Sinus Hemodynamics Variation with Tilted Transcatheter Aortic Valve Deployments
Leaflet thrombosis is a complication associated with transcatheter aortic valve (TAV) replacement (TAVR) correlated with sinus flow stasis. Sinus hemodynamics are important because they dictate shear stress and washout necessary to avoid stasis on TAV leaflets. Sinus flow is controlled by TAV axial...
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| Veröffentlicht in: | Annals of biomedical engineering 2019-01, Vol.47 (1), p.75-84 |
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| creator | Hatoum, Hoda Dollery, Jennifer Lilly, Scott M. Crestanello, Juan A. Dasi, Lakshmi Prasad |
| description | Leaflet thrombosis is a complication associated with transcatheter aortic valve (TAV) replacement (TAVR) correlated with sinus flow stasis. Sinus hemodynamics are important because they dictate shear stress and washout necessary to avoid stasis on TAV leaflets. Sinus flow is controlled by TAV axial deployment position but little is known regarding TAV axis misalignment effect. This study aims to elucidate TAV angular misalignment with respect to aortic root axis effect on sinus flow stasis potentially leading to leaflet thrombosis. Sinus hemodynamics were assessed
in vitro
using particle-image velocimetry in three different angular misalignments with respect to aorta axis: untilted, tilted away from the sinus and tilted towards sinus. A 26 mm Edwards SAPIEN3 was implanted in a 3D printed model of an anatomically realistic aortic root. TAV hemodynamics, sinus vortex tracking, leaflet shear stress probability density functions, and sinus blood time to washout were calculated. While pressure gradients differed insignificantly, blood velocity and vorticity decreased significantly in both tilted cases sinuses. Shear stress probability near the leaflet decreases with tilt indicating stasis. TAV tilted away from the sinus is the most unfavorable scenario with poor washout. TAV axial misalignment adds to factors list that could influence leaflet thrombosis risk through modifying sinus hemodynamics and washout. |
| doi_str_mv | 10.1007/s10439-018-02120-0 |
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in vitro
using particle-image velocimetry in three different angular misalignments with respect to aorta axis: untilted, tilted away from the sinus and tilted towards sinus. A 26 mm Edwards SAPIEN3 was implanted in a 3D printed model of an anatomically realistic aortic root. TAV hemodynamics, sinus vortex tracking, leaflet shear stress probability density functions, and sinus blood time to washout were calculated. While pressure gradients differed insignificantly, blood velocity and vorticity decreased significantly in both tilted cases sinuses. Shear stress probability near the leaflet decreases with tilt indicating stasis. TAV tilted away from the sinus is the most unfavorable scenario with poor washout. TAV axial misalignment adds to factors list that could influence leaflet thrombosis risk through modifying sinus hemodynamics and washout.</description><identifier>ISSN: 0090-6964</identifier><identifier>ISSN: 1573-9686</identifier><identifier>EISSN: 1573-9686</identifier><identifier>DOI: 10.1007/s10439-018-02120-0</identifier><identifier>PMID: 30151733</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aorta ; Aortic valve ; Biochemistry ; Biological and Medical Physics ; Biomedical and Life Sciences ; Biomedical Engineering and Bioengineering ; Biomedicine ; Biophysics ; Blood ; Blood pressure ; Circulatory system ; Classical Mechanics ; Computational fluid dynamics ; Female ; Hemodynamics ; Humans ; Male ; Mathematical analysis ; Misalignment ; Models, Cardiovascular ; Pressure gradients ; Printing, Three-Dimensional ; Probability density functions ; Shear stress ; Sinus of Valsalva - physiopathology ; Sinuses ; Three dimensional models ; Three dimensional printing ; Thromboembolism ; Thrombosis ; Transcatheter Aortic Valve Replacement ; Velocimetry ; Velocity measurement ; Vorticity</subject><ispartof>Annals of biomedical engineering, 2019-01, Vol.47 (1), p.75-84</ispartof><rights>Biomedical Engineering Society 2018</rights><rights>Annals of Biomedical Engineering is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-19599815a6b050357d6f2cd037524676c440eba2291f3484adbfd58c8c5619c33</citedby><cites>FETCH-LOGICAL-c474t-19599815a6b050357d6f2cd037524676c440eba2291f3484adbfd58c8c5619c33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10439-018-02120-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10439-018-02120-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30151733$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hatoum, Hoda</creatorcontrib><creatorcontrib>Dollery, Jennifer</creatorcontrib><creatorcontrib>Lilly, Scott M.