ACADEMIC
CARDIOVASCULAR
ENGINEERING
As engineering and medicine converge, researchers are making gains in understanding and treating causes of
cardiovascular disease.
By Santhosh Seshadhri, Technical Services Engineer, ANSYS, Inc.
C
ardiovascular diseases are
the main cause of illness
and premature death in the
European Union (EU). This
class of diseases that affect
the heart and blood vessels
accounts for approximately 40 percent of
deaths, with a combined direct/indirect
economic cost of approximately €196 bil-
lion per year. National health systems are
tasked with providing health services to
an increasingly aging population under
tight fiscal constraints with the addi-
tional challenge of providing personal-
ized healthcare, which tailors treatment
to the individual patient. Because predic-
tive models of cardiovascular disease and
device intervention are expected to yield
substantial health and economic benefits,
research in this area has received increas-
ing attention and funding in recent years.
ANSYS is playing an integral role in
cardiovascular research, collaborating in
EU projects @neurIST, GEMSS, COPHIT,
BloodSim, BREIN and RT3S. MeDDiCA
(Medical Devices Design in Cardiovascular
Applications) is one such multidisci-
plinary and multi-center project funded
integration of observations, theories
and predictions across a range of tempo- Cardiovascular
by the European Community’s Seventh
Framework Programme. This Marie Curie
ral and spatial scales. Interactions can
be investigated in silico (via computer)
diseases
Initial Training Network (dedicated to to bring new insight about phenomena account for
approximately
making research careers more attrac- observed in vitro (in an artificial envi-
tive to young people) involves a number ronment, such as a test tube) and in vivo
of universities across Europe that simu-
late cardiovascular problems of interest
(via medical testing of a living organism)
and to assist in the formulation and vali- 40 percent
with the support of ANSYS engineering
tools. A key goal of the MeDDiCA network
dation of new hypotheses. The nature of
such research is highly multidisciplinary,
of deaths in
is nurturing early-stage Ph.D.’s and post- combining aspects of physics, chem- the European
Union.
doctoral researchers in a variety of disci- istry, mathematics, engineering, com-
plines to help them develop a broad range puter science, biology and medicine. The
of scientific and individual skills. following examples of cardiovascular
State-of-the-art simulations of the research as part of the MeDDiCA project
cardiovascular system are based on the focus on the heart and the blood vessels.
© 2013 ANSYS, INC. ANSYS ADVANTAGE Volume VII | Issue 2 | 2013 48
Leaflets
TOP
VIEW
X
Z } Target planes
Y
Valve holder
Top of the hinge
“flat level”
SIDE
VIEW
X Y
Atrial side
Z
CFD simulation for velocity distributions of leakage jet of bileaflet mechanical heart valve. Results on the left side are negative because the plane is on the
negative side of the y-axis. COURTESY TECHNICAL UNIVERSITY OF CLUJ-NAPOCA, ROMANIA AND ISTITUTO SUPERIORE DI SANITÀ, ITALY.
HEART VALVES
Today, physicians routinely replace damaged or deteriorated
valves in the human heart. Now that the surgical challenges
of the procedure are largely overcome, what remains is a com-
plex engineering challenge: to design a valve prosthesis that
matches the function and performance of a healthy heart valve.
Bileaflet mechanical heart valves (BMHVs) are utilized often
because they do not suffer from durability issues. However, they
must satisfy certain characteristics, including backflow leakage
during valve closure, which is vital for healthy valve dynam-
ics. This backflow helps to prevent areas of stagnant flow and
inhibits microthrombus (blood clot) formation. However, if
the magnitude of shear stress due to the retrograde flow is too
large, it can lead to platelet activation that causes blood clots
Representation of flow field inside lumped parameter to 3-D coupled
or hemolysis (the abnormal breakdown of red blood cells). model of left heart and arterial system at peak systole (heart muscle
To evaluate and optimize the effectiveness of a valve design contraction). This FSI model represents the movement of both the
requires analyzing its flow dynamics. However, it is challeng- ventricular walls and the leaflets to investigate valve–valve interaction.
