Prosthetic valve thrombosis (PVT) is a serious complication affecting prosthetic heart valves. The transvalvular mean pressure gradient (MPG) derived by Doppler echocardiography is a crucial index to diagnose PVT but may result in false negatives mainly in case of bileaflet mechanical valves (BMVs) in mitral position. This may happen because MPG estimation relies on simplifying assumptions on the transvalvular fluid dynamics or because Doppler examination is manual and operator dependent. A deeper understanding of these issues may allow for improving PVT diagnosis and management. To this aim, we used in vitro and fluid–structure interaction (FSI) modeling to simulate the function of a real mitral BMV in different configurations: normally functioning and stenotic with symmetric and completely asymmetric leaflet opening, respectively. In each condition, the MPG was measured in vitro, computed directly from FSI simulations and derived from the corresponding velocity field through a Doppler-like postprocessing approach. Following verification versus in vitro data, MPG computational data were analyzed to test their dependency on the severity of fluid-dynamic derangements and on the measurement site. Computed MPG clearly discriminated between normally functioning and stenotic configurations. They did not depend markedly on the site of measurement, yet differences below 3 mmHg were found between MPG values at the central and lateral orifices of the BMV. This evidence suggests a mild uncertainty of the Doppler-based evaluation of the MPG due to probe positioning, which yet may lead to false negatives when analyzing subjects with almost normal MPG.

References

References
1.
Caceres-Loriga
,
F. M.
,
Pérez-Lopez
,
H.
,
Santos-Gracia
,
J.
, and
Morlans-Hernandez
,
K.
,
2006
, “
Prosthetic Heart Valve Thrombosis: Pathogenesis, Diagnosis and Management
,”
Int. J. Cardiol.
,
110
, pp.
1
6
.
2.
Roudaut
,
R.
,
Serri
,
K.
, and
Lafitte
,
S.
,
2007
, “
Thrombosis of Prosthetic Heart Valves: Diagnosis and Therapeutic Considerations
,”
Heart
,
93
(
1
), pp.
137
142
.
3.
Zoghbi
,
W. A.
,
Chambers
,
J. B.
,
Dumesnil
,
J. G.
,
Foster
,
E.
,
Gottdiener
,
J. S.
,
Grayburn
,
P. A.
,
Khandheria
,
B. K.
,
Levine
,
R. A.
,
Marx
,
G. R.
,
Miller
,
F. A.
,
Nakatani
,
S.
,
Quinones
,
M. A.
,
Rakowski
,
H.
,
Rodriguez
,
L. L.
,
Swaminathan
,
M.
,
Waggoner
,
A. D.
,
Weissman
,
N. J.
, and
Zabalgoitia
,
M.
,
2009
, “
Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound. A Report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, Developed in Conjunction
,”
J. Am. Soc. Echocardiography
,
22
(
9
), pp.
975
1014
.
4.
Montorsi
,
P.
,
Cavoretto
,
D.
,
Alimento
,
M.
,
Muratori
,
M.
, and
Pepi
,
M.
,
2003
, “
Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?
,”
Circulation
,
108
(
10
), pp.
II79
II84
.
5.
Muratori
,
M.
,
Montorsi
,
P.
,
Teruzzi
,
G.
,
Celeste
,
F.
,
Doria
,
E.
,
Alamanni
,
F.
, and
Pepi
,
M.
,
2006
, “
Feasibility and Diagnostic Accuracy of Quantitative Assessment of Mechanical Prostheses Leaflet Motion by Transthoracic and Transesophageal Echocardiography in Suspected Prosthetic Valve Dysfunction
,”
Am. J. Cardiol.
,
97
(
1
), pp.
94
100
.
6.
Cheng
,
R.
,
Lai
,
Y. G.
, and
Chandran
,
K. B.
,
2004
, “
Three-Dimensional Fluid-Structural Interaction Simulation of Bileaflet Mechanical Heart Valve Flow Dynamics
,”
Ann. Biomed. Eng.
,
32
(
11
), pp.
1471
1483
.
7.
Nobili
,
M.
,
Morbiducci
,
U.
,
Ponzini
,
R.
,
Del Gaudio
,
C.
,
Balducci
,
A.
,
Grigioni
,
M.
,
Maria Montevecchi
,
F.
, and
Redaelli
,
A.
