Development of squeeze flow in mechanical heart valve: a particle image velocimetry investigation.

Fluid between the reducing flow channel of the valve occluder and the orifice wall tends to be squeezed out of the flow channel, causing a high-speed flow. The squeeze flow is accompanied by a sharp local pressure drop, which may result in potential cavitation phenomenon in a mechanical heart valve (MHV). Limited experimental investigation has been conducted into the flow physics of this squeeze flow phenomenon, which is likely to be the origin of MHV cavitation. We used a pulsatile test loop simulating physiologic flow conditions and an actual-size transparent MHV model for flow visualization. A digital particle image velocimetry (DPIV) system incorporated with a microscope was applied to observe flow within a narrowing channel. A triggering mechanism was designed so that the DPIV system could be timed to capture images when the valve occluder was near its closing position. A series of images within the channel from 1.4 to 0.1 mm were captured. As the gap between the tip of the valve occluder and orifice wall becomes narrower, evidence of high-speed jet flow becomes more apparent. When the flow channel is reduced to around 0.1 mm, flow velocity of up to 2 m/s was noted. A sudden increase in high-speed jet flow causes a corresponding reduction in local pressure, and is a likely source for potential cavitation.

Mechanisms of mechanical heart valve cavitation: investigation using a tilting disk valve model.

BACKGROUND AND AIM OF THE STUDY: The induction of mechanical heart valve (MHV) cavitation was investigated using a 27 mm Medtronic Hall (MH27) tilting disk valve. METHODS: The MH27 valve was mounted in the mitral position of a simulating pulse flow system, and stroboscopic lighting used to visualize cavitation bubbles on the occluder inflow surface at the instant of valve closure. MHV cavitation was monitored using a digital camera with 0.04 mm/pixel resolution sufficient to render the tiny bubbles clearly visible on the computer monitor screen. RESULTS: Cavitation on MH27 valve was classified as five types according to the time, site and shape of the cavitation bubbles. Valve cavitation occurred at the instant of occluder impact with the valve seat at closing. The impact motion was subdivided into three temporal phases: (i) squeezing flow; (ii) elastic collision; and (iii) leaflet rebound. MHV cavitation caused by vortices was found to be initiated by the squeezing jet and/or by the transvalvular leakage jets. By using a tension wave which swept across the occluder surface immediately upon elastic impact, nuclei in the vortex core were expanded to form cavitation bubbles. CONCLUSION: Analysis of the shape and location of the cavitation bubbles permitted a better understanding of MHV cavitation mechanisms, based on the fluid dynamics of jet vortex and tension wave propagations.

Digital particle image velocimetry investigation of the pulsating flow around a simplified 2-D model of a bileaflet heart valve.

BACKGROUND AND AIM OF STUDY: Strong interactions are believed to exist between the pulsating valvular flow and the valve leaflet motions. Hinge position, indicated by d/W (d = distance between the two axes of the hinge pivots; W = width of the testing section in the middle plane), plays a critical role in MHV performance. An optimized hinge position for a bileaflet heart valve can be identified as a design criterion for better valve performance. METHODS: A two-dimensional (2-D) digital particle image velocimetry (DPIV) system was used to map the transient flow field of a simplified 2-D model of a bileaflet heart valve with a hydraulic diameter enlarged three-fold under pressure waveforms which was expanded based on Womersley number and Euler number considerations. Six different hinge positions were investigated. RESULTS: At extreme hinge positions (d/W <0.2 or d/W >0.3), large-scale and long-duration stagnation of flow was found in the central orifice, and instability and highly disturbed flow was noted in plots of velocity vectors. CONCLUSION: The transient flow pattern in the vicinity of the valve was greatly affected by the hinge position of moving leaflets. An optimum d/W in the range 0.2-0.3 yielded good velocity field and opening and closing behaviors.

Computational fluid dynamics study of a protruded-hinge bileaflet mechanical heart valve.

