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As living standards rise, more and more people are paying attention to their own health, especially issues such as cerebral thrombosis, cerebral infarction, and other cerebral blood flow problems. An accurate simulation of blood flow within cerebral vessels has emerged as a crucial area of research. In this study, we focus on microcirculatory blood flow in ischemic brain tissue and employ a 0D‐1D geometric multi‐scale coupled model to characterize this process. Given the intricate nature of human cerebral vessels, we apply a numerical method combining the finite element method and the third‐order Runge–Kutta method to resolve the coupled model. To enhance computational efficiency, we introduce a fast method based on the reduced‐order extrapolation algorithm. Our numerical example underscores the stability of the method and convergence accuracy to Oh3+τ3, while significantly improving the accuracy and efficiency of blood flow simulation, making the mechanism analysis more accurate. Additionally, we present examples detailing variations and distribution of intracranial pressure and blood flow in ischemic brain tissue throughout a cardiac cycle. Both reduced vascular compliance and vascular stenosis can have adverse effects on intracranial cerebral pressure and blood flow, leading to insufficient local oxygen supply and negative effects on brain function. Meanwhile, there will also be corresponding changes in volume flow and pulsatile blood pressure. [ABSTRACT FROM AUTHOR]

The dialysis catheter indwelling in human bodies has a high risk of inducing thrombus and stenosis. Biomechanical research showed that such physiological complications are triggered by the wall shear stress of the vascular vessel. This study aimed to assess the impact of CVC implantation on central venous haemodynamics and the potential alterations in the haemodynamic environment related to thrombus development. The SVC structure was built from the images from computed tomography. The blood flow was calculated using the Carreau model, and the fluid domain was determined by CFD. The vascular wall and the CVC were computed using FEA. The elastic interaction between the vessel wall and the flow field was considered using FSI simulation. With consideration of the effect of coupling, it was shown that the catheter vibrated in the vascular systems due to the periodic variation of blood pressure, with an amplitude of up to 10% of the vessel width. Spiral flow was observed along the catheter after CVC indwelling, and recirculation flow appeared near the catheter tip. High OSI and WSS regions occurred at the catheter tip and the vascular junction. The arterial lumen tip had a larger effect on the WSS and OSI values on the vascular wall. Considering FSI simulation, the movement of the catheter inside the blood flow was simulated in the deformable vessel. After CVC indwelling, spiral flow and recirculation flow were observed near the regions with high WSS and OSI values. [ABSTRACT FROM AUTHOR]

In this study, a moving boundary deformation model based on four‐dimensional computed tomography angiography (4D‐CTA) with high temporal resolution is constructed, and blood flow dynamics of cerebral aneurysms are investigated by numerical simulation. A realistic moving boundary deformation model of a cerebral aneurysm was constructed based on 4D‐CTA in each phase. Four hemodynamic factors (wall shear stress [WSS], wall shear stress divergence [WSSD], oscillatory shear index [OSI], and residual residence time [RRT]) were obtained from numerical simulations, and these factors were evaluated in basilar artery aneurysms. Comparison of the rigid body condition and the moving boundary condition investigating the relationship between wall displacement and hemodynamic factors clarified that the spatial‐averaged WSS and maximum WSSD considering only the aneurysmal dome has a large difference between conditions during the peak systole, and there were also significant differences in OSI and RRT. [ABSTRACT FROM AUTHOR]

The deformability of blood vessels in one‐dimensional blood flow models is typically described through a pressure‐area relation, known as the tube law. The most used tube laws take into account the elastic and viscous components of the tension of the vessel wall. Accurately parametrizing the tube laws is vital for replicating pressure and flow wave propagation phenomena. Here, we present a novel mathematical‐property‐preserving approach for the estimation of the parameters of the elastic and viscoelastic tube laws. Our goal was to estimate the parameters by using ovine and human in vitro data, while constraining them to meet prescribed mathematical properties. Results show that both elastic and viscoelastic tube laws accurately describe experimental pressure‐area data concerning both quantitative and qualitative aspects. Additionally, the viscoelastic tube law can provide a qualitative explanation for the observed hysteresis cycles. The two models were evaluated using two approaches: (i) allowing all parameters to freely vary within their respective ranges and (ii) fixing some of the parameters. The former approach was found to be the most suitable for reproducing pressure‐area curves. [ABSTRACT FROM AUTHOR]

The work presented here provides the guidelines and results for designing and implementing a highly sensitive modified Van der Pol – Duffing oscillator with a trigonometric damping function (VTD). This VTD can exhibit periodic and quasi‐chaotic behavior necessary for application in weak signal detection. Here, we present two proposals: (1) A method based on a quasi‐chaotic intermittent array (ANLIOA), whose all VTD parameters are calculated and fine‐tuned toward a critical state between chaotic and periodic state through a Lyapunov exponent procedure, and (2) A method based on a single oscillator in an adaptive stopping oscillation system (ANLSOS), where VTD is established within an oscillatory regime. Both systems can detect non‐stationary signals while reconstructing the time‐frequency spectrogram in high resolution within severe noise conditions. The systems were adapted for the detection of a synthesized Doppler signal corresponding to the blood flow velocity profile from an artery. Comparative results using typical oscillators such as Duffing or Van der Pol demonstrate the superiority of the VTD oscillator in detection when used for both methods, whose mean absolute percentage error reached around 6% for a signal‐to‐noise ratio (SNR) of −10 dB. Furthermore, compared to other time‐frequency methods, ANLIOA and ANLSOS promise high precision in detecting Doppler signals with low rates of frequency changes while minimizing energy emission and avoiding possible bio‐thermal effects. [ABSTRACT FROM AUTHOR]

The reconstruction of blood velocity in a vessel from contrast enhanced x‐ray computed tomography projections is a complex inverse problem. It can be formulated as reconstruction problem with a partial differential equation constraint. A solution can be estimated with the a variational adjoint method and proper orthogonal decomposition (POD) basis. In this work, we investigate new inversion approaches based on PODs coupled with deep learning methods. The effectiveness of the reconstruction methods is shown with simulated realistic stationary blood flows in a vessel. The methods outperform the reduced adjoint method and show large speed‐up at the online stage. [ABSTRACT FROM AUTHOR]

