Including coronary ostia in patient-specific 3D models of the whole aortic valve apparatus, derived from TEE, for biomechanical simulations

There is an increasing interest in the numerical modeling and simulation of the aortic valve behavior and functioning, on the different stages involved as healthy, stenotic or replacement procedure. As echocardiography is a ubiquitous and economic modality, the geometric model construction based on such images is therefore of major interest. In this paper, a new patient-specific approach for modeling the complete aortic valve apparatus - derived from parameters extracted from 3D transesophageal echocardiographs -that includes for the first time the left ventricle outflow tract and the coronary ostia, both crucial for proper assessment of valve biomechanical behavior, is presented. An innovative method for characterizing coronary pressures from patient-specific clinical data, to be used as boundary conditions for the numerical simulation is also described. Results from experiments were presented to evaluate the novel aspects of the model, that permits to compare the existing models (non-coronary model NCM) and the proposed new coronary model (CM). Variations of displacement and stress on each leaflet prove the need of considering leaflet asymmetry. Computed quantities in the results sections are within the range of physiological data. This permits to conclude that the proposed aortic valve apparatus model of the aortic valve apparatus improves on previous ones by considering this extremely complex structure in greater detail.