BACKGROUND AND AIM OF THE STUDY: Following clinical experience with the Medtronic Parallel bileaflet mechanical heart valve, considerable interest has been shown in investigating fluid mechanics inside the hinge socket. Most of these studies involved hinges that are recessed into the valve housing, such as the St. Jude Medical (SJM), CarboMedics, Sorin and On-X bileaflet mechanical heart valves. The aim of this study was to investigate the flow fields of a protruded hinge under steady flow conditions, with the occluder in its fully open position. Computational fluid dynamics (CFD) simulation using the Fluent 4.4.7 commercial solver was applied in this investigation. This protruded hinge mechanism for pivoting the occluder is an in-house design from the Cardiovascular Dynamics Laboratory, Nanyang Technological University. METHODS: The Fluent 4.4.7 code was run on a Silicon Graphic Inc. computer (4-CPUx185 MHz) in the CFD simulation. A body-fitted coordinates (BFC) grid was generated to cover the entire valvular flow domain, including the interior of the hinge and leaflet. Clearance between the leaflet and pivot housing was 50-70 microm. In the vicinity of the protruded hinge, mesh cells were small compared with hinge dimensions. A power law distribution of grid points was applied to optimize the number of cells used to cluster the entire flow field. The overall computational flow domain of the valve channel, including the floating leaflet and immersed hinge, was approximately 170,000 cells in total. Inside the hinge socket, approximately 10,000 cells were generated. A comparative model with recessed hinge that resembled the SJM valve hinge design was modeled. Due to geometric difficulties, an unstructured grid scheme was applied. Great attention was focused within the hinge pocket, in particular to the clearance between the hinge pivot and leaflet. A total of 2 million cells was generated for the whole computational flow domain. RESULTS: Under steady flow conditions, with the leaflet fixed in an open position, the protruded hinge design yielded a pair of small vortices that formed behind the stoppers. A low-magnitude velocity was observed inside the hinge clearance. Vortices developed behind the protruded stopper. Migrating flow was noted beneath the leaflet clearance as a result of pressure difference across the leaflet. For the recessed hinge design, reverse flow dominated the inside of the hinge socket, and developed into a pair of vortices at high Reynolds number. CONCLUSION: The protruded hinge mechanism was designed to expose the overall hinge region to the mainstream flow for a positive washing effect. Flow in this protruded hinge design is, in general, found to be three-dimensional. Initial results under steady flow conditions showed low laminar and turbulent shear stress, while the hinge clearance was well washed.

Bioprosthetic heart valve leaflet motion monitored by dual camera stereo photogrammetry.

Dual camera stereo photogrammetry (DCSP) was applied to investigate the leaflet motion of bioprosthetic heart valves (BHVs) in a physiologic pulse flow loop (PFL). A 25-mm bovine pericardial valve was installed in the aortic valve position of the PFL, which was operated at a pulse rate of 70 beats/min and a cardiac output of 5 l/min. The systolic/diastolic aortic pressure was maintained at 120/80 mmHg to mimic the physiologic load experienced by the aortic valve. The leaflet of the test valve was marked with 80 India ink dots to form a fan-shaped matrix. From the acquired image sequences, 3-D coordinates of the marker matrix were derived and hence the surface contour, local mean and Gaussian curvatures at each opening and closing phase during one cardiac cycle were reconstructed. It is generally believed that the long-term failure rate of BHV is related to the uneven distribution of mechanical stresses occurring in the leaflet material during opening and closing. Unfortunately, a quantitative analysis of the leaflet motion under physiological conditions has not been reported. The newly developed technique permits frame-by-frame mapping of the leaflet surface, which is essential for dynamic analysis of stress-strain behavior in BHV.

Application of an unstructured grid algorithm to artificial heart valve simulations.

The time varying flow pattern in the vicinity of mechanical heart valves (MHV) is fairly complex: it involves multiple passages and moving leaflets. The numeric simulation of unsteady flows in these multiple passages with moving boundaries presents a major challenge to computational fluid dynamics (CFD). Two major difficulties in the numeric simulation of MHV flows are 1) the generation of a body fitted grid within the multipassage device and 2) moving leaflets. The conventional finite difference and finite volume scheme obtained by using a structured grid have serious deficiencies in these applications. To fit the grid lines with the various angles of the moving MHV, the grid may often become too skewed for accurate numeric solution. To overcome these deficiencies, significant effort and attention should be placed on the grid generation and moving grid scheme. We present an unstructured moving grid finite volume method for heart valve simulations. The Navier-Stokes equations are discretized on a general tetrahedral mesh by using a finite volume scheme. With this scheme, the mesh can be automatically generated with any commercial software. The method is applied to a tilting disk (Medtronic Hall 29mm, Medtronic, Inc., Minneapolis, MN) heart valve, and results are compared with that of the steady flow solutions. Significant differences between steady and unsteady flow solutions are observed.

Pressure and flow fields in the hinge region of bileaflet mechanical heart valves.