In this paper, we develop an algorithm to simulate blood flows in aneurysmal arteries and focus on the construction of robust and efficient multilevel preconditioners to speed up the convergence of both linear and nonlinear solvers. The work is motivated by the observation that in the local aneurysmal region, the flow is often quite complicated with one or more vortices, but in the healthy section of the artery, the principal component of blood flows along the centerline of the artery. Based on this observation, we introduce a novel two‐level additive Schwarz method with a mixed‐dimensional coarse preconditioner. The key components of the preconditioner include (1) a three‐dimensional coarse preconditioner covering the aneurysm; (2) a one‐dimensional coarse preconditioner covering the central line of the healthy section of the artery; (3) a collection of three‐dimensional overlapping subdomain preconditioners covering the fine meshes of the entire artery; (4) extension/restriction operators constructed by radial basis functions. The blood flow is modeled by the unsteady incompressible Navier–Stokes equations with resistance outflow boundary conditions discretized by a stabilized finite element method on fully unstructured meshes and the second‐order backward differentiation formula in time. The resulting large nonlinear algebraic systems are solved by a Newton‐Krylov algorithm accelerated by the new preconditioner in two ways: (1) the initial guess of Newton is obtained by solving a linear system defined by the coarse preconditioner; (2) the Krylov solver of the Jacobian system is preconditioned by the new preconditioner. Numerical experiments indicate that the proposed preconditioner is highly effective and robust for complex flows in a patient‐specific artery with aneurysm, and it significantly reduces the numbers of linear and nonlinear iterations. [ABSTRACT FROM AUTHOR]

A major challenge in the computational fluid dynamics modeling of the heart function is the simulation of isovolumetric phases when the hemodynamics problem is driven by a prescribed boundary displacement. During such phases, both atrioventricular and semilunar valves are closed: consequently, the ventricular pressure may not be uniquely defined, and spurious oscillations may arise in numerical simulations. These oscillations can strongly affect valve dynamics models driven by the blood flow, making unlikely to recovering physiological dynamics. Hence, prescribed opening and closing times are usually employed, or the isovolumetric phases are neglected altogether. In this article, we propose a suitable modification of the Resistive Immersed Implicit Surface (RIIS) method (Fedele et al., Biomech Model Mechanobiol 2017, 16, 1779–1803) by introducing a reaction term to correctly capture the pressure transients during isovolumetric phases. The method, that we call Augmented RIIS (ARIIS) method, extends the previously proposed ARIS method (This et al., Int J Numer Methods Biomed Eng 2020, 36, e3223) to the case of a mesh which is not body‐fitted to the valves. We test the proposed method on two different benchmark problems, including a new simplified problem that retains all the characteristics of a heart cycle. We apply the ARIIS method to a fluid dynamics simulation of a realistic left heart geometry, and we show that ARIIS allows to correctly simulate isovolumetric phases, differently from standard RIIS method. Finally, we demonstrate that by the new method the cardiac valves can open and close without prescribing any opening/closing times. [ABSTRACT FROM AUTHOR]

Restenosis typically occurs in regions of low and oscillating wall shear stress, which also favor the accumulation of atherogenic macromolecules such as low‐density lipoprotein (LDL). This study aims to evaluate LDL transport and accumulation at the carotid artery bifurcation following carotid artery stenting (CAS) by means of computational simulation. The computational model consists of coupled blood flow and LDL transport, with the latter being modeled as a dilute substance dissolved in the blood and transported by the flow through a convection‐diffusion transport equation. The endothelial layer was assumed to be permeable to LDL, and the hydraulic conductivity of LDL was shear‐dependent. Anatomically realistic geometric models of the carotid bifurcation were built based on pre‐ and post‐stent computed tomography (CT) scans. The influence of stent design was investigated by virtually deploying two different types of stents (open‐ and closed‐cell stents) into the same carotid bifurcation model. Predicted LDL concentrations were compared between the post‐stent carotid models and the relatively normal contralateral model reconstructed from patient‐specific CT images. Our results show elevated LDL concentration in the distal section of the stent in all post‐stent models, where LDL concentration is 20 times higher than that in the contralateral carotid. Compared with the open‐cell stents, the closed‐cell stents have larger areas exposed to high LDL concentration, suggesting an increased risk of stent restenosis. This computational approach is readily applicable to multiple patient studies and, once fully validated against follow‐up data, it can help elucidate the role of stent strut design in the development of in‐stent restenosis after CAS. [ABSTRACT FROM AUTHOR]

In this work, we develop numerical methods for the solution of blood flow and coagulation on dynamic adaptive moving meshes. We consider the blood flow as a flow of incompressible Newtonian fluid governed by the Navier–Stokes equations. The blood coagulation is introduced through the additional Darcy term, with a permeability coefficient dependent on reactions. To this end, we introduce moving mesh collocated finite‐volume methods for the Navier–Stokes equations, advection–diffusion equations, and a method for the stiff cascade of reactions. A monolithic nonlinear system is solved to advance the solution in time. The finite volume method for the Navier–Stokes equations features collocated arrangement of pressure and velocity unknowns and a coupled momentum and mass flux. The method is conservative and inf‐sup stable despite the saddle point nature of the system. It is verified on a series of analytical problems and applied to the blood flow problem in the deforming domain of the right ventricle, reconstructed from a time series of computed tomography scans. At last, we demonstrate the ability to model the coagulation process in deforming microfluidic capillaries. [ABSTRACT FROM AUTHOR]

Blood flow within the left ventricle provides important information regarding cardiac function in health and disease. The mitral valve strongly influences the formation of flow structures and there exist various approaches for the representation of the valve in numerical models of left ventricular blood flow. However, a systematic comparison of the various mitral valve models is missing, making a priori decisions considering the overall model's context of use impossible. Within this study, a benchmark setup to compare the influence of mitral valve modeling strategies on intraventricular flow features was developed. Then, five mitral valve models of increasing complexity: no modeling, static wall, 2D and 3D porous medium with time‐dependent porosity, and one‐way fluid–structure interaction (FSI) were compared with each other. The flow features velocity, kinetic energy, transmitral pressure drop, vortex formation, flow asymmetry as well as computational cost and ease‐of‐implementation were evaluated. The one‐way FSI approach provides the highest level of flow detail, which is accompanied by the highest numerical costs and challenges with the implementation. As an alternative, the porous medium approach with the expansion including time‐dependent porosity provides good results with up to 10% deviations in the flow features (except the transmitral pressure drop) in comparison to the FSI model and only a fraction (11%) of numerical costs. However, jet propagation speed is highly underestimated by all alternative approaches to the FSI model. Taken together, our benchmark setup allows a quantitative comparison of various mitral valve modeling approaches and is provided to the scientific community for further testing and expansion. [ABSTRACT FROM AUTHOR]

