Patient-specific Hemodynamic Simulations Research Articles

A new method for scaling inlet flow waveform in hemodynamic analysis of aortic dissection.

Computational fluid dynamics (CFD) simulations have shown great potentials in cardiovascular disease diagnosis and postoperative assessment. Patient-specific and well-tuned boundary conditions are key to obtaining accurate and reliable hemodynamic results. However, CFD simulations are usually performed under non-patient-specific flow conditions due to the absence of in vivo flow and pressure measurements. This study proposes a new method to overcome this challenge by tuning inlet boundary conditions using data extracted from electrocardiogram (ECG). Five patient-specific geometric models of type B aortic dissection were reconstructed from computed tomography (CT) images. Other available data included stoke volume (SV), ECG, and 4D-flow magnetic resonance imaging (MRI). ECG waveforms were processed to extract patient-specific systole to diastole ratio (SDR). Inlet boundary conditions were defined based on a generic aortic flow waveform tuned using (1) SV only, and (2) with ECG and SV (ECG + SV). 4D-flow MRI derived inlet boundary conditions were also used in patient-specific simulations to provide the gold standard for comparison and validation. Simulations using inlet flow waveform tuned with ECG + SV not only successfully reproduced flow distributions in the descending aorta but also provided accurate prediction of time-averaged wall shear stress (TAWSS) in the primary entry tear (PET) and abdominal regions, as well as maximum pressure difference, ∆Pmax, from the aortic root to the distal false lumen. Compared with simulations with inlet waveform tuned with SV alone, using ECG + SV in the tuning method significantly reduced the error in false lumen ejection fraction at the PET (from 149.1% to 6.2%), reduced errors in TAWSS at the PET (from 54.1% to 5.7%) and in the abdominal region (from 61.3% to 11.1%), and improved ∆Pmax prediction (from 283.1% to 18.8%) However, neither of these inlet waveforms could be used for accurate prediction of TAWSS in the ascending aorta. This study demonstrates the importance of SDR in tailoring inlet flow waveforms for patient-specific hemodynamic simulations. A well-tuned flow waveform is essential for ensuring that the simulation results are patient-specific, thereby enhancing the confidence and fidelity of computational tools in future clinical applications.

A hemodynamic analysis of fenestrated physician-modified endograft repair for complicated aortic dissections involving the visceral arteries

ObjectiveThe aim of this study is to perform patient-specific hemodynamic simulations of the patients with complicated aortic dissection underwent Physician-modified endograft (PMEG) and evaluate the treatment outcome. Method12 patient-specific models were reconstructed from computed tomography angiography (CTA) data of 6 patients with complicated aortic dissection before and after the PMEG. Hemodynamic simulations were conducted with the same time-varying volumetric flow rate extracted from the literature and 3-element Windkessel model (3 EWM) boundary conditions were applied at the aortic outlet. Hemodynamic indicators such as time-averaged wall shear stress (TAWSS), relative residence time (RRT) and endothelial cell activation potential (ECAP) were obtained to evaluate the postoperative effect of PMEG. ResultsComparing with the preoperative models, the flow rates of most visceral arteries were increased in the postoperative models (PSMA = 0.012, PRRA = 0.013, and PLRA = 0.005). Pressure and TAWSS in visceral regions were significantly reduced (PP = 0.003 and PTAWSS = 0.017). With the false lumens (FL) covered by the stent grafts, the average TAWSS level increased in the regions of postoperative abdominal aorta (P = 0.002), and the average RRT and ECAP values decreased significantly (PRRT = 0.02 and PECAP = 0.003). ConclusionThis study shows that PMEG, as a new technique for the treatment of complicated aortic dissection involving the distal tears in the visceral region, can effectively restore the abnormal blood supply of the visceral arteries, reduce the risk of aortic rupture, the formation of aortic dissection aneurysm (ADA), and thrombosis. This corresponds well with clinical retrospective studies and 1-year follow-up outcomes. The findings of this study are of great significance for the development of PMEG.