</creatorcontrib><creatorcontrib>Crestanello, Juan A.</creatorcontrib><creatorcontrib>Dasi, Lakshmi Prasad</creatorcontrib><title>Sinus Hemodynamics Variation with Tilted Transcatheter Aortic Valve Deployments</title><title>Annals of biomedical engineering</title><addtitle>Ann Biomed Eng</addtitle><addtitle>Ann Biomed Eng</addtitle><description>Leaflet thrombosis is a complication associated with transcatheter aortic valve (TAV) replacement (TAVR) correlated with sinus flow stasis. Sinus hemodynamics are important because they dictate shear stress and washout necessary to avoid stasis on TAV leaflets. Sinus flow is controlled by TAV axial deployment position but little is known regarding TAV axis misalignment effect. This study aims to elucidate TAV angular misalignment with respect to aortic root axis effect on sinus flow stasis potentially leading to leaflet thrombosis. Sinus hemodynamics were assessed
in vitro
using particle-image velocimetry in three different angular misalignments with respect to aorta axis: untilted, tilted away from the sinus and tilted towards sinus. A 26 mm Edwards SAPIEN3 was implanted in a 3D printed model of an anatomically realistic aortic root. TAV hemodynamics, sinus vortex tracking, leaflet shear stress probability density functions, and sinus blood time to washout were calculated. While pressure gradients differed insignificantly, blood velocity and vorticity decreased significantly in both tilted cases sinuses. Shear stress probability near the leaflet decreases with tilt indicating stasis. TAV tilted away from the sinus is the most unfavorable scenario with poor washout. TAV axial misalignment adds to factors list that could influence leaflet thrombosis risk through modifying sinus hemodynamics and washout.</description><subject>Aorta</subject><subject>Aortic valve</subject><subject>Biochemistry</subject><subject>Biological and Medical Physics</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedical Engineering and Bioengineering</subject><subject>Biomedicine</subject><subject>Biophysics</subject><subject>Blood</subject><subject>Blood pressure</subject><subject>Circulatory system</subject><subject>Classical Mechanics</subject><subject>Computational fluid dynamics</subject><subject>Female</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Male</subject><subject>Mathematical analysis</subject><subject>Misalignment</subject><subject>Models, Cardiovascular</subject><subject>Pressure gradients</subject><subject>Printing, Three-Dimensional</subject><subject>Probability density functions</subject><subject>Shear stress</subject><subject>Sinus of Valsalva - physiopathology</subject><subject>Sinuses</subject><subject>Three dimensional models</subject><subject>Three dimensional printing</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><subject>Transcatheter Aortic Valve Replacement</subject><subject>Velocimetry</subject><subject>Velocity measurement</subject><subject>Vorticity</subject><issn>0090-6964</issn><issn>1573-9686</issn><issn>1573-9686</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kT1vFDEQhi0EIpeEP0CBVqKh2TD-XjeRopAPpEgpuNBaPq8352jXPmxv0P17HC4JkIJqinnmnRk9CL3HcIQB5OeMgVHVAu5aIJhAC6_QAnNJWyU68RotABS0Qgm2h_ZzvgPAuKP8LdqjgDmWlC7Q9Tcf5txcuin222Amb3Pz3SRvio-h-enLuln6sbi-WSYTsjVl7YpLzUlMxduKjveu-eI2Y9xOLpR8iN4MZszu3WM9QDfnZ8vTy_bq-uLr6clVa5lkpcWKK9VhbsQKOFAuezEQ2wOVnDAhhWUM3MoQovBAWcdMvxp63tnOcoGVpfQAHe9yN_Nqcr2tu5MZ9Sb5yaStjsbrfzvBr_VtvNeCSsGA1IBPjwEp_phdLnry2bpxNMHFOWsCitdbuBQV_fgCvYtzCvW9B4oqDIKySpEdZVPMObnh-RgM-sGX3vnS1Zf-7UtDHfrw9xvPI0-CKkB3QK6tcOvSn93_if0F_E-gcg</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Hatoum, Hoda</creator><creator>Dollery, Jennifer</creator><creator>Lilly, Scott M.</creator><creator>Crestanello, Juan A.</creator><creator>Dasi, Lakshmi Prasad</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QF</scope><scope>7QO</scope><scope>7QQ</scope><scope>7SC</scope><scope>7SE</scope><scope>7SP</scope><scope>7SR</scope><scope>7TA</scope><scope>7TB</scope><scope>7U5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8BQ</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>F28</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H8D</scope><scope>H8G</scope><scope>HCIFZ</scope><scope>JG9</scope><scope>JQ2</scope><scope>K9.