Prediction of blood cell flow is known as the difficult research by reason of the complexity of blood vessel. In this study, considering the complex structure of blood vessels, a mechanical model for red blood cell (RBC) based on unstructured grid has been established to study the flow characteristics of RBCs in complex blood vessels. In the model, the strain‐energy function by Skalak is employed to model the shear elasticity and surface‐area conservation of the membrane, and the hinge spring is used to describe the forces originating from local bending of the membrane. The immersed boundary method is utilized to couple the interphase force. Using the model, the stretching test of RBC is compared with the experiment data, and the good agreement verified the validation of the present model. The morphology of red blood cell and the blood viscosity in micro‐vessel are studied. RBCs move with a symmetric shape (parachute shape) in small blood vessels, and the buckling instability is observed when the RBC flow slowly through a micro‐vessel or a converging–diverging capillary. When the vessel diameter is around 10 μm, the reverse Fahraeus‐Lindqvist effect is presented. The blood apparent viscosity shows linear increase with the blood hematocrit. In addition, Malaria infection can make the RBC deformability decreased and the blood apparent viscosity increased. [ABSTRACT FROM AUTHOR]

Central venous disease (CVD) with stenosis or occlusion is a severe and prevalent complication for chronic hemodialysis (HD) patients, resulting in dialysis access dysfunction. Percutaneous transluminal angioplasty with stent placement (PTS) has become one of the first‐line treatments for CVD. In clinical practice, the extra stents would be used if the curative efficacy of a single stent were unsatisfactory. Aiming to evaluate the therapeutic effect of different PTS schemes, computational fluid dynamics (CFD) simulations on four patients were performed to compare the hemodynamic characteristics of real‐life HD patients after stent placement. The three‐dimensional central vein's models of each patient were built using computational tomography angiography (CTA) images, and idealized models were constructed as contrast. Two inlet velocity modes were imposed to imitate the blood flow rate of healthy and HD patients. The hemodynamic parameters for different patients were investigated, including wall shear stress (WSS), velocity, and helicity. The results showed that the implantation of double stents is able to improve flexibility. When subjected to external force, the double stents have better radial stiffness. This paper evaluated the therapeutic efficacy of stent placement and provided a theoretical basis for CVD intervention in hemodialysis patients. [ABSTRACT FROM AUTHOR]

Aortic dissection is a life‐threatening condition with a rising prevalence in the elderly population, possibly as a consequence of the increasing population life expectancy. Untreated aortic dissection can lead to myocardial infarction, aortic branch malperfusion or occlusion, rupture, aneurysm formation and death. This study aims to assess the potential of a biomechanical model in predicting the risks of a non‐dilated thoracic aorta with Stanford type A dissection. To achieve this, a fully coupled fluid–structure interaction model was developed under realistic blood flow conditions. This model of the aorta was developed by considering three‐dimensional artery geometry, multiple artery layers, hyperelastic artery wall, in vivo‐based physiological time‐varying blood velocity profiles, and non‐Newtonian blood behaviours. The results demonstrate that in a thoracic aorta with Stanford type A dissection, the wall shear stress (WSS) is significantly low in the ascending aorta and false lumen, leading to potential aortic dilation and thrombus formation. The results also reveal that the WSS is highly related to blood flow patterns. The aortic arch region near the brachiocephalic and left common carotid artery is prone to rupture, showing a good agreement with the clinical reports. The results have been translated into their potential clinical relevance by revealing the role of the stress state, WSS and flow characteristics as the main parameters affecting lesion progression, including rupture and aneurysm. The developed model can be tailored for patient‐specific studies and utilised as a predictive tool to estimate aneurysm growth and initiation of wall rupture inside the human thoracic aorta. [ABSTRACT FROM AUTHOR]

The cerebrovascular blood vessels feed necessary agents such as oxygen, glucose, and so forth. to the brain which maintains the smooth functioning of the human body. However, the blood–brain barrier as a vascular border restricts the entry of drugs that can be necessary for the treatment of neurological disorders. The fluid shear stress in the cerebrovascular blood vessels may regulate the drug delivery in the interface between the cerebrovascular blood vessels and the brain. The intensity of influence by various factors that affects the shear stress in the cerebrovascular blood vessels is scarcely addressed in the present study. A hybrid approach of computational fluid dynamics and Taguchi analysis is proposed to evaluate the influence of various geometrical and operating factors on the shear stress in the microfluidic cerebrovascular channel. Furthermore, the non‐Newtonian behavior of blood flow is considered to evaluate the shear stress in the microfluidic cerebrovascular channel. The Newtonian and six non‐Newtonian fluids models of Carreau, Carreau–Yasuda, Casson, Cross, Ostwald–de Waele, and Herschel–Bulkley are numerically tested under various conditions of the flow rate, width, and height of the channel to find the viscosity influence on the shear stress. The Taguchi analysis consisting of range and variance analyses is applied to the L16 orthogonal array to evaluate the effect of various factors on shear stress in terms of influence order, range, F value, and percentage contribution. The parameters for the considered six non‐Newtonian fluid models are proposed to accurately map the viscosity behavior with shear strain compared to the actual blood flow behavior. The Newtonian, Carreau, and Carreau–Yasuda non‐Newtonian fluid models are found accurately with maximum errors between the experimental and numerical shear stress results as 2.17%, 1.30%, and 1.48%, respectively. The shear stress decreases with an increase in the width and height of the channel and a decrease in the viscosity for all flow rates. The porosity is evaluated as a highly influential factor followed by the flow rate, width, and height of the channel in decreasing order based on their effects on the shear stress. The modified shear stress equation is proposed with an accuracy of 0.96 by integrating the effect of porosity in addition to width, height, flow rate, and viscosity. The in‐vitro microfluidic cerebrovascular model could be designed and manufactured based on the proposed results on influence order, F value, and percentage contribution of various factors in direction of achieving the in‐vivo level shear stress. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve implantation (TAVI) is a minimally invasive intervention for the treatment of severe aortic valve stenosis. The main cause of failure is the structural deterioration of the implanted prosthetic leaflets, possibly inducing a valvular re‐stenosis 5–10 years after the implantation. Based solely on pre‐implantation data, the aim of this work is to identify fluid‐dynamics and structural indices that may predict the possible valvular deterioration, in order to assist the clinicians in the decision‐making phase and in the intervention design. Patient‐specific, pre‐implantation geometries of the aortic root, the ascending aorta, and the native valvular calcifications were reconstructed from computed tomography images. The stent of the prosthesis was modeled as a hollow cylinder and virtually implanted in the reconstructed domain. The fluid‐structure interaction between the blood flow, the stent, and the residual native tissue surrounding the prosthesis was simulated by a computational solver with suitable boundary conditions. Hemodynamical and structural indicators were analyzed for five different patients that underwent TAVI – three with prosthetic valve degeneration and two without degeneration – and the comparison of the results showed a correlation between the leaflets' structural degeneration and the wall shear stress distribution on the proximal aortic wall. This investigation represents a first step towards computational predictive analysis of TAVI degeneration, based on pre‐implantation data and without requiring additional peri‐operative or follow‐up information. Indeed, being able to identify patients more likely to experience degeneration after TAVI may help to schedule a patient‐specific timing of follow‐up. [ABSTRACT FROM AUTHOR]