Hemodynamic Assessment of the Pathological Left Ventricle Function under Rest and Exercise Conditions

Purpose: The analysis of pathological human left ventricular hemodynamics using high-resolved image-based blood flow simulations shows a major potential for examining mitral valve insufficiency (MI) under exercise conditions. Since capturing and simulating the patient-specific movement of the left ventricle (LV) during rest and exercise is challenging, this study aims to propose a workflow to analyze the hemodynamics within the pathologically moving LV. Methods: Patient-specific ultrasound (US) data of ten patients with MI in different stages were captured with three-dimensional real-time echocardiography. US measurements were performed while patients were resting and while doing handgrip exercise (2–4 min work). Patient-specific hemodynamic simulations were carried out based on the captured ventricular wall movement. Velocity and kinetic energy were analyzed for rest and exercise and for the different MI stages. Results: The results reveal a dependency of the kinetic energy over time in the ventricular volume curves. Concerning the comparison between rest and exercise, the left ventricular function reveals lower systolic kinetic energy under exercise (kinetic energy normalized by EDV; mean ± standard deviation: rest = 0.16 ± 0.14; exercise = 0.06 ± 0.05; p-value = 0.04). Comparing patients with non-limiting (MI I) and mild/moderate (MI II/III) MI, lower velocities (mean ± standard deviation: non-limiting = 0.10 ± 0.03; mild/moderate = 0.06 ± 0.02; p-value = 0.01) and lower diastolic kinetic energy (kinetic energy normalized by EDV; mean ± standard deviation: non-limiting = 0.45 ± 0.30; mild/moderate = 0.20 ± 0.19; p-value = 0.03) were found for the latter. Conclusion: With the proposed workflow, the hemodynamics within LVs with MI can be analyzed under rest and exercise. The results reveal the importance of the patient-specific wall movement when analyzing intraventricular hemodynamics. These findings can be further used within patient-specific simulations, based on varying the imaging and segmentation methods.

Characterization of hemodynamics in anomalous aortic origin of coronary arteries using patient-specific modeling

The anomalous aortic origin of coronary arteries (AAOCA) is a congenital disease that can lead to sudden cardiac death (SCD) during strenuous physical activity. Despite AAOCA being the second leading cause of SCD among young athletes, the mechanism behind sudden cardiac death remains mostly unknown. Computational fluid dynamics provides a powerful tool for studying how pathologic anatomy can affect different hemodynamic states. The present study investigates the effect of AAOCA on patient hemodynamics. We performed patient-specific hemodynamic simulations of interarterial AAOCA at baseline and in the exercise state using our massively parallel flow solver. Additionally, we investigate how surgical correction via coronary unroofing impacts patient blood flow. Results show that patient-specific AAOCA models exhibited higher interarterial time-averaged wall shear stress (TAWSS) values compared to the control patients. The oscillatory shear index had no impact on AAOCA. Finally, the coronary unroofing procedure normalized the elevated TAWSS by decreasing TAWSS in the postoperative patient. The present study provides a proof of concept for the potential hemodynamic factors underlying coronary ischemia in AAOCA during exercise state.

Patient-specific hemodynamic analysis of IVCS-induced DVT

The aim of this study is to perform patient-specific hemodynamic simulations of patients with iliac vein compression syndrome (IVCS) and evaluate the deep venous thrombosis (DVT) potential, with clinical observations as reference. 15 patient-specific IVCS models were reconstructed from computed tomography venography (CTV) data, and divided into three groups, i.e. two groups with thrombosis: Group A (complete obstruction) and Group B (incomplete obstruction), and a third group without DVT, Group C. Hemodynamic simulations were conducted with patient-specific inlet flow rates. The blood residue was predicted using the blood stasis model. Time histories of old blood volume fraction (OBVF) was obtained, in addition to conventional hemodynamic parameters such as wall shear stress (WSS). The mean area-averaged WSS of the stenosis region for Group A and Group B were 3.68 Pa and 1.78 Pa, respectively. For the telecentric end region, the WSS were 0.76 Pa and 0.58 Pa, respectively. For Group C, the WSS at these two regions were 4.61 Pa and 1.57 Pa, respectively. The OBVF was 74.0% at the stenosis region and 76.2% at the telecentric end region for Group A, much higher than 4.8% and 43.1% of Group B. For Group C, the OBVF at the two regions were close to 0. This corresponded well with clinical observations. The potential of DVT can be predicted through patient-specific hemodynamic simulations in combination of blood stasis model. The findings of this study are of great significance for the preoperative evaluation and treatment prognosis of IVCS patients with DVT.