,
2008
, “
Numerical Simulation of the Dynamics of a Bileaflet Prosthetic Heart Valve Using a Fluid-Structure Interaction Approach
,”
J. Biomech.
,
41
(
11
), pp.
2539
2550
.
8.
Nobili
,
M.
,
Passoni
,
G.
, and
Redaelli
,
A.
,
2007
, “
Two Fluid-Structure Approaches for 3D Simulation of St. Jude Medical Bileaflet Valve Opening
,”
J. Appl. Biomater. Biomech.
,
5
(
1
), pp.
49
59
.https://journals.sagepub.com/doi/abs/10.1177/228080000700500107
9.
Redaelli
,
A.
,
Bothorel
,
H.
,
Votta
,
E.
,
Soncini
,
M.
,
Morbiducci
,
U.
,
Del Gaudio
,
C.
,
Balducci
,
A.
, and
Grigioni
,
M.
,
2004
, “
3-D Simulation of the St. Jude Medical Bileaflet Valve Opening Process: Fluid-Structure Interaction Study and Experimental Validation
,”
J. Heart Valve Dis.
,
13
(
5
), pp.
804
813
.https://www.ncbi.nlm.nih.gov/pubmed/15473484
10.
Souli
,
M.
,
Ouahsine
,
A.
, and
Lewin
,
L.
,
2000
, “
ALE Formulation for Fluid-Structure Interaction Problems
,”
Comput. Methods Appl. Mech. Eng.
,
190
(
5–7
), pp.
659
675
.
11.
Ge
,
L.
, and
Sotiropoulos
,
F.
,
2007
, “
A Numerical Method for Solving the 3D Unsteady Incompressible Navier-Stokes Equations in Curvilinear Domains With Complex Immersed Boundaries
,”
J. Comput. Phys.
,
225
(
2
), pp.
1782
1809
.
12.
Gilmanov
,
A.
, and
Sotiropoulos
,
F.
,
2005
, “
A Hybrid Cartesian/Immersed Boundary Method for Simulating Flows With 3D, Geometrically Complex, Moving Bodies
,”
J. Comput. Phys.
,
207
(
2
), pp.
457
492
.
13.
Peskin
,
C. S.
,
1972
, “
Flow Patterns Around Heart Valves: A Numerical Method
,”
J. Comput. Phys.
,
10
(
2
), pp.
252
271
.
14.
Annerel
,
S.
,
Claessens
,
T.
,
Degroote
,
J.
,
Segers
,
P.
, and
Vierendeels
,
J.
,
2014
, “
Validation of a Numerical FSI Simulation of an Aortic BMHV by In Vitro PIV Experiments
,”
Med. Eng. Phys.
,
36
(
8
), pp.
1014
1023
.
15.
Annerel
,
S.
,
Degroote
,
J.
,
Claessens
,
T.
,
Segers
,
P.
,
Verdonck
,
P.
, and
Vierendeels
,
J.
,
2012
, “
The Upstream Boundary Condition Influences the Leaflet Opening Dynamics in the Numerical FSI Simulation of an Aortic BMHV
,”
Int. J. Numer. Method. Biomed. Eng.
,
28
(
6–7
), pp.
745
760
.
16.
Borazjani
,
I.
,
Ge
,
L.
, and
Sotiropoulos
,
F.
,
2010
, “
High-Resolution Fluid-Structure Interaction Simulations of Flow Through a bi-Leaflet Mechanical Heart Valve in an Anatomic Aorta
,”
Ann. Biomed. Eng.
,
38
(
2
), pp.
326
344
.
17.
De Beule
,
M.
,
Mortier
,
P.
,
Carlier
,
S. G.
,
Verhegghe
,
B.
,
Van Impe
,
R.
, and
Verdonck
,
P.
,
2008
, “
Realistic Finite Element-Based Stent Design: The Impact of Balloon Folding
,”
J. Biomech.
,
41
(
2
), pp.
383
389
.
18.
Su
,
B.
,
Kabinejadian
,
F.
,
Phang
,
H. Q.
,
Kumar
,
G. P.
,
Cui
,
F.
,
Kim
,
S.
,
Tan
,
R. S.
,
Hon
,
J. K. F.
,
Allen
,
J. C.
,
Leo
,
H. L.
, and
Zhong
,
L.
,
2015
, “
Numerical Modeling of Intraventricular Flow During Diastole After Implantation of BMHV
,”
PLoS One
,
10
(
5
), p.
e0126315
.