Numerical simulations of pulsatile blood flow in an aortic coarctation require the use of turbulence modeling. This paper considers three models from the class of large eddy simulation (LES) models (Smagorinsky, Vreman, σ‐model) and one model from the class of variational multiscale models (residual‐based) within a finite element framework. The influence of these models on the estimation of clinically relevant biomarkers used to assess the degree of severity of the pathological condition (pressure difference, secondary flow degree, normalized flow displacement, wall shear stress) is investigated in detail. The simulations show that most methods are consistent in terms of severity indicators such as pressure difference and stenotic velocity. Moreover, using second‐order velocity finite elements, different turbulence models might lead to considerably different results concerning other clinically relevant quantities such as wall shear stresses. These differences may be attributed to differences in numerical dissipation introduced by the turbulence models. [ABSTRACT FROM AUTHOR]

Aortic dissection is caused by a tear on the aortic wall that allows blood to flow through the wall layers. Usually, this tear involves the intimal and partly the medial layer of the aortic wall. As a result, a new false lumen develops besides the original aorta, denoted then as the true lumen. The local hemodynamic conditions such as flow disturbances, recirculations and low wall shear stress may cause thrombus formation and growth in the false lumen. Since the false lumen status is a significant predictor for late‐dissection‐related deaths, it is of great importance in the medical management of patients with aortic dissection. The hemodynamic changes in the aorta also alter the electrical conductivity of blood. Since the blood is much more conductive than other tissues in the body, such changes can be identified with non‐invasive methods such as impedance cardiography. Therefore, in this study, the capability of impedance cardiography in monitoring thrombosis in the false lumen is studied by multiphysics simulations to assist clinicians in the medical management of patients under treatment. To tackle this problem, a 3D computational fluid dynamics simulation has been set up to model thrombosis in the false lumen and its impact on the blood flow‐induced conductivity changes. The electrical conductivity changes of blood have been assigned as material properties of the blood‐filled aorta in a 3D finite element electric simulation model to investigate the impact of conductivity changes on the measured impedance from the body's surface. The results show remarkable changes in the electrical conductivity distribution in the measurement region due to thrombosis in the false lumen, which significantly impacts the morphology of the impedance cardiogram. Thus, frequent monitoring of impedance cardiography signals may allow tracking the thrombus formation and growth in the false lumen. [ABSTRACT FROM AUTHOR]

Fibrin is an important product of the coagulation cascade, and plays an eminent role in platelet stabilization. Since coagulation cascade models typically involve the reaction kinetics of dozens of proteins, which will incur burdensome computational costs when coupled to blood flow in complex geometries, researchers often ignore this process when constructing thrombosis models. However, previous studies have shown that fundamental aspects of coagulation can be reproduced with simpler models, which motivated us to obtain a reduced‐order model of fibrin generation through a systematic approach. Therefore, we introduced a semi‐automatic framework to perform model‐reduction of cascade reactions in this study, which consisted of two processes. Specifically, the retained protein species and cascade reactions were determined based on published studies and simulation results from the full cascade model, while the optimal reaction rates for the new cascade network were determined using a genetic algorithm. The framework has been applied to a 19‐species coagulation model that triggers fibrin generation in internal fields via reactive boundaries, and a 10‐species reduced‐order model was obtained to reproduce the kinetics of fibrinogenesis in the full cascade model at different boundary tissue factor concentrations. This reduced‐order model of fibrinogenesis would be valuable for thrombosis modeling that considers both the coagulation cascade and platelet activity. Furthermore, the framework proposed herein can also be applied to the reductions of other cascade reaction models. [ABSTRACT FROM AUTHOR]

Introduction: Left subclavian artery (LSA) bypass surgery is mainly carried out for patients with severe left subclavian occlusion. This article aimed to evaluate the hemodynamic effects of different surgical bypass modes on LSA revascularization. Methods: Three‐dimensional models of the aorta were reconstructed from CTA images of a patient with LSA occlusion, a patient with type B aortic dissection with LSA coverage during thoracic endovascular aortic repair, and a healthy 74‐year‐old man, resulting in six modes for each person: healthy LSA mode, LSA occlusion mode and four bypass modes. Hemodynamic parameters, including flow field, flow distribution, pressure gradient, and wall shear stress, were calculated using computational fluid dynamics. Results: After LSA bypass surgery, distal LSA blood flow resulting from left common carotid artery (LCCA) to distal LSA bypass was 100% of that in the healthy mode, while the other modes yielded flows at least 91%. Moreover, reversed flow only completely disappeared with LCCA to distal LSA bypass, whereas reverse flow was observed in the other three modes in early systole. Conclusion: Left common carotid artery to distal LSA bypass can effectively reduce reverse blood flow in the left vertebral artery, and it is a feasible, effective, and safe option for LSA revascularization in patients with left subclavian occlusion. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to demonstrate the importance of a compliant wall approach in modeling of non‐Newtonian and non‐physiological blood flows. A case study of a stenosed and symptomatic carotid bifurcation was considered to show the influence of the wall‐resilience assumption on the flow parameters obtained with numerical simulations. Patient‐specific data concerning the geometry and flow conditions were collected and used to carry out two‐way coupled fluid structure interaction simulations of the pulsatile blood flow through carotid artery. The wall compliance was considered separately as related to the wall‐elasticity and as associated with the reaction of the loose connective tissue surrounding the carotid bifurcation. The obtained hemodynamic parameters were compared to those which were found in rigid‐wall simulations. The difference between the results obtained for rigid‐wall and compliant‐wall approaches for the peak‐systolic area‐averaged wall shear stress achieved 35%, whereas the difference between the time‐averaged local vorticity and shear strain reached, respectively, 42% and 43%. The influence of the highly resilient wall on the monitored hemodynamic parameters was significant even if time‐averaged values are compared, which suggests that these metrics are considerably overestimated if the wall compliance is not considered. Moreover, the findings show that the mechanical response of the loose connective tissue cannot be neglected in blood flow simulations. Additionally, this study indicates that stiffening of the arterial wall due to atherosclerosis significantly rises hemodynamic parameters. This explains the therapeutic benefits of surgical removal of plaque lesions formed in the carotid bifurcation (endarterectomy). [ABSTRACT FROM AUTHOR]