COURTESY TECHNICAL UNIVERSITY OF CLUJ-NAPOCA, ROMANIA.
ing and time-consuming to obtain detailed measurements solely
using in vitro methods. Computational fluid dynamics (CFD)
allows researchers to study flow dynamics at high resolution,
With surgical challenges largely overcome, what remains is a complex
engineering challenge ― to design a valve prosthesis that matches the
function and performance of a healthy heart valve.
© 2013 ANSYS, INC. ANSYS ADVANTAGE Volume VII | Issue 2 | 2013 49
ACADEMIC
particularly in areas that are not visually cross-bridge cycle and calcium dynam- left-ventricle contraction to a three-
accessible. Validation with experiments ics that give rise to the heart’s beating. dimensional FSI model of a bileaflet
can be necessary to confirm that CFD To specify boundary conditions, the mechanical heart valve, researchers can
results are accurate. MeDDiCA researchers model uses a geometrical multiscale gain insight into the global biomechanics
have compared observations of the leak- approach that couples lumped-parameter of the valve, leading to studies that inves-
age jets for a BMHV obtained in experi- models (of lower dimension) with 3-D tigate possible sources for hemolytic and
ments using particle image velocimetry, models. Some features are modeled cavitation drawbacks.
a method that measures velocities in fluid at a high level of detail (3-D domain), Researchers used coupling between
by taking two images shortly after each while the remaining part of the sys- 0-D models (MATLAB) and 3-D CFD mod-
other, to findings from CFD predictions tem is simplified to a lumped-parameter els to exchange pressure and flow values.
using ANSYS software. Researchers deter- representation This multiscale, multiphysics model
mined that comparison of CFD results to Multiphysics and multiscale modeling enables a more-detailed understand-
experiment is reasonable for the fully allow FSI to be investigated in silico. ing of flow-induced stresses on valve
closed position of the valve. Modeling helps to assess the fluid mechanics based on physiological
Artificial valve function is driven by mechanics of prosthetic heart valves and changes to pressures and flows. It allows
interaction between the blood (fluid) and to improve the design of these devices researchers to study the influence of
the motion of the solid valve structure. by minimizing the potential for blood biological parameters and variables
Simulating the dynamic fluid–structure clots and increasing valve durability. at various scales, and it also provides
interaction (FSI) of heart valves is chal- Implementation of moving mesh algo- insight into underlying biological mech-
lenging, but, over the past decade, simula- rithms in ANSYS CFD software allows anisms that affect functionality of the
tions have become increasingly realistic, researchers to analyze fluid dynam- mitral valve under both healthy and
evolving from conceptual 2-D geome- ics in a more realistic way compared to diseased conditions.
tries to patient-specific 3-D geometries. non-FSI simulations ― for example, to
Research within MeDDiCA employs a provide information about valve leaflet STENTED VESSELS
novel multiscale model of mitral heart motion during opening/closing stages Arterial restenosis is the recurrence of
valve dynamics that incorporates features and to determine dynamic leaflet stresses. narrowing of a blood vessel (usually a cor-
from the cellular level — the actin–myosin By coupling a multiscale model of onary artery) after corrective surgery to
A B C
D E F
Structural mechanics and fluid dynamics can be used to study the formation of thickened artery walls after a stent implant. A) Bare metal stent. B) Finite
element model in initial configuration (7.5 mm length, 2.8 mm diameter cylinder) prior to radial expansion of vessel wall. After expansion and subsequent
release of stent, C) stress contours on inner surface of vessel. D) Use of CFD to analyze coronary stent, implanted in porcine coronary artery and reconstructed
from micro-CT, for identification of regions prone to formation of in-stent restenosis; velocity plotted on transversal plane of stented geometry. E) Comparison
of histology to identical cross-section of numerical domain; traced red line depicts internal vessel structure, which corresponds with numerical model. Arrow
indicates same position in histology F) numerical plot of wall-shear stress. COURTESY UNIVERSITY OF SHEFFIELD UK AND POLITECNICO DI MILANO, ITALY.