BACKGROUND AND AIM OF THE STUDY: Recent clinical thrombotic experiences with the Medtronic Parallel (MP) bileaflet heart valve have highlighted the need for new methods to assess preclinical valve hinge flow. The aim of the current study was to investigate hinge pivot flow fields in bileaflet mechanical heart valves using flow visualization in scaled x5 magnification transparent polymer models and computational fluid dynamic (CFD) analysis using CFD 2000 STORM code. METHODS: Polymeric x5 flow models of the On-X, St. Jude Medical (SJM) and MP bileaflet heart valves were constructed using laser stereolithography to replicate the interior geometry while maintaining realistic manufacturing tolerances. Each hinge flow experiment was carried out by installing the transparent x5 model in a pulsatile flow loop, which was designed according to Womersley number similitude requirements. Motions of suspended microparticles in the valve hinge area, recorded by laser imaging techniques, were used to visualize hinge flow. Experimentally measured parameters were used as input for CFD analysis. CFD simulations were made by solving the Navier-Stokes equation using a finite volume method with the pressure-based algorithm for continuity, and a pressure-implicit with splitting of operators (PISO) algorithm for pressure-velocity coupling. Moving grid methodology was employed to simulate periodic motion of the valve leaflets. CFD hinge flow results were visualized on four parallel planes at different depths in the hinge socket. The hinge flow patterns of the three types of bileaflet heart valve design are discussed. RESULTS: Prominent vortex formation and stagnant flow areas were noticed in the pivot region of the MP valve. Vortices persisted throughout both the forward- and reverse-flow phases. These flow structures were not observed in the hinge areas of the SJM and On-X valves. CONCLUSIONS: Vortex formation observed in the MP valve may contribute to the high thrombogenic potential of this valve. The absence of such vortices and areas of stagnant flow in the On-X and SJM valves indicate that hinge flow conditions in these valves do not favor mechanically induced thrombogenesis or thromboembolic events.

Time-frequency analysis of transient pressure signals for a mechanical heart valve cavitation study.

A series of transient pressure signals (TPSs) can be measured using a miniature pressure transducer mounted near the tip of the inflow side of a mechanical heart valve (MHV) occluder during closure. A relationship appears to exist between the intensity and pattern of the TPS and the cavitation potential of a MHV. To study the relationship between MHV cavitation and the TPSs, we installed an MHV in a valve testing chamber of a digitally controlled burst test loop. A charge coupled device (CCD) camera and a personal computer based image grabbing program was used to visualize cavitation bubbles appearing on or near the occluder surface. One bileaflet MHV was used as the model for this study. Cavitation bubbles were observed within 300 microsec of the leaflet/housing impact. The valve was tested at various driving pressures between 100 and 1,300 mmHg. MHV cavitation bubble intensities were qualitatively classified into three categories: 1) strong, 2) weak, and 3) none. Digital images of the MHV occluder inflow surface were recorded simultaneously with the TPSs. TPSs were studied by the time-frequency analysis method (spectrogram) and correlated to MHV cavitation potential. The intensity of the cavitation bubbles was found to be associated with burst test loop driving pressures during leaflet closure.

In vitro evaluation of the long-body On-X bileaflet heart valve.

BACKGROUND AND AIMS OF THE STUDY: In order to optimize the length-to-diameter ratio, a series of circular aluminum rings with flared inlet and varying ring lengths, with internal diameters corresponding to that of 19 mm replacement prosthetic heart valve orifices, were tested in a steady-flow hydraulic system. The study aim was to determine the ring length-to-internal diameter ratio that produces the best hydraulic efficiency (i.e. lowest pressure gradient) within the physiologic flow rate range. METHODS: Each ring was tested at flow rates of 10, 15, 20, 25 and 30 l/min and length-to-diameter ratio effect on hydraulic efficiency determined experimentally. The hydraulic effect was most significant for a ratio of about 0.6, with an increase to 1.2 providing little additional benefit. Thus, a ratio of about 0.6 was considered optimum in terms of hydraulic efficiency and incorporated into the design of the On-X bileaflet mechanical heart valve (BHV) series. An in vitro hydrodynamic study of the smallest (19 mm) and largest (25 mm) clinical On-X aortic valves was performed at two independent laboratories. Standard St. Jude Medical BHVs were used as the study controls. RESULTS: Steady-flow experiments showed that the pressure gradient in the On-X valve was about 50% less than that of the comparable size control. The pulsatile flow study demonstrated a similar pressure gradient advantage. Laser Doppler anemometer velocity profiles taken downstream of the On-X valve at the aortic root showed typical characteristics of bileaflet valves, with three velocity peaks. The peak velocity reached 1.6 m/s for the On-X and 1.75 m/s for the control valve. A recirculating vortex was seen in the sinus cavity during the ejection period. This vortex, found in most aortic valves (including bioprostheses), is believed to provide a beneficial wash-out of the valve region and assist in valve closure. CONCLUSIONS: These two independent studies clearly demonstrated that the elongated valve body and comparably larger flow area helped to improve the valve hydrodynamic performance, which is especially beneficial in the smallest (19 mm) size valve.