Mathematical and computational modeling of the cardiovascular system is increasingly providing non‐invasive alternatives to traditional invasive clinical procedures. Moreover, it has the potential for generating additional diagnostic markers. In blood flow computations, the personalization of spatially distributed (i.e., 3D) models is a key step which relies on the formulation and numerical solution of inverse problems using clinical data, typically medical images for measuring both anatomy and function of the vasculature. In the last years, the development and application of inverse methods has rapidly expanded most likely due to the increased availability of data in clinical centers and the growing interest of modelers and clinicians in collaborating. Therefore, this work aims to provide a wide and comparative overview of literature within the last decade. We review the current state of the art of inverse problems in blood flows, focusing on studies considering fully dimensional fluid and fluid–solid models. The relevant physical models and hemodynamic measurement techniques are introduced, followed by a survey of mathematical data assimilation approaches used to solve different kinds of inverse problems, namely state and parameter estimation. An exhaustive discussion of the literature of the last decade is presented, structured by types of problems, models and available data. [ABSTRACT FROM AUTHOR]

In this work, we present mixed dimensional models for simulating blood flow and transport processes in breast tissue and the vascular tree supplying it. These processes are considered, to start from the aortic inlet to the capillaries and tissue of the breast. Large variations in biophysical properties and flow conditions exist in this system necessitating the use of different flow models for different geometries and flow regimes. In total, we consider four different model types. First, a system of 1D nonlinear hyperbolic partial differential equations (PDEs) is considered to simulate blood flow in larger arteries with highly elastic vessel walls. Second, we assign 1D linearized hyperbolic PDEs to model the smaller arteries with stiffer vessel walls. The third model type consists of ODE systems (0D models). It is used to model the arterioles and peripheral circulation. Finally, homogenized 3D porous media models are considered to simulate flow and transport in capillaries and tissue within the breast volume. Sink terms are used to account for the influence of the venous and lymphatic systems. Combining the four model types, we obtain two different 1D–0D–3D coupled models for simulating blood flow and transport processes: The first model results in a fully coupled 1D–0D–3D model covering the complete path from the aorta to the breast combining a generic arterial network with a patient specific breast network and geometry. The second model is a reduced one based on the separation of the generic and patient specific parts. The information from a calibrated fully coupled model is used as inflow condition for the patient specific sub‐model allowing a significant computational cost reduction. Several numerical experiments are conducted to calibrate the generic model parameters and to demonstrate realistic flow simulations compared to existing data on blood flow in the human breast and vascular system. Moreover, we use two different breast vasculature and tissue data sets to illustrate the robustness of our reduced sub‐model approach. [ABSTRACT FROM AUTHOR]

The lack of mechanically effective contraction of the left atrium (LA) during atrial fibrillation (AF) disturbs blood flow, increasing the risk of thrombosis and ischemic stroke. Thrombosis is most likely in the left atrial appendage (LAA), a small narrow sac where blood is prone to stagnate. Slow flow promotes the formation of erythrocyte aggregates in the LAA, also known as rouleaux, causing viscosity gradients that are usually disregarded in patient‐specific simulations. To evaluate these non‐Newtonian effects, we built atrial models derived from 4D computed tomography scans of patients and carried out computational fluid dynamics simulations using the Carreau–Yasuda constitutive relation. We examined six patients, three of whom had AF and LAA thrombosis or a history of transient ischemic attacks (TIAs). We modeled the effects of hematocrit and rouleaux formation kinetics by varying the parameterization of the Carreau–Yasuda relation and modulating non‐Newtonian viscosity changes based on residence time. Comparing non‐Newtonian and Newtonian simulations indicates that slow flow in the LAA increases blood viscosity, altering secondary swirling flows and intensifying blood stasis. While some of these effects are subtle when examined using instantaneous metrics like shear rate or kinetic energy, they are manifested in the blood residence time, which accumulates over multiple heartbeats. Our data also reveal that LAA blood stasis worsens when hematocrit increases, offering a potential new mechanism for the clinically reported correlation between hematocrit and stroke incidence. In summary, we submit that hematocrit‐dependent non‐Newtonian blood rheology should be considered when calculating patient‐specific blood stasis indices by computational fluid dynamics. [ABSTRACT FROM AUTHOR]

In medicine field, dynamic investigation of aorta artery has received attention due to its notable functions and significance upon performance of heart and individual health. Because, aortic injuries cause lethal occurrences having numerous mortality rates. Therefore, more probes, in particular, dynamic response of aorta arteries conveying blood flow containing pharmaceutical nanoparticles is essential. In present research, we attempt to model biomechanically the dynamic instability assessment of aorta arteries with atherosclerosis in tissue matrix conveying blood including pharmaceutical magnetic nanoparticles. Thus, according to classical cylindrical shell theory, the aorta arteries will be considered as elastic cylindrical vessels and symmetric lipid tissue is utilized in order to model atherosclerosis in the artery. Applying magnetic field to nanoparticles results in attraction of lipid tissue in artery. Moreover, the nature of blood flow is regarded non‐Newtonian based on Casson, Carreau, and power law models. Using Hamilton's principle, the motion equations are derived and based on differential quadrature method, the dynamic instability region of aorta artery is obtained. The influences of different variables such as magnetic field, magnetic nanoparticle's volume percent, combined effects of the tissue, lipid's height and length, and non‐Newtonian models upon dynamic behavior of aorta artery are investigated. According to the results, increase in lipid's height leads to increase in resonance frequency of aorta arteries. [ABSTRACT FROM AUTHOR]

Summary: The mechanism of many cardiovascular diseases can be understood by studying the pressure distribution in blood vessels. Direct pressure measurements, however, require invasive probing and provide only single‐point data. Alternatively, relative pressure fields can be reconstructed from imaging‐based velocity measurements by considering viscous and inertial forces. Both contributions can be potential troublemakers in pressure reconstruction: the former due to its higher‐order derivatives, and the latter because of the quadratic nonlinearity in the convective acceleration. Viscous and convective terms can be treated in various forms, which, although equivalent for ideal measurements, can perform differently in practice. In fact, multiple versions are often used in literature, with no apparent consensus on the more suitable variants. In this context, the present work investigates the performance of different versions of relative pressure estimators. For viscous effects, in particular, two new modified estimators are presented to circumvent second‐order differentiation without requiring surface integrals. In‐silico and in‐vitro data in the typical regime of cerebrovascular flows are considered, allowing a systematic noise sensitivity study. Convective terms are shown to be the main source of error, even for flows with pronounced viscous component. Moreover, the conservation (often integrated) form of convection exhibits higher noise sensitivity than the standard convective description, in all three families of estimators considered here. For the classical pressure Poisson estimator, the present modified version of the viscous term tends to yield better accuracy than the (recently introduced) integrated form, although this effect is in most cases negligible when compared to convection‐related errors. [ABSTRACT FROM AUTHOR]

