markers correlated with A1C hemoglobin or lipid biomarkers. This suggests that potential therapeutic targets of the early vascular remodeling are beyond standard glycemic and lipid control.

Generalized versus Patient-Specific Inflow Boundary Conditions in Computational Fluid Dynamics Simulations of Cerebral Aneurysmal Hemodynamics

Attempts have been made to associate intracranial aneurysmal hemodynamics with aneurysm growth and rupture status. Hemodynamics in aneurysms is traditionally determined with computational fluid dynamics by using generalized inflow boundary conditions in a parent artery. Recently, patient-specific inflow boundary conditions are being implemented more frequently. Our purpose was to compare intracranial aneurysm hemodynamics based on generalized versus patient-specific inflow boundary conditions. For 36 patients, geometric models of aneurysms were determined by using 3D rotational angiography. 2D phase-contrast MR imaging velocity measurements of the parent artery were performed. Computational fluid dynamics simulations were performed twice: once by using patient-specific phase-contrast MR imaging velocity profiles and once by using generalized Womersley profiles as inflow boundary conditions. Resulting mean and maximum wall shear stress and oscillatory shear index values were analyzed, and hemodynamic characteristics were qualitatively compared. Quantitative analysis showed statistically significant differences for mean and maximum wall shear stress values between both inflow boundary conditions (P < .001). Qualitative assessment of hemodynamic characteristics showed differences in 21 cases: high wall shear stress location (n = 8), deflection location (n = 3), lobulation wall shear stress (n = 12), and/or vortex and inflow jet stability (n = 9). The latter showed more instability for the generalized inflow boundary conditions in 7 of 9 patients. Using generalized and patient-specific inflow boundary conditions for computational fluid dynamics results in different wall shear stress magnitudes and hemodynamic characteristics. Generalized inflow boundary conditions result in more vortices and inflow jet instabilities. This study emphasizes the necessity of patient-specific inflow boundary conditions for calculation of hemodynamics in cerebral aneurysms by using computational fluid dynamics techniques.

Numerical Simulation to Investigate the Effect of Non Newtonian Properties of Blood on Wall Shear Stress in Diseased Artery

Wall Shear Stress (WSS) in the artery is one of the indicators for brain artery disease progression. WSS is proportional to the viscosity and shear rate of the flowing fluid. In this study, WSS of cerebral artery with aneurysm was predicted using Computational Fluid Dynamics (CFD). The effect of non-Newtonian properties of blood will be studied by comparing Power law model with Newtonian model. Based on the results, maximum value of WSS is 150 Pa for Newtonian model and for Power Law model is 24 Pa. Newtonian model was found overpredicted the WSS resulted from Power Law.

Mechanisms of microbubble–vessel interactions and induced stresses: A numerical study

Oscillating microbubbles within microvessels could induce stresses that lead to bioeffects or vascular damage. Previous work has attributed vascular damage to the vessel expansion or bubble jet. However, ultra-high speed images of recent studies suggest that it could happen due to the vascular invagination. Numerical simulations of confined bubbles could provide insight into understanding the mechanism behind bubble-vessel interactions. In this study, a finite element model of a coupled bubble/fluid/vessel system was developed and validated with experimental data. Also, for a more realistic study viscoelastic properties of microvessels were assessed and incorporated into this comprehensive numerical model. The wall shear stress (WSS) and circumferential stress (CS), metrics of vascular damage, were calculated from these simulations. Resultant amplitudes of oscillation were within 15% of those measured in experiments (four cases). Among the experimental cases, it was numerically found that maximum WSS values were between 1.1-18.3 kPa during bubble expansion and 1.5-74 kPa during bubble collapse. CS was between 0.43-2.2 MPa during expansion and 0.44-6 MPa while invaginated. This finding confirmed that vascular damage could occur during vascular invaginations. Predicted thresholds in which these stresses are higher during vessel invagination were calculated from simulations.