Hydrodynamics of a long-body bileaflet mechanical heart valve.

A new bileaflet substitute mechanical heart valve (MHV) that incorporates an optimal length-to-annulus ratio for improved hydrodynamic efficiency was recently introduced. Efforts have been made on this new prosthesis to use the current advances in carbon materials and design technology to achieve higher net forward flow with minimal energy loss for the smaller aortic valves, while reducing regurgitant closure volume for the larger size valves by an elongated orifice. Benchtop experiments performed in a pulsatile flow loop, under simulated physiologic conditions, substantiated these improvements as claimed.

Dynamic characterization of a new accelerated heart valve tester.

This paper presents a new accelerated prosthetic heart valve tester prototype that incorporates a camshaft and poppet valves. A three element Windkessel system is used to mimic the afterload of the human systemic circulation. The device is capable of testing eight valves simultaneously at a rate up to 1,250 cycles/min, while the flow rate, the pressure, and the valve loading can be monitored and adjusted individually. The tester was characterized and calibrated using a set of eight Carpentier-Edwards bioprostheses at a flow rate varying between 3 and 5 L/min. The experiment was carried out with the pressure difference across the closed heart valve maintained between 140 and 190 mmHg. Smooth and complete opening and closing of the valve leaflets was achieved at all cycling rates. This confirms that the velocity profiles approaching the test valves were uniform, an important factor that allows the test valves to open and close synchronously each time.

Transient pressure signals in mechanical heart valve cavitation.

The purpose of this investigation was to establish a correlation between mechanical heart valve (MHV) cavitation and transient pressure (TP) signals at MHV closure. This correlation may suggest a possible method to detect in vivo MHV cavitation. In a pulsatile mock flow loop, a study was performed to measure TP and observe cavitation bubble inception at MHV closure under simulated physiologic ventricular and aortic pressures at heart rates of 70, 90, 120, and 140 beats/min with corresponding cardiac outputs of 5.0, 6.0, 7.5, and 8.5 L/min, respectively. The experimental study included two bileaflet MHV prostheses: 1) St. Jude Medical 31 mm and 2) Carbomedics 31 mm. High fidelity piezo-electric pressure transducers were used to measure TP immediately before and after the valve leaflet/housing impact. A stroboscopic lighting imaging technique was developed to capture cavitation bubbles on the MHV inflow surfaces at selected time delays ranging from 25 microseconds to 1 ms after the leaflet/housing impact. The TP traces measured 10 mm away from the valve leaflet tip showed a large pressure reduction peak at the leaflet/housing impact, and subsequent high frequency pressure oscillations (HPOs) while the cavitation bubbles were observed. The occurrence of cavitation bubbles and HPO bursts were found to be random on a beat by beat basis. However, the amplitude of the TP reduction, the intensity of the cavitation bubble (size and number), and the intensity of HPO were found to increase with the test heart rate. A correlation between the MHV cavitation bubbles and the HPO burst was positively established. Power spectrum analysis of the TP signals further showed that the frequency of the HPO (cavitation bubble collapse pressures) ranged from 100 to 450 kHz.

Bileaflet mechanical heart valves at low cardiac output.

Several earlier studies have indicated that bileaflet mechanical heart valves behave irregularly at low cardiac output and low pulse rate conditions, and that their hydrodynamic performances are generally inadequate. The authors conducted in vitro experiments in a pulsatile mock circulatory loop to compare the performance of the St. Jude Medical (SJM) valve and a long body bileaflet prosthesis recently introduced by Medical Carbon Research Institute (MCRI) (Austin, TX). The new MCRI mechanical heart valve model was designed with emphasis on improved hydrodynamic efficacy by introducing a long body with parallel leaflets and by leaflets increasing the flow area. Experimental studies were conducted on five test valves (MCRI 19 mm, MCRI 25 mm, SJM 19 mm, SJM 23 mm, and SJM 29 mm) with cardiac outputs of 2.0, 2.5, 3.0, and 3.5 L/min at a pulse rate of 40 beats/min, and 3.5, 4.0, 4.5, and 5.0 L/min at a pulse rate of 70 beats/min. Transvalvular pressure drop and closure volume were assessed by measuring the instantaneous ventricular and aortic pressures and aortic flow. The leaflet motions of the tested valves were observed by direct video recording using a charge coupled device camera while the flow measurements were being conducted. Testing under simulated physiologic ventricular and aortic pressure waveforms, the results of this study show that the MCRI bileaflets remained fully open during the entire ejection phase, even at very low cardiac output conditions (2.0 L/min). The closure volume (defined as percentage of forward flow volume) increased with decreasing cardiac output, as reported earlier by others. Comparative results also indicate that the MCRI design has nearly a two size pressure drop advantage over the SJM, with significantly smaller closure volume.