Coronary artery bypass grafts (CABG) surgery is an invasive procedure performed to circumvent partial or complete blood flow blockage in coronary artery disease. In this work, we apply a numerical optimal flow control model to patient‐specific geometries of CABG, reconstructed from clinical images of real‐life surgical cases, in parameterized settings. The aim of these applications is to match known physiological data with numerical hemodynamics corresponding to different scenarios, arisen by tuning some parameters. Such applications are an initial step toward matching patient‐specific physiological data in patient‐specific vascular geometries as best as possible. Two critical challenges that reportedly arise in such problems are: (a) lack of robust quantification of meaningful boundary conditions required to match known data as best as possible and (b) high computational cost. In this work, we utilize unknown control variables in the optimal flow control problems to take care of the first challenge. Moreover, to address the second challenge, we propose a time‐efficient and reliable computational environment for such parameterized problems by projecting them onto a low‐dimensional solution manifold through proper orthogonal decomposition‐Galerkin. [ABSTRACT FROM AUTHOR]

A compartmental model of the cardiorespiratory system featuring pulsatile blood flow and gas transport, as well as closed loop mechanisms of cardiorespiratory regulation is presented. Short timescale regulatory action includes baroreflex, peripheral and central chemoreflex feedback. The cardiorespiratory model is composed by compartments to describe blood flow and gas exchange in the major systemic and pulmonic regions. The control systems include formulations to afferent activity of arterial baroreceptor and peripheral and central chemoreceptors. Simulations described here include situations of hypoxia, hypercapnia, and hemorrhage. The overall responses of our simulations agree with physiological (experimental) and theoretical data. Our results suggest that the present model could be used to further understand the interplay among major regulatory mechanisms in the functioning of the cardiovascular and respiratory systems in cases of normal and abnormal physiological conditions. [ABSTRACT FROM AUTHOR]

Aortic cross‐clamping is a common strategy during vascular surgery, however, its instantaneous impact on hemodynamics is unknown. We, therefore, developed two numerical models to estimate the immediate impact of aortic clamping on the vascular properties. To assess the validity of the models, we recorded continuous invasive pressure signals during abdominal aneurysm repair surgery, immediately before and after clamping. The first model is a zero‐dimensional (0D) three‐element Windkessel model, which we coupled to a gradient‐based parameter estimation algorithm to identify patient‐specific parameters such as vascular resistance and compliance. We found a 10% increase in the total resistance and a 20% decrease in the total compliance after clamping. The second model is a nine‐artery network corresponding to an average human body in which we solved the one‐dimensional (1D) blood flow equations. With a similar parameter estimation method and using the results from the 0D model, we identified the resistance boundary conditions of the 1D network. Determining the patient‐specific total resistance and the distribution of peripheral resistances through the parameter estimation process was sufficient for the 1D model to accurately reproduce the impact of clamping on the pressure waveform. Both models gave an accurate description of the pressure wave and had a high correlation (R2 >.95) with experimental blood pressure data. [ABSTRACT FROM AUTHOR]

Fenestration is a rare congenital abnormality that refers to a segmental duplication of arteries. It is still not clear about the role of fenestrations in the etiology and pathological evolution of vascular diseases. This study aims to investigate the hemodynamic influence brought by various sizes and locations of fenestration in basilar artery models. A series presumptive fenestration models were established based on a normal basilar artery model with various sizes and locations. Identical boundary conditions were utilized in the computational fluid dynamics simulations and different flow patterns in the fenestration and bifurcation regions were comprehensively analyzed. Wall shear stress (WSS)‐related parameters such as oscillatory shear index (OSI) and aneurysm formation index (AFI) were computed and compared. The value of WSS on fenestration increased by the fenestration's tortuosity, and nearly‐circular fenestration suffered higher WSS than narrow‐strips one. Also, high OSI and low AFI value mainly occurred in the bifurcation region, indicating a high level of turbulence and high risk of aneurysm formation. The location of fenestration mainly changed the impact force of blood flow on the bifurcation and the disorder characteristics of blood flow, while the size of fenestration changed the WSS distribution on the proximal inner wall and bifurcation region of fenestration. In summary, the nearly‐circular fenestration should be stratified carefully which may results in a high risk inducing unfavorable vascular wall remodeling. [ABSTRACT FROM AUTHOR]

The goal of this paper is to investigate the validity of a hybrid embedded/homogenized in‐silico approach for modeling perfusion through solid tumors. The rationale behind this novel idea is that only the larger blood vessels have to be explicitly resolved while the smaller scales of the vasculature are homogenized. As opposed to typical discrete or fully resolved 1D–3D models, the required data can be obtained with in‐vivo imaging techniques since the morphology of the smaller vessels is not necessary. By contrast, the larger vessels, whose topology and structure is attainable noninvasively, are resolved and embedded as one‐dimensional inclusions into the three‐dimensional tissue domain which is modeled as a porous medium. A sound mortar‐type formulation is employed to couple the two representations of the vasculature. We validate the hybrid model and optimize its parameters by comparing its results to a corresponding fully resolved model based on several well‐defined metrics. These tests are performed on a complex data set of three different tumor types with heterogeneous vascular architectures. The correspondence of the hybrid model in terms of mean representative elementary volume blood and interstitial fluid pressures is excellent with relative errors of less than 4%. Larger, but less important and explicable errors are present in terms of blood flow in the smaller, homogenized vessels. We finally discuss and demonstrate how the hybrid model can be further improved to apply it for studies on tumor perfusion and the efficacy of drug delivery. [ABSTRACT FROM AUTHOR]