© 2013 ANSYS, INC. ANSYS ADVANTAGE Volume VII | Issue 2 | 2013 50
remove or reduce a previous narrowing vascular wall stress. Additionally, com- micro-CT data (use of X-rays to deter-
(stenosis). It is a significant limitation for putational fluid dynamics of the altered mine the 3-D structure). Because corre-
long-term success of endovascular inter- vascular geometry after stent implanta- sponding tissue images were available,
ventions (minimally invasive surgery per- tion provides very detailed information a direct correlation could be made with
formed though major blood vessels) such regarding flow domain, including local structural mechanics and CFD results.
as stent implants, in which a wire mesh variations in wall-shear stress, which is Using computational analyses, MeDDiCA
is guided through the vessel to the loca- impossible to measure experimentally in researchers identified the regions of
tion of a narrowing and expanded once complex geometries and in vivo. the stented artery that were subject
in place to improve blood flow. In fact, To examine structural and fluid to higher compressive stress and to a
despite improved success rates of stent dynamic changes following stent reduction in mean fluid wall-shear
implantation to relieve a thickened artery implantation along with their possi- stress areas that may be more prone to
wall (an occlusive atherosclerotic lesion), ble association with biological out- formation of restenosis. By using stent
acute inflammation of the vessel wall and comes, researchers simulated a porcine geometry derived from in vivo data of
resultant in-stent restenosis still occur in right coronary artery using the in vivo an implanted stent, the availability of
20 percent of all bare-metal stent cases. stent geometry reconstructed from corresponding tissue data allows the
The severity of restenosis is associ-
ated with both initial injury of the arterial
wall during stent deployment and subse-
quent biological response over time. Local
fluid dynamics might affect the migration
pattern of smooth muscle cells and endo-
thelial cells that line the heart and blood
vessels during initial healing stages, so
wall-shear stress due to blood flow may
be a potential accelerator. The interaction
between the stent and the vessel is com-
plex; it is challenging to study this proc-
ess in vivo. Investigating the structural
mechanics and fluid dynamics of stented
vessels can give insight into the processes
governing initiation and progression of
restenosis. It also can provide guidance
for optimizing stent design.
Placement of a stent into the artery
changes both the structural and the
hemodynamic environment of the vessel.
Experimental techniques can be applied
to study stent deformation in vitro, using
stereo-optical methods to measure 3-D
stent geometry. However, detailed exper-
imental measurement of stress dis-
tribution within the vessel wall is not
possible, so a finite element (or structural
mechanics) model (FEM) is a powerful
tool for studying changes in the artery’s
A multiscale model of the heart is used to compute left ventricular pressure, which, in turn, is
mechanical environment following stent employed as a boundary condition for ANSYS CFX software using an immersed boundary approach to
implantation. Corresponding images of simulate the dynamics of the mitral valve. COURTESY UNIVERSITY COLLEGE LONDON.
the tissue structure allow researchers to
correlate the occurrence of restenosis and
CFD of altered vascular geometry after stent implantation
provides detailed information regarding the flow domain,
which is impossible to measure experimentally.
© 2013 ANSYS, INC. ANSYS ADVANTAGE Volume VII | Issue 2 | 2013 51
ACADEMIC
Radial artery
mechanobiology of stent implantation
to be explored in detail. Further studies
of the relationship between localization
of vascular wall stress, fluid dynamic
Cephalic vein
parameters and in-stent restenosis will
provide a deeper understanding of the
phenomenon, leading to the identifica-
tion of new design solutions and helping
to guide developments in clinical tech-
niques to unblock arteries.
ACCESSING THE CIRCULATORY
SYSTEM FOR HEMODIALYSIS
Because there is a lack of kidney donors, Balloon
the majority of end-stage renal disease
patients need to be treated with hemo-
dialysis. This treatment uses an external Artery
machine to perform some kidney func- Stent
tions by circulating the patient’s blood
through it; therefore, it requires creat- A
ing a permanent vascular access, typi-
cally obtained by connecting a vein onto
an artery to form an arteriovenous fis-
tula (AVF) into which a catheter can be
inserted to connect to the hemodialy-
sis machine. The hemodynamics inside
the AVF is likely to induce several com-
plications, but clinical tests are unable
to determine which sites are more prone B
to cardiovascular problems. Modeling
can help to answer clinical questions
about local hemodynamic and structural
stresses and their relationship with the
onset of complications from AVF forma-
tion. The treatment of these complica-
tions can also be simulated.
