COVID-19 and thrombosis: The role of hemodynamics.

Severe coronavirus disease 2019 (COVID-19) is characterized by an increased risk of thromboembolic events, a leading cause for adverse outcomes in patients afflicted by the more serious manifestation of the disease. These thromboembolic complications expressed as sepsis-induced coagulopathy, disseminated intravascular coagulation, venous and arterial thromboembolism, pulmonary embolism, microthrombosis, and thrombotic microangiopathy have been observed to affect different organs such as the lungs, heart, kidneys, and brain. Endothelial injury and dysfunction have been identified as the critical pathway towards thrombogenesis, and contributions of other mechanisms such as hypercoagulability, cytokine storm, neutrophils have been studied. However, the contribution of hemodynamic pathways towards thrombosis in severe COVID-19 cases has not been investigated. From the classical theory of Virchow's triad to the contemporary studies on the effect of shear enhanced platelet activation, it is well established that hemodynamics plays a role in the initiation and growth of thrombosis. This article reviews recent studies on COVID-19 related thrombotic events and offers hypotheses on how hemodynamics may be responsible for some of the adverse outcomes observed in severe COVID-19 cases. While thrombogenesis through endothelial injury and the effects of hypercoagulability on thrombosis are briefly addressed, the crux of the discussion is focused on hemodynamic factors such as stasis, turbulent flow, and non-physiological shear stress and their effects on thrombosis. In addition, hemodynamics-dependent venous, arterial, and microvascular thrombosis in COVID-19 cases is discussed. We also propose further investigation of diagnostic and therapeutic options that address the hemodynamics aspects of COVID-19 thrombus formation to assess their potential in patient care.

Influence of near-wall PIV data on recirculation hemodynamics in a patient-specific moderate stenosis: Experimental-numerical comparison.

BACKGROUND: Recirculation zones within the blood vessels are known to influence the initiation and progression of atherosclerotic lesions. Quantification of recirculation parameters with accuracy remains subjective due to uncertainties in measurement of velocity and derived wall shear stress (WSS). OBJECTIVE: The primary aim is to determine recirculation height and length from PIV experiments while validating with two different numerical methods: finite-element (FE) and -volume (FV). Secondary aim is to analyze how FE and FV compare within themselves. METHODS: PIV measurements were performed to obtain velocity profiles at eight cross sections downstream of stenosis at flow rate of 200 ml/min. WSS was obtained by linear/quadratic interpolation of experimental velocity measurements close to wall. RESULTS: Recirculation length obtained from PIV technique was 1.47 cm and was within 2.2% of previously reported in-vitro measurements. Derived recirculation length from PIV agreed within 6.8% and 8.2% of the FE and FV calculations, respectively. For lower shear rate, linear interpolation with five data points results in least error. For higher shear rate either higher order (quadratic) interpolation with five data points or lower order (linear) with lesser (three) data points leads to better results. CONCLUSION: Accuracy of the recirculation parameters is dependent on number of near wall PIV data points and the type of interpolation algorithm used.

Experimental Assessment of Flow Fields Associated with Heart Valve Prostheses Using Particle Image Velocimetry (PIV): Recommendations for Best Practices.

Experimental flow field characterization is a critical component of the assessment of the hemolytic and thrombogenic potential of heart valve substitutes, thus it is important to identify best practices for these experimental techniques. This paper presents a brief review of commonly used flow assessment techniques such as Particle image velocimetry (PIV), Laser doppler velocimetry, and Phase contrast magnetic resonance imaging and a comparison of these methodologies. In particular, recommendations for setting up planar PIV experiments such as recommended imaging instrumentation, acquisition and data processing are discussed in the context of heart valve flows. Multiple metrics such as residence time, local velocity and shear stress that have been identified in the literature as being relevant to hemolysis and thrombosis in heart valves are discussed. Additionally, a framework for uncertainty analysis and data reporting for PIV studies of heart valves is presented in this paper. It is anticipated that this paper will provide useful information for heart valve device manufacturers and researchers to assess heart valve flow fields for the potential for hemolysis and thrombosis.

Experimental investigation and computational modeling of hydrodynamics in bifurcating microchannels.

Methods involving microfluidics have been used in several chemical, biological and medical applications. In particular, a network of bifurcating microchannels can be used to distribute flow in a large space. In this work, we carried out experiments to determine hydrodynamic characteristics of bifurcating microfluidic networks. We measured pressure drop across bifurcating networks of various complexities for various flow rates. We also measured planar velocity fields in these networks by using particle image velocimetry. We further analyzed hydrodynamics in these networks using mathematical and computational modeling. Our results show that the experimental frictional resistances of complex bifurcating microchannels are 25-30% greater than that predicted by Navier-Stokes equations. Experimentally measured velocity profiles indicate that flow distributes equally at a bifurcation regardless of the complexity of the network. Flow division other than bifurcation such as trifurcation or quadruplication can lead to heterogeneities. These findings were verified by the results from the numerical simulations.