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Quantitative Assessment of Turbulence and Flow Eccentricity in an Aortic Coarctation: Impact of Virtual Interventions

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Abstract

Turbulence and flow eccentricity can be measured by magnetic resonance imaging (MRI) and may play an important role in the pathogenesis of numerous cardiovascular diseases. In the present study, we propose quantitative techniques to assess turbulent kinetic energy (TKE) and flow eccentricity that could assist in the evaluation and treatment of stenotic severities. These hemodynamic parameters were studied in a pre-treated aortic coarctation (CoA) and after several virtual interventions using computational fluid dynamics (CFD), to demonstrate the effect of different dilatation options on the flow field. Patient-specific geometry and flow conditions were derived from MRI data. The unsteady pulsatile flow was resolved by large eddy simulation including non-Newtonian blood rheology. Results showed an inverse asymptotic relationship between the total amount of TKE and degree of dilatation of the stenosis, where turbulent flow proximal the constriction limits the possible improvement by treating the CoA alone. Spatiotemporal maps of TKE and flow eccentricity could be linked to the characteristics of the jet, where improved flow conditions were favored by an eccentric dilatation of the CoA. By including these flow markers into a combined MRI–CFD intervention framework, CoA therapy has not only the possibility to produce predictions via simulation, but can also be validated pre- and immediate post treatment, as well as during follow-up studies.

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Acknowledgments

This research was supported by grants from the Swedish Research Council and the Center for Industrial Information Technology (CENIIT). We also like to acknowledge the Center of Medical Image Science and Visualization (CMIV, http://www.cmiv.liu.se/) for providing necessary MRI data and the National Supercomputer Centre (NSC) for the computational resources via grants from the Swedish National Infrastructure for Computing (SNIC).

Conflict of interest

M. Karlsson received non-financial support from the Swedish National Infrastructure for Computing, T. Ebbers grants from the Center for Industrial Information Technology at Linköping University, the Swedish Research Council and the Swedish e-Science Research Center.

Statement of human studies

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Statement of animal studies

No animal studies were carried out by the authors for this article.

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Correspondence to Magnus Andersson.

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Associate Editor Pedro del Nido oversaw the review of this article.

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Andersson, M., Lantz, J., Ebbers, T. et al. Quantitative Assessment of Turbulence and Flow Eccentricity in an Aortic Coarctation: Impact of Virtual Interventions. Cardiovasc Eng Tech 6, 281–293 (2015) doi:10.1007/s13239-015-0218-x

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Keywords

  • Computational fluid dynamics
  • Large eddy simulation
  • Turbulent kinetic energy
  • Flow displacement
  • Non-Newtonian
  • Carreau
  • Virtual treatment
  • Magnetic resonance imaging