MeDDiCA researchers have employed C
ANSYS fluid dynamics and structural
mechanics software to study fluid–struc-
Geometry of patient-specific arteriovenous fistula; A) magnification shows ANSYS simulation of stent
ture interactions within a patient-specific deployment following balloon angioplasty. B) Velocity streamlines at peak systole in stenosed patient-
AVF that develops an arterial stenosis. specific case and C) after endovascular treatment by balloon angioplasty. Notice that the treatment
The results highlight the regions of the locally reduces maximum velocity value at the stenosis, but hardly impacts blood flow distribution farther
downstream. COURTESY UTC-COMPIÈGNE, FRANCE.
vasculature that are more prone to com-
plications due to altered hemodynamics
and wall mechanics. The team also has
numerically simulated treating the ste-
nosis with two therapies: balloon angio-
plasty, with and without subsequent SIMULATION DELIVERS NEW to model the biological interaction of med-
stenting. Comparing the results of the MEDICAL INSIGHT ical devices with the vessel wall, espe-
FSI simulations before and after treat- Modeling and simulation are well-estab- cially as the disease evolves. Researchers
ment, the research team identified the lished practices in the aeronautics and car should not think of these as merely bio-
influence of the stenosis on blood flow manufacturing industries; the methods logical problems, but rather as mechano-
and wall stresses. Both treatments are are an integral part of the design process. biological problems — the mechanical
equally effective in restoring the heart’s Similarly, these techniques are utilized environment plays a governing role for
work load, but stenting may help to pre- to guide the design of medical devices, the biology. Mechanical analyses play
vent restenosis in the months following such as stents and artificial heart valves, a vital role in understanding biology
treatment by preventing contraction of by simulating their mechanical interac- and predicting biological processes.
the vessel. tion with the vessel wall and blood flow State-of-the-art simulation models
dynamics. It is, however, more challenging integrate observations, theories and
© 2013 ANSYS, INC. ANSYS ADVANTAGE Volume VII | Issue 2 | 2013 52
These are not merely biological problems, they
are mechanobiological problems — the mechanical
environment plays a governing role for the biology.
predictions across a range of temporal Author’s Note References
and spatial scales, scientific disciplines Contributors to this article include: Paul Watton, MeDDiCA: www.meddica.eu
and anatomical subsystems. Models that University of Oxford, U.K.; Justin Penrose, ANSYS; @neurIST: www.aneurist.org
enable the cardiovascular system and its Benjamin Bhattacharya Gosh and Vanessa Diaz, GEMSS (IST-2001-37153): www.gemss.de
interactions to be investigated in silico can University College London, U.K.; Brandis Keller, COPHIT (IST-1999-14004)
shed new light on phenomena observed Gabriele Dubini and Francesco Migliavacca, BloodSim (Esprit 28350)
in vitro and in vivo, assisting in the for- Politecnico di Milano, Italy; Claudia Maria BREIN
mulation and validation of new hypoth- Amatruda, Iwona Zwierzak and Andrew Narracott, RT3S: www.rt3s.eu
eses and integration of novel, improved University of Sheffield, U.K.; Iolanda Decorato and
clinical tools to guide diagnosis and Anne-Virginie Salsac, Université de Technologie
optimize personalized treatment. ANSYS de Compiègne, France; Li Yan, Rajeev Kumar
software is already playing a vital role in Nallamothu and Dan Rafiroiu, Technical University
such models and will play an increasingly of Cluj-Napoca, Romania; Guanglei Wang Giuseppe
important role in the future. D’Avenio and Mauro Grigioni, Istituto Superiore di
Sanità, Italy.
Automotive Simulation
World Congress
Frankfurt am Main, Germany
29 - 30 October 2013
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© 2013 ANSYS, INC. ANSYS ADVANTAGE Volume VII | Issue 2 | 2013 53