</scope><scope>KR7</scope><scope>L6V</scope><scope>L7M</scope><scope>LK8</scope><scope>L~C</scope><scope>L~D</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>M7S</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190101</creationdate><title>Sinus Hemodynamics Variation with Tilted Transcatheter Aortic Valve Deployments</title><author>Hatoum, Hoda ; Dollery, Jennifer ; Lilly, Scott M. ; Crestanello, Juan A. ; Dasi, Lakshmi Prasad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-19599815a6b050357d6f2cd037524676c440eba2291f3484adbfd58c8c5619c33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aorta</topic><topic>Aortic valve</topic><topic>Biochemistry</topic><topic>Biological and Medical Physics</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedical Engineering and Bioengineering</topic><topic>Biomedicine</topic><topic>Biophysics</topic><topic>Blood</topic><topic>Blood pressure</topic><topic>Circulatory system</topic><topic>Classical Mechanics</topic><topic>Computational fluid dynamics</topic><topic>Female</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Male</topic><topic>Mathematical analysis</topic><topic>Misalignment</topic><topic>Models, Cardiovascular</topic><topic>Pressure gradients</topic><topic>Printing, Three-Dimensional</topic><topic>Probability density functions</topic><topic>Shear stress</topic><topic>Sinus of Valsalva - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of biomedical engineering</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hatoum, Hoda</au><au>Dollery, Jennifer</au><au>Lilly, Scott M.</au><au>Crestanello, Juan A.</au><au>Dasi, Lakshmi Prasad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sinus Hemodynamics Variation with Tilted Transcatheter Aortic Valve Deployments</atitle><jtitle>Annals of biomedical engineering</jtitle><stitle>Ann Biomed Eng</stitle><addtitle>Ann Biomed Eng</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>47</volume><issue>1</issue><spage>75</spage><epage>84</epage><pages>75-84</pages><issn>0090-6964</issn><issn>1573-9686</issn><eissn>1573-9686</eissn><abstract>Leaflet thrombosis is a complication associated with transcatheter aortic valve (TAV) replacement (TAVR) correlated with sinus flow stasis. Sinus hemodynamics are important because they dictate shear stress and washout necessary to avoid stasis on TAV leaflets. Sinus flow is controlled by TAV axial deployment position but little is known regarding TAV axis misalignment effect. This study aims to elucidate TAV angular misalignment with respect to aortic root axis effect on sinus flow stasis potentially leading to leaflet thrombosis. Sinus hemodynamics were assessed
in vitro
using particle-image velocimetry in three different angular misalignments with respect to aorta axis: untilted, tilted away from the sinus and tilted towards sinus. A 26 mm Edwards SAPIEN3 was implanted in a 3D printed model of an anatomically realistic aortic root. TAV hemodynamics, sinus vortex tracking, leaflet shear stress probability density functions, and sinus blood time to washout were calculated. While pressure gradients differed insignificantly, blood velocity and vorticity decreased significantly in both tilted cases sinuses. Shear stress probability near the leaflet decreases with tilt indicating stasis. TAV tilted away from the sinus is the most unfavorable scenario with poor washout. TAV axial misalignment adds to factors list that could influence leaflet thrombosis risk through modifying sinus hemodynamics and washout.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30151733</pmid><doi>10.1007/s10439-018-02120-0</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aorta Aortic valve Biochemistry Biological and Medical Physics Biomedical and Life Sciences Biomedical Engineering and Bioengineering Biomedicine Biophysics Blood Blood pressure Circulatory system Classical Mechanics Computational fluid dynamics Female Hemodynamics Humans Male Mathematical analysis Misalignment Models, Cardiovascular Pressure gradients Printing, Three-Dimensional Probability density functions Shear stress Sinus of Valsalva - physiopathology Sinuses Three dimensional models Three dimensional printing Thromboembolism Thrombosis Transcatheter Aortic Valve Replacement Velocimetry Velocity measurement Vorticity |
| title | Sinus Hemodynamics Variation with Tilted Transcatheter Aortic Valve Deployments |
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