The nested block preconditioning technique for the incompressible Navier–Stokes equations with emphasis on hemodynamic simulations

We develop a novel iterative solution method for the incompressible Navier–Stokes equations with boundary conditions coupled with reduced models. The iterative algorithm is designed based on the variational multiscale formulation and the generalized-α scheme. The spatiotemporal discretization leads to a block structure of the resulting consistent tangent matrix in the Newton–Raphson procedure. As a generalization of the conventional block preconditioners, a three-level nested block preconditioner is introduced to attain a better representation of the Schur complement, which plays a key role in the overall algorithm robustness and efficiency. This approach provides a flexible, algorithmic way to handle the Schur complement for problems involving multiscale and multiphysics coupling. The solution method is implemented and benchmarked against experimental data from the nozzle challenge problem issued by the US Food and Drug Administration. The robustness, efficiency, and parallel scalability of the proposed technique are then examined in several settings, including moderately high Reynolds number flows and physiological flows with strong resistance effect due to coupled downstream vasculature models. Two patient-specific hemodynamic simulations, covering systemic and pulmonary flows, are performed to further corroborate the efficacy of the proposed methodology.

Performance portability study for massively parallel computational fluid dynamics application on scalable heterogeneous architectures

Patient-specific hemodynamic simulations have the potential to greatly improve both the diagnosis and treatment of a variety of vascular diseases. Portability will enable wider adoption of computational fluid dynamics (CFD) applications in the biomedical research community and targeting to platforms ideally suited to different vascular regions. In this work, we present a case study in performance portability that assesses (1) the ease of porting an MPI application optimized for one specific architecture to new platforms using variants of hybrid MPI＋X programming models; (2) performance portability seen when simulating blood flow in three different vascular regions on diverse heterogeneous architectures; (3) model-based performance prediction for future architectures; and (4) performance scaling of the hybrid MPI＋X programming on parallel heterogeneous systems. We discuss the lessons learned in porting HARVEY, a massively parallel CFD application, from traditional multicore CPUs to diverse heterogeneous architectures ranging from NVIDIA/AMD GPUs to Intel MICs and Altera FPGAs.

Gap-free segmentation of vascular networks with automatic image processing pipeline

Current image processing techniques capture large vessels reliably but often fail to preserve connectivity in bifurcations and small vessels. Imaging artifacts and noise can create gaps and discontinuity of intensity that hinders segmentation of vascular trees. However, topological analysis of vascular trees require proper connectivity without gaps, loops or dangling segments. Proper tree connectivity is also important for high quality rendering of surface meshes for scientific visualization or 3D printing. We present a fully automated vessel enhancement pipeline with automated parameter settings for vessel enhancement of tree-like structures from customary imaging sources, including 3D rotational angiography, magnetic resonance angiography, magnetic resonance venography, and computed tomography angiography. The output of the filter pipeline is a vessel-enhanced image which is ideal for generating anatomical consistent network representations of the cerebral angioarchitecture for further topological or statistical analysis. The filter pipeline combined with computational modeling can potentially improve computer-aided diagnosis of cerebrovascular diseases by delivering biometrics and anatomy of the vasculature. It may serve as the first step in fully automatic epidemiological analysis of large clinical datasets. The automatic analysis would enable rigorous statistical comparison of biometrics in subject-specific vascular trees. The robust and accurate image segmentation using a validated filter pipeline would also eliminate operator dependency that has been observed in manual segmentation. Moreover, manual segmentation is time prohibitive given that vascular trees have more than thousands of segments and bifurcations so that interactive segmentation consumes excessive human resources. Subject-specific trees are a first step toward patient-specific hemodynamic simulations for assessing treatment outcomes.

