Abstract

Pulmonary valves do not display a fibrous annulus as do other valves in the heart; thus, pulmonary valves can be implanted at multiple orientations and locations within the right ventricular outflow tract (RVOT). This gives surgeons more freedom when implanting the valve but it also results in uncertainties regarding placement, particularly with respect to valve orientation. We investigate the pulmonary artery hemodynamics and valve leaflet dynamics of pulmonary valve replacements (PVRs) with various orientations via fluid–structure interaction (FSI) models. A canonical model of the branching pulmonary artery is coupled with a dynamic model of a pulmonary valve, and from this we quantify the effect of valve implant orientation on the postvalvular hemodynamics and leaflet dynamics. Metrics such as turbulent kinetic energy (TKE), branch pulmonary artery flow distributions, projected valve opening area (PVOA), and pressure differentials across the valve leaflets are analyzed. Our results indicate that off-axis orientation results in higher pressure forces and flow and energy asymmetry, which potentially have implications for long-term durability of implanted bioprosthetic valves.

References

1.
Kogon
,
B. E.
,
Rosenblum
,
J. M.
, and
Mori
,
M.
,
2015
, “
Current Readings: Issues Surrounding Pulmonary Valve Replacement in Repaired Tetralogy of Fallot
,”
Semin. Thorac. Cardiovasc. Surg.
,
27
, pp.
57
64
.10.1053/j.semtcvs.2015.02.010
2.
Nomoto
,
R.
,
Sleeper
,
L. A.
,
Borisuk
,
M. J.
,
Bergerson
,
L.
,
Pigula
,
F. A.
,
Emani
,
S.
,
Fynn-Thompson
,
F.
,
Mayer
,
J. E.
,
del Nido
,
P. J.
, and
Baird
,
C. W.
,
2016
, “
Outcome and Performance of Bioprosthetic Pulmonary Valve Replacement in Patients With Congenital Heart Disease
,”
J. Thorac. Cardiovasc. Surg.
,
152
(
5
), pp.
1333
1342.e3
.10.1016/j.jtcvs.2016.06.064
3.
Egbe
,
A. C.
,
Vallabhajosyula
,
S.
, and
Connolly
,
H. M.
,
2020
, “
Trends and Outcomes of Pulmonary Valve Replacement in Tetralogy of Fallot
,”
Int. J. Cardiol.
,
299
, pp.
136
139
.10.1016/j.ijcard.2019.07.063
4.
Conijn
,
M.
, and
Krings
,
G. J.
,
2021
, “
Computational Analysis of the Pulmonary Arteries in Congenital Heart Disease: A Review of the Methods and Results
,”
Comput. Math. Methods Med.
,
2021
, pp.
1
10
.10.1155/2021/2618625
5.
Mosbahi
,
S.
,
Mickaily-Huber
,
E.
,
Charbonnier
,
D.
,
Hullin
,
R.
,
Burki
,
M.
,
Ferrari
,
E.
,
von Segesser
,
L. K.
, and
Berdajs
,
D. A.
,
2014
, “
Computational Fluid Dynamics of the Right Ventricular Outflow Tract and of the Pulmonary Artery: A Bench Model of Flow Dynamics
,”
Interact. Cardiovasc. Thorac. Surg.
,
19
(
4
), pp.
611
616
.10.1093/icvts/ivu202
6.
Caiazzo
,
A.
,
Guibert
,
R.
,
Boudjemline
,
Y.
, and
Vignon-Clementel
,
I. E.
,
2015
, “
Blood Flow Simulations for the Design of Stented Valve Reducer in Enlarged Ventricular Outflow Tracts
,”
Cardiovasc. Eng. Technol.
,
6
(
4
), pp.
485
500
.10.1007/s13239-015-0240-z
7.
Azadani
,
A. N.
,
Jaussaud
,
N.
,
Ge
,
L.
,
Chitsaz
,
S.
,
Chuter
,
T. A.
, and
Tseng
,
E. E.
,
2011
, “
Valve-in-Valve Hemodynamics of 20-mm Transcatheter Aortic Valves in Small Bioprostheses
,”
Ann. Thorac. Surg.
,
92
(
2
), pp.
548
555
.10.1016/j.athoracsur.2011.04.009
8.
Hatoum
,
H.
,
Dollery
,
J.
,
Lilly
,
S. M.
,
Crestanello
,
J. A.
, and
Dasi
,
L. P.
,
2018
, “