Unsteady blood flow and mass transfer of a human left coronary artery bifurcation: FSI vs. CFD

In this study, a Fluid Solid Interaction analysis (FSI) of a computerized tomography (CT) scan reconstructed left coronary artery was performed. The arterial wall was modeled as an isotropic hyperelastic material. The arterial wall shear stress (WSS) was computed in order to investigate a correlation between flow-induced wall shear stress and geometry of the artery. An unsteady state FSI analysis with a commercial finite element software was performed in order to evaluate the maximum and the minimum wall shear stress as a function of the flow regime and the arterial wall compliance in the left coronary. As boundary conditions, physiological pressure waveforms were applied. Comparison of the computational results between the FSI and rigid-wall models showed that the wall shear stress (WSS) distributions were substantially affected by the arterial wall compliance. In particular, the minimum and maximum WSS values significantly vary.

Wall shear stress mapping in the rotating cage geometry and evaluation of drag reduction efficiency using an electrochemical method

The local wall shear stress (WSS) mapping in the rotating cage (RC) has been obtained from measuring the diffusion current due to the electrochemical reduction of methyl viologen used as tracer system for both Newtonian and non-Newtonian solutions. The latter were achieved with oleyltrimethyl ammonium, a cationic surfactant, and sodium salicylate as counter-ion, forming thread-like micelles which induce drag reduction conditions. The maximum WSS values were detected in the middle of the coupon in agreement with observation of corroded coupons in erosion–corrosion tests. Maximum values of 65% for drag reduction were measured at the same locations.

Effects of different stent designs on local hemodynamics in stented arteries

Following the deployment of a coronary stent and disruption of an atheromatous plaque, the deformation of the arterial wall and the presence of the stent struts create a new fluid dynamic field, which can cause an abnormal biological response. In this study 3D computational models were used to analyze the fluid dynamic disturbances induced by the placement of a stent inside a coronary artery. Stents models were first expanded against a simplified arterial plaque, with a solid mechanics analysis, and then subjected to a fluid flow simulation under pulsatile physiological conditions. Spatial and temporal distribution of arterial wall shear stress (WSS) was investigated after the expansion of stents of different designs and different strut thicknesses. Common oscillatory WSS behavior was detected in all stent models. Comparing stent and vessel wall surfaces, maximum WSS values (in the order of 1 Pa) were located on the stent surface area. WSS spatial distribution on the vascular wall surface showed decreasing values from the center of the vessel wall portion delimited by the stent struts to the wall regions close to the struts. The hemodynamic effects induced by two different thickness values for the same stent design were investigated, too, and a reduced extension of low WSS region (<0.5 Pa) was observed for the model with a thicker strut.

Mining data from hemodynamic simulations via Bayesian emulation

Background:Arterial geometry variability is inevitable both within and across individuals. To ensure realistic prediction of cardiovascular flows, there is a need for efficient numerical methods that can systematically account for geometric uncertainty.Methods and results:A statistical framework based on Bayesian Gaussian process modeling was proposed for mining data generated from computer simulations. The proposed approach was applied to analyze the influence of geometric parameters on hemodynamics in the human carotid artery bifurcation. A parametric model in conjunction with a design of computer experiments strategy was used for generating a set of observational data that contains the maximum wall shear stress values for a range of probable arterial geometries. The dataset was mined via a Bayesian Gaussian process emulator to estimate: (a) the influence of key parameters on the output via sensitivity analysis, (b) uncertainty in output as a function of uncertainty in input, and (c) which settings of the input parameters result in maximum and minimum values of the output. Finally, potential diagnostic indicators were proposed that can be used to aid the assessment of stroke risk for a given patient's geometry.

Investigation of the wall region of gas-liquid flow using an electrodiffusional technique

Measurements of the hydrodynamic characteristics of upward gas-liquid flow in an inclined channel were performed. Experiments were made by an electrodiffusional method using microprobes for wall shear stress and liquid velocity measurements. Special attention was paid to the study of two-phase flow structure in the vicinity of the wall. A strong effect of the channel orientation on the characteristics of the flow was demonstrated. The results show that maximum wall shear stress values correspond to an intermediate channel inclination. High values of near-wall void fraction result in the reduction of liquid velocity fluctuations in horizontal and near-horizontal channel positions.