In Vitro Validation of Patient-Specific Hemodynamic Simulations in Coronary Aneurysms Caused by Kawasaki Disease.

To perform experimental validation of computational fluid dynamics (CFD) applied to patient specific coronary aneurysm anatomy of Kawasaki disease. We quantified hemodynamics in a patient-specific coronary artery aneurysm physical phantom under physiologic rest and exercise flow conditions. Using phase contrast MRI (PCMRI), we acquired 3-component flow velocity at two slice locations in the aneurysms. We then performed numerical simulations with the same geometry and inflow conditions, and performed qualitative and quantitative comparisons of velocities between experimental measurements and simulation results. We observed excellent qualitative agreement in flow pattern features. The quantitative spatially and temporally varying differences in velocity between PCMRI and CFD were proportional to the flow velocity. As a result, the percent discrepancy between simulation and experiment was relatively constant regardless of flow velocity variations. Through 1D and 2D quantitative comparisons, we found a 5-17% difference between measured and simulated velocities. Additional analysis assessed wall shear stress differences between deformable and rigid wall simulations. This study demonstrated that CFD produced good qualitative and quantitative predictions of velocities in a realistic coronary aneurysm anatomy under physiological flow conditions. The results provide insights on factors that may influence the level of agreement, and a set of in vitro experimental data that can be used by others to compare against CFD simulation results. The findings of this study increase confidence in the use of CFD for investigating hemodynamics in the specialized anatomy of coronary aneurysms. This provides a basis for future hemodynamics studies in patient-specific models of Kawasaki disease.

Distinct trends of pulsatility found at the necks of ruptured and unruptured aneurysms

BackgroundAneurysm hemodynamics has been shown to be an important factor in aneurysm growth and rupture. Although pulsatility is essential for blood flow and vascular wall function, studies of pulsatile flow...

Investigation of intracranial aneurysm hemodynamics following flow diverter stent treatment

Flow diverters (FDs) are high density meshed stents designed to reduce blood flow into intra-cranial aneurysms. Though the FD is one of many intracranial aneurysm (IA) treatments, FD implantation may also result in the growth and rupture of residual aneurysms. The purpose of this research is to investigate the effect of FD implantation on IA hemodynamics. Computational fluid dynamics (CFD) was conducted to analyze dynamic and resistance forces after FD deployment. Simulation results for the successful case (patient A) showed that FD flow resistance force was higher than dynamic force. This indicated that the FD provided sufficient resistance to reduce flow into the aneurysm. As a result, flow velocity magnitude at the aneurysm neck was reduced by 95%. On the other hand, the flow velocity magnitude at the aneurysm neck was reduced by about 50% for the unsuccessful case (patient B). The reason was that the flow resistance force at the aneurysm neck section was calculated to be lower than the flow driving force. In order to completely occlude the aneurysm, a higher resistance FD stent is to be required to suppress the dynamic forces. Patient-specific hemodynamic simulations offer means of quantitative estimation FD treatment outcomes.

Fluid-structure interaction simulations of the Fontan procedure using variable wall properties.