This paper presents a lattice Boltzmann framework for the transient simulation of blood flow using biologically inspired geometries and pressure boundary conditions. The Kuang‐Luo rheological model is used to represent blood as a homogeneous continuum. This model includes the two primary non‐Newtonian characteristics of blood, namely viscoplasticity and pseudoplasticity. This paper makes two contributions. First, the numerical challenges associated with zero strain rates and infinite viscosity, as a consequence of the yield stress in the Kuang‐Luo model, were addressed by regularising the constitutive equation so that the viscosity tends towards a finite value at low strain rates. A two‐relaxation‐time operator, which exhibits improved performance over the single‐relaxation‐time operator and lower computational overhead than the multiple‐relaxation‐time operator, is employed in the collision process. The recursive relationship between the local strain rate and relaxation rate was addressed by use of an implicit solver for these two quantities. The implemented model was benchmarked against analytic solutions for Poiseuille flow between parallel plates in two dimensions and in a cylindrical tube in three dimensions. More importantly, the transient performance of the implemented model was demonstrated by matching the predicted start‐up flow of the Poiseuille flow of a Bingham fluid with the corresponding analytical solution. Second, the numerical developments were applied in the simulation of transient blood flow in complex configurations. The development and implementation of physically inspired pressure profiles highlighted the shortcomings of using a sinusoidal pressure profile in the prediction of velocity and stress distributions. Finally, the simulation of blood flow in a section of a carotid artery indicated a number of flow characteristics that will be of interest to future investigations of clinical problems. [ABSTRACT FROM AUTHOR]

Numerical simulations of cardiac blood pump systems are integral to the optimization of device design, hydraulic performance and hemocompatibility. In wave membrane blood pumps, blood propulsion arises from the wave propagation along an oscillating immersed membrane, which generates small pockets of fluid that are pushed towards the outlet against an adverse pressure gradient. We studied the Fluid–Structure Interaction between the oscillating membrane and the blood flow via three‐dimensional simulations using the Extended Finite Element Method (XFEM), an unfitted numerical technique that avoids remeshing by using a fluid fixed mesh. Our three‐dimensional numerical simulations in a realistic pump geometry highlighted, for the first time in this field of application, that XFEM is a reliable strategy to handle complex industrial problems. Moreover, they showed the role of the membrane deformation in promoting a blood flow towards the outlet despite an adverse pressure gradient. We also simulated the pump system at different pressure conditions and we validated the numerical results against in‐vitro experimental data. [ABSTRACT FROM AUTHOR]

Murine models have been widely used to investigate the mechanobiology of aortic atherosclerosis and dissections, which develop preferably at different anatomic locations of aorta. Based MRI and finite element analysis with fluid–structure interaction, we numerically investigated factors that may affect the blood flow and structural mechanics of rat aorta. The results indicated that aortic root motion greatly increases time‐averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), displacement of the aorta, and enhances helical flow pattern but has limited influence on effective stress, which is highly modulated by blood pressure. Moreover, the influence of the motion component on these indicators is different with axial motion more obvious than planar motion. Surrounding fixation of the intercostal arteries and the branch vessels on aortic arch would reduce the influence of aortic root motion. The compliance of the aorta has different influences at different regions, leading to decrease in TAWSS and helical flow, increase in OSI, RRT at the aortic arch, but has reversed effects on the branch vessels. When compared with the steady flow, the pulsatile blood flow would obviously increase the WSS, the displacement, and the effective stress in most regions. In conclusion, to accurately quantify the blood flow and structural mechanics of rat aorta, the motion of the aortic root, the compliance of aortic wall, and the pulsation of blood flow should be considered. However, when only focusing on the effective stress in rat aorta, the motion of the aortic root may be neglected. [ABSTRACT FROM AUTHOR]

This paper shows how to obtain in addition to the standard deviations available after a data assimilation procedure based on the ensemble Kalman filter, an apportioning of the total uncertainty in the outputs of a patient‐specific blood flow model into small portions of uncertainty due to input parameters. Statistical indicators generally used for identifying the importance of numerical parameters, namely the Sobol' first order and total indices, are introduced and discussed. These allow the identification of the importance rank of the different input parameters for the patient‐specific blood flow model, as well as the influence of the interactions between these parameters on the model output variance. The results show that knowing the importance rank of the model input parameters during the assimilation procedure is useful to avoid unnecessary over‐solving and to find a suitable stopping criterion in clinical situations where faster diagnosis is always requested. Indeed, the work permits to reduce typically by a factor of six the time to solution and most importantly with very limited extra calculation using already available information. [ABSTRACT FROM AUTHOR]

In the present work, blood flow behavior in a single artery and in arterial network is studied using time domain based one‐dimensional wave propagation model retaining the nonlinear convective force. 1‐D Navier–Stokes equation is used to model the flow behavior of the blood, using three unknown parameters: flow rate (q), cross‐sectional area of artery (A) and pressure (p) based formulation. Three different approximate velocity profile functions across the cross‐section namely modified flat, parabolic and the one proposed by Bessems are used to calculate the nonlinear convective force and the frictional force. Two different constitutive models, linear elastic model and standard linear solid model (Zener model) are used to model the arterial wall mechanical behavior. The system of partial differential equations is discretized using finite element and Crank Nicolson methods in space and time domains, respectively. Based on the formulation, an in house finite element code is developed to simulate flow behavior in both a single artery as well as in arterial network consisting of 20 small and large size arteries. Simulations are performed by enforcing a flow rate at the inlet and Windkessel model at the outlet. The results for elastic arterial wall model are found to be in good agreement with the results available in the literature. The flow rate/pressure predictions using different velocity profile functions are found to be nearly the same, however the Bessems velocity profile predicts more closer to 3D results compared to modified flat and parabolic profiles. Whereas, significant difference is found in the results predicted using elastic and viscoelastic artery wall models. [ABSTRACT FROM AUTHOR]

Computational hemodynamics is being developed as an alternative approach for assisting clinical diagnosis and treatment planning for liver diseases. The technology is non‐invasive, but the computational time could be high when the full geometry of the blood vessels is taken into account. Existing approaches use either one‐dimensional model of the artery or simplified three‐dimensional tubular geometry in order to reduce the computational time, but the accuracy is sometime compromised, for example, when simulating blood flows in arteries with plaque. In this work, we study a highly parallel method for the transient incompressible Navier–Stokes equations for the simulation of the blood flows in the full three‐dimensional patient‐specific hepatic artery, portal vein and hepatic vein. As applications, we also simulate the flow in a patient with hepatectomy and calculate the S (PPG). One of the advantages of simulating blood flows in all hepatic vessels is that it provides a direct estimate of the PPG, which is a gold standard value to assess the portal hypertension. Moreover, the robustness and scalability of the algorithm are also investigated. A 83% parallel efficiency is achieved for solving a problem with 7 million elements on a supercomputer with more than 1000 processor cores. [ABSTRACT FROM AUTHOR]