Implantation Depth and Rotational Orientation Effect on Valve-in-Valve Hemodynamics and Sinus Flow
,”
Ann. Thorac. Surg.
,
106
(
1
), pp.
70
78
.10.1016/j.athoracsur.2018.01.070
9.
Schiavone
,
N. K.
,
Elkins
,
C. J.
,
McElhinney
,
D. B.
,
Eaton
,
J. K.
, and
Marsden
,
A. L.
,
2021
, “
In Vitro Assessment of Right Ventricular Outflow Tract Anatomy and Valve Orientation Effects on Bioprosthetic Pulmonary Valve Hemodynamics
,”
Cardiovasc. Eng. Technol.
,
12
(
2
), pp.
215
231
.10.1007/s13239-020-00507-6
10.
Mittal
,
R.
,
Dong
,
H.
,
Bozkurttas
,
M.
,
Najjar
,
F. M.
,
Vargas
,
A.
, and
von Loebbecke
,
A.
,
2008
, “
A Versatile Sharp Interface Immersed Boundary Method for Incompressible Flows With Complex Boundaries
,”
J. Comput. Phys.
,
227
(
10
), pp.
4825
4852
.10.1016/j.jcp.2008.01.028
11.
de Tullio
,
M. D.
, and
Pascazio
,
G.
,
2016
, “
A Moving-Least-Squares Immersed Boundary Method for Simulating the Fluid–Structure Interaction of Elastic Bodies With Arbitrary Thickness
,”
J. Comput. Phys.
,
325
, pp.
201
225
.10.1016/j.jcp.2016.08.020
12.
Seo
,
J. H.
,
Zhu
,
C.
,
Resar
,
J.
, and
Mittal
,
R.
,
2020
, “
Flow Physics of Normal and Abnormal Bioprosthetic Aortic Valves
,”
Int. J. Heat Fluid Flow
,
86
, p.
108740
.10.1016/j.ijheatfluidflow.2020.108740
13.
Bailoor
,
S.
,
Seo
,
J. H.
,
Dasi
,
L. P.
,
Schena
,
S.
, and
Mittal
,
R.
,
2021
, “
A Computational Study of the Hemodynamics of Bioprosthetic Aortic Valves With Reduced Leaflet Motion
,”
J. Biomech.
,
120
, p.
110350
.10.1016/j.jbiomech.2021.110350
14.
Berger
,
T.
,
Siepe
,
M.
,
Simon
,
B.
,
Beyersdorf
,
F.
,
Chen
,
Z.
,
Kondov
,
S.
,
Schlett
,
C. L.
, et al.,
2022
, “
Pulmonary Artery Diameter: Means and Normal Limits—Assessment by Computed Tomography Angiography
,”
Interact. Cardiovasc. Thorac. Surg.
,
34
(
4
), pp.
637
644
.10.1093/icvts/ivab308
15.
Knobel
,
Z.
,
Kellenberger
,
C. J.
,
Kaiser
,
T.
,
Albisetti
,
M.
,
Bergsträsser
,
E.
, and
Valsangiacomo Buechel
,
E. R.
,
2011
, “
Geometry and Dimensions of the Pulmonary Artery Bifurcation in Children and Adolescents: Assessment In Vivo by Contrast-Enhanced MR-Angiography
,”
Int. J. Cardiovasc. Imaging
,
27
(
3
), pp.
385
396
.10.1007/s10554-010-9672-6
16.
Guibert
,
R.
,
McLeod
,
K.
,
Caiazzo
,
A.
,
Mansi
,
T.
,
Fernández
,
M. A.
,
Sermesant
,
M.
,
Pennec
,
X.
,
Vignon-Clementel
,
I. E.
,
Boudjemline
,
Y.
, and
Gerbeau
,
J. F.
,
2014
, “
Group-Wise Construction of Reduced Models for Understanding and Characterization of Pulmonary Blood Flows From Medical Images
,”
Med. Image Anal.
,
18
(
1
), pp.
63
82
.10.1016/j.media.2013.09.003
17.
Boumpouli
,
M.
,
Danton
,
M. H.
,
Gourlay
,
T.
, and
Kazakidi
,
A.
,
2020
, “
Blood Flow Simulations in the Pulmonary Bifurcation in Relation to Adult Patients With Repaired Tetralogy of Fallot
,”
Med. Eng. Phys.
,
85
, pp.
123
138
.10.1016/j.medengphy.2020.09.014
18.
Hudani
,
A.
,
White
,
J. A.
,
Greenway
,
S. C.
, and
Garcia
,
J.
,
2022
, “
Whole-Heart Assessment of Turbulent Kinetic Energy in the Repaired Tetralogy of Fallot
,”
Appl. Sci.
,
12
(
21
), p.
10946
.10.3390/app122110946
19.
Kostyunin
,
A. E.
,
Yuzhalin
,
A. E.
,
Rezvova
,
M. A.
,
Ovcharenko
,
E. A.
,
Glushkova
,
T. V.
, and
Kutikhin
,
A. G.
,
2020
, “
Degeneration of Bioprosthetic Heart Valves: Update 2020
,”
J. Am. Heart Assoc.
,
9
(
19
), pp.
1
16
.10.1161/JAHA.120.018506
You do not currently have access to this content.