Children born with single ventricle heart defects typically undergo a staged surgical procedure culminating in a total cavopulmonary connection (TCPC) or Fontan surgery. The goal of this work was to perform physiologic, patient-specific hemodynamic simulations of two post-operative TCPC patients by using fluid-structure interaction (FSI) simulations. Data from two patients are presented, and post-op anatomy is reconstructed from MRI data. Respiration rate, heart rate, and venous pressures are obtained from catheterization data, and inflow rates are obtained from phase contrast MRI data and are used together with a respiratory model. Lumped parameter (Windkessel) boundary conditions are used at the outlets. We perform FSI simulations by using an arbitrary Lagrangian-Eulerian finite element framework to account for motion of the blood vessel walls in the TCPC. This study is the first to introduce variable elastic properties for the different areas of the TCPC, including a Gore-Tex conduit. Quantities such as wall shear stresses and pressures at critical locations are extracted from the simulation and are compared with pressure tracings from clinical data as well as with rigid wall simulations. Hepatic flow distribution and energy efficiency are also calculated and compared for all cases. There is little effect of FSI on pressure tracings, hepatic flow distribution, and time-averaged energy efficiency. However, the effect of FSI on wall shear stress, instantaneous energy efficiency, and wall motion is significant and should be considered in future work, particularly for accurate prediction of thrombus formation.

Effects of parent artery segmentation and aneurismal-wall elasticity on patient-specific hemodynamic simulations

It is well known that hemodynamics and wall tension play an important role in the formation, growth and rupture of aneurysms. In the present study, the authors investigated the influence of parent artery segmentation and aneurismal-wall elasticity on patient-specific hemodynamic simulations with two patient-specific cases of cerebral aneurysms. Realistic models of the aneurysms were constructed from 3-D angiography images and blood flow dynamics was studied under physiologically representative waveform of inflow. For each aneurysm three computational models were constructed: Model 1 with more extensive upstream parent artery with the rigid arterial and aneurismal wall, Model 2 with the partial upstream parent artery with the elastic arterial and aneurismal wall, Model 3 with more extensive upstream parent artery with the rigid wall for arterial wall far from the aneurysm and the elastic wall for arterial wall near the aneurysm. The results show that Model 1 could predict complex intra-aneurismal flow patterns and wall shear stress distribution in the aneurysm, but is unable to give aneurismal wall deformation and tension, Model 2 demonstrates aneurismal wall deformation and tension, but fails to properly model inflow pattern contributed by the upstream parent artery, resulting in local misunderstanding Wall Shear Stress (WSS) distribution, Model 3 can overcome limitations of the former two models, and give an overall and accurate analysis on intra-aneurismal flow patterns, wall shear stress distribution, aneuri-smal-wall deformation and tension. Therefore we suggest that the proper length of extensive upstream parent artery and aneuri-smal-wall elasticity should be considered carefully in establishing computational model to predict the intra-aneurismal hemodynamic and wall tension.

The effect of aneurismal-wall mechanical properties on patient-specific hemodynamic simulations: two clinical case reports

Hemodynamic factors such as the wall shear stress play an important role in the pathogenesis and treatment of cerebral aneurysms. In present study, we apply computational fluid–structure interaction analyses on cerebral aneurysms with two different constitutive relations for aneurismal wall in order to investigate the effect of the aneurismal wall mechanical properties on the simulation results. We carry out these analyses by using two patient-specific models of cerebral aneurysms of different sizes located in different branches of the circle of Willis. The models are constructed from 3D rotational angiography image data and blood flow dynamics is studied under physiologically representative waveform of inflow. From the patient models analyzed in this investigation, we find that the deformations of cerebral aneurysms are very small. But due to the nonlinear character of the Navier–Stokes equations, these small deformations could have significant influences on the flow characteristics. In addition, we find that the aneurismal-wall mechanical properties have great effects on the deformation distribution of the aneurysm, which also affects the wall shear stress distribution and flow patterns. Therefore, how to define a proper constitutive relation for aneurismal wall should be considered carefully in the hemodynamic simulation.

Influence of wall elasticity in patient-specific hemodynamic simulations

Recent reports indicate that the rupture risk for cerebral aneurysms is less than the risk of surgical complications. Being able to predict the rupture of aneurysms would help making better-informed decisions and avoiding unnecessary surgical operations. The wall shear stress is known to play an important role in vascular diseases. We carry out computational fluid–structure interaction analyses to investigate the influence of the arterial-wall deformation on the hemodynamic factors, including the wall shear stress distribution. The results show various patterns of this influence, depending very much on the arterial geometry.