19.
Votta
,
E.
,
Le
,
T. B.
,
Stevanella
,
M.
,
Fusini
,
L.
,
Caiani
,
E. G.
,
Redaelli
,
A.
, and
Sotiropoulos
,
F.
,
2013
, “
Toward Patient-Specific Simulations of Cardiac Valves: State-of-the-Art and Future Directions
,”
J. Biomech.
,
46
(
2
), pp.
217
228
.
20.
Vismara
,
R.
,
Pavesi
,
A.
,
Votta
,
E.
,
Taramasso
,
M.
,
Maisano
,
F.
, and
Fiore
,
G. B.
,
2011
, “
A Pulsatile Simulator for the In Vitro Analysis of the Mitral Valve With Tri-Axial Papillary Muscle Displacement
,”
Int. J. Artif. Organs
,
34
(
4
), pp.
383
391
.
21.
Quaini
,
A.
,
Canic
,
S.
,
Glowinski
,
R.
,
Igo
,
S.
,
Hartley
,
C. J.
,
Zoghbi
,
W.
, and
Little
,
S.
,
2012
, “
Validation of a 3D Computational Fluid-Structure Interaction Model Simulating Flow Through an Elastic Aperture
,”
J. Biomech.
,
45
(
2
), pp.
310
318
.
22.
ANSYS,
2012
, “ANSYS FLUENT User's Guide Release 14.5,”
ANSYS
,
Canonsburg, PA
.
23.
Yoganathan
,
A. P.
,
Chandran
,
K. B.
, and
Sotiropoulos
,
F.
,
2005
, “
Flow in Prosthetic Heart Valves: State-of-the-Art and Future Directions
,”
Ann. Biomed. Eng.
,
33
(
12
), pp.
1689
1694
.
24.
Montorsi
,
P.
,
Cavoretto
,
D.
,
Parolari
,
A.
,
Muratori
,
M.
,
Alimento
,
M.
, and
Pepi
,
M.
,
2002
, “
Diagnosing Prosthetic Mitral Valve Thrombosis and the Effect of the Type of Prosthesis
,”
Am. J. Cardiol.
,
90
(
1
), pp.
73
76
.
25.
Erdil
,
N.
,
Cetin
,
L.
,
Demirkilic
,
U.
,
Tatar
,
H.
, and
Uzun
,
M.
,
2003
, “
Experience of the Small Size (25 mm) Sorin Bicarbon Bileaflet Prosthetic Valve in Patients With Small Mitral Annuli
,”
J. Card. Surg.
,
18
(
6
), pp.
532
538
.
26.
Horstkotte
,
D.
, and
Burckhardt
,
D.
,
1995
, “
Prosthetic Valve Thormbosis
,”
J. Heart Valve Dis.
,
4
(
2
), pp.
141
153
.
27.
Montorsi
,
P.
,
De Bernardi
,
F.
,
Muratori
,
M.
,
Cavoretto
,
D.
, and
Pepi
,
M.
,
2000
, “
Role of Cine-Fluoroscopy, Transthoracic, and Transesophageal Echocardiography in Patients With Suspected Prosthetic Heart Valve Thrombosis
,”
Am. J. Cardiol.
,
85
(
1
), pp.
58
64
.
28.
Evin
,
M.
,
Guivier-Curien
,
C.
,
Pibarot
,
P.
,
Kadem
,
L.
, and
Rieu
,
R.
,
2016
, “
Are the Current Doppler Echocardiography Criteria Able to Discriminate Mitral Bileaflet Mechanical Heart Valve Malfunction? An In Vivo Study
,”
Artif. Organs
,
40
(
5
), pp.
E52
E60
.
29.
Annerel
,
S.
,
Degroote
,
J.
,
Claessens
,
T.
,
Dahl
,
S. K.
,
Skallerud
,
B.
,
Hellevik
,
L. R.
,
van Ransbeeck
,
P.
,
Segers
,
P.
,
Verdonck
,
P.
, and
Vierendeels
,
J.
,
2012
, “
A Fast Strong Coupling Algorithm for the Partitioned Fluid-Structure Interaction Simulation of BMHVs
,”
Comput. Methods Biomech. Biomed. Eng.
,
15
(
12
), pp.
1281
1312
.
You do not currently have access to this content.