Numerical study of squeeze-flow in tilting disc mechanical heart valves.

BACKGROUND AND AIM OF THE STUDY: The squeeze-flow that develops during valve closure is believed to cause cavitation in mitral mechanical heart valves (MHVs). METHODS: Squeeze-flow was studied in tilting disc MHVs using two different numerical approaches. In the first decoupled analysis, experimental measurements of valve closing velocities were input into a computer model which simulated the resulting flow field. The second coupled approach involved simulation of the occluder motion and housing deformation in response to the surrounding flow. RESULTS: Both models predicted the likelihood of cavitation during the squeeze-flow phase of valve closure. They also indicated that valve mounting compliance influences the squeeze-flow field. The coupled analysis also showed that squeeze-flow is influenced by fluid viscosity and the geometry of the contact region. CONCLUSIONS: These parameters could therefore influence the inception of cavitation in tilting disc mitral MHVs.

Fluid dynamics of venous valve closure.

In vitro experiment was performed on a stented bovine jugular vein valve (VV, 14 mm I.D. x 2 cm long) and a stentless bovine jugular vein valve conduit (10 mm I.D. x 6 cm long) in a hydraulic flow loop with a downstream oscillatory pressure source to mimic respiratory changes. Simultaneous measurements were made on the valve opening area, conduit and sinus diameter changes using a specially designed laser optic system. Visualization of flow fields both proximal and distal to the venous valve, and the valve opening area were simultaneously recorded by using two video cameras. Laser Doppler anemometer surveys were made at three cross sections: the valve inlet, the valve exist, and 2 cm downstream of the venous valve to quantity flow reflux at valve closure. The experiment confirmed that the VV is a pressure-operated rather than a flow-driven device and that little or no reflux is needed to close the valve completely. The experiment further demonstrated that the VV sinus expands rapidly against back pressure, a critical character to consider in venous prosthesis design.

Transient pressure at closing of a monoleaflet mechanical heart valve prosthesis: mounting compliance effect.

An in vitro experimental study was performed to investigate the mounting compliance effect on the occluder closing dynamics and the transient pressure at the closing of the mitral Medtronic Hall (MH) mechanical heart valve (MHV). The closing velocity and the transient pressure were simultaneously measured at heart rates of 70, 90, 120, and 140 beats/minute with cardiac outputs of 5.0, 6.0, 7.5, and 8.5 liters/minute, respectively. The experiment was conducted under simulated physiologic ventricular and aortic pressures in a pulsatile mock flow loop. The characteristics of the transient pressure were investigated by detailed mapping of the transient pressure field in the atrial chamber using high frequency pressure transducers. Simultaneous measurements of the occluder closing velocity and the transient pressure around the seat stop of the MH showed that the transient pressure generated on the inflow side dropped below the vapor pressure of liquid during the occluder's sudden deceleration at closing. The amplitude of the transient pressure reduction (TR) was proportional to the occluder approaching velocity. The development of the transient pressure in the rigid and flexible mountings were significantly different. In the rigid mounting (RM), the pressure was reduced below the liquid's vapor pressure and maintained below -350 mmHg for approximately 180 microseconds. Strong signals of high frequency pressure oscillations (HPO) were recorded in the transient pressure traces. The timing of the HPO was found to be consistent with that of the cavitation bubble collapse as observed by others. In the flexible mounting (FM), TR also occurred, but recovered quickly and was followed immediately by a positive pressure spike. Relatively weak HPO appeared in the transient pressure trace. The mapping of the transient pressure field showed that both the transient pressure reduction (on the major orifice side) or rise (on the minor orifice side) as well as the HPO were locally generated near the valve occluder surface. The transient pressure attenuated with distance away from the occluder surface. The HPO were detectable as far as 40 mm away from the occluder surface. The rigid mounting pressure signals showed characteristically two occurrences of high frequency pressure oscillations. The HPO with smaller amplitude occurred first after the initiation of the TR, followed by a burst of strong HPO at about 450 microseconds. It is believed that they were the result of the collapse of cavitation bubbles. The strong HPO did not appear in the flexible mounting signals. The study indicated that the mounting compliance played a significant role in the MHV cavitation inception and the subsequent bubble growth. It also suggested the possibility of detecting the cavitation by using a high frequency pressure transducer positioned in the atrial chamber.