Modern approaches to modelling cardiac perfusion now commonly describe the myocardium using the framework of poroelasticity. Cardiac tissue can be described as a saturated porous medium composed of the pore fluid (blood) and the skeleton (myocytes and collagen scaffold). In previous studies fluid–structure interaction in the heart has been treated in a variety of ways, but in most cases, the myocardium is assumed to be a hyperelastic fibre‐reinforced material. Conversely, models that treat the myocardium as a poroelastic material typically neglect interactions between the myocardium and intracardiac blood flow. This work presents a poroelastic immersed finite element framework to model left ventricular dynamics in a three‐phase poroelastic system composed of the pore blood fluid, the skeleton, and the chamber fluid. We benchmark our approach by examining a pair of prototypical poroelastic formations using a simple cubic geometry considered in the prior work by Chapelle et al (2010). This cubic model also enables us to compare the differences between system behaviour when using isotropic and anisotropic material models for the skeleton. With this framework, we also simulate the poroelastic dynamics of a three‐dimensional left ventricle, in which the myocardium is described by the Holzapfel–Ogden law. Results obtained using the poroelastic model are compared to those of a corresponding hyperelastic model studied previously. We find that the poroelastic LV behaves differently from the hyperelastic LV model. For example, accounting for perfusion results in a smaller diastolic chamber volume, agreeing well with the well‐known wall‐stiffening effect under perfusion reported previously. Meanwhile differences in systolic function, such as fibre strain in the basal and middle ventricle, are found to be comparatively minor. [ABSTRACT FROM AUTHOR]

When modeling a detoxifying organ function, an important component is the impact of flow on the metabolism of a compound of interest carried by the blood. We here study the effects of red blood cells (such as the Fahraeus‐Lindqvist effect and plasma skimming) on blood flow in typical microcirculatory components such as tubes, bifurcations and entire networks, with particular emphasis on the liver as important representative of detoxifying organs. In one of the plasma skimming models, under certain conditions, oscillations between states are found and analyzed in a methodical study to identify their causes and influencing parameters. The flow solution obtained is then used to define the velocity at which a compound would be transported. A convection‐reaction equation is studied to simulate the transport of a compound in blood and its uptake by the surrounding cells. Different types of signal sharpness have to be handled depending on the application to address different temporal compound concentration profiles. To permit executing the studied models numerically stable and accurate, we here extend existing transport schemes to handle converging bifurcations, and more generally multi‐furcations. We study the accuracy of different numerical schemes as well as the effect of reactions and of the network itself on the bolus shape. Even though this study is guided by applications in liver micro‐architecture, the proposed methodology is general and can readily be applied to other capillary network geometries, hence to other organs or to bioengineered network designs. [ABSTRACT FROM AUTHOR]

In this work, we introduce an algorithmic approach to generate microvascular networks starting from larger vessels that can be reconstructed without noticeable segmentation errors. Contrary to larger vessels, the reconstruction of fine‐scale components of microvascular networks shows significant segmentation errors, and an accurate mapping is time and cost intense. Thus there is a need for fast and reliable reconstruction algorithms yielding surrogate networks having similar stochastic properties as the original ones. The microvascular networks are constructed in a marching way by adding vessels to the outlets of the vascular tree from the previous step. To optimise the structure of the vascular trees, we use Murray's law to determine the radii of the vessels and bifurcation angles. In each step, we compute the local gradient of the partial pressure of oxygen and adapt the orientation of the new vessels to this gradient. At the same time, we use the partial pressure of oxygen to check whether the considered tissue block is supplied sufficiently with oxygen. Computing the partial pressure of oxygen, we use a 3D‐1D coupled model for blood flow and oxygen transport. To decrease the complexity of a fully coupled 3D model, we reduce the blood vessel network to a 1D graph structure and use a bi‐directional coupling with the tissue which is described by a 3D homogeneous porous medium. The resulting surrogate networks are analysed with respect to morphological and physiological aspects. [ABSTRACT FROM AUTHOR]

The alteration of blood flow around an OPTEASE inferior vena cava filter with one or two blood clots attached was investigated by means of computational fluid dynamics. We used a patient‐specific vein wall geometry, and we generated different clot models with shapes adapted to the filter and vein wall geometries. A total of eight geometries, with one or two clots and a total clot volume of 0.5 or 1 cm3, were considered. A non‐Newtonian model for blood viscosity was adopted and the possible development of turbulence was accounted for by means of a three‐equation model. Two blood flow rates were considered for each case, representative for rest and exercise conditions. In exercise conditions, flow unsteadiness and even turbulence was detected in some cases. Pressure and wall shear stress (WSS) distributions were modified in all cases. Clots attached to the filter downstream basket considerably increased averaged WSS values by up to almost 50%. In all the cases a flow recirculation region appeared downstream of the clot. The degree of flow stagnation in these regions, an indicator of propensity to thrombogenesis, was estimated in terms of mean residence times and mean blood viscosity. High levels of flow stagnation were detected in rest conditions in the wake of those clots that were placed upstream from the filter. Our results suggest that one downstream placed big clot, showing a higher tendency to induce flow instabilities and turbulence, might be more harmful than two small clots placed in tandem. [ABSTRACT FROM AUTHOR]

The turbulence in the blood flow, caused by plaque deposition on the arterial wall, increases by the combined effect of the complex plaque geometries and the pulsatile blood flow. The correlation between the plaque geometry, the pulsatile inlet flow and the induced turbulence in a constricted artery is investigated in this study. Pressure drop, flow velocity and wall shear stress are determined for stenosed coronary artery models with three different degrees of asymmetric stenosis and for different heart working conditions. A Computational Fluid Dynamics model, validated against experimental data published in the literature, was developed to simulate the blood pulsatile flow inside a stenosed coronary artery model. The transitional flow behaviour was quantified by investigation of the changes in the turbulence kinetic energy. It was shown that the separation starts from the side of the asymmetric stenosis and spreads to its opposite side further downstream. The results suggest that there is a high risk of the formation of a secondary stenosis at a downstream distance equal to 10 times of the artery diameter at the side and bottom regions of the first stenosis due to the existence of the recirculation zones and low shear stresses. Finally, a stenosed patient‐specific coronary artery model was employed to illustrate the applicability of the obtained results for real geometry models. The results of this study provide a good prediction of pressure drop and blood flow rate, which can be applied in the investigation of the heart muscle workout and the required heart power. [ABSTRACT FROM AUTHOR]

The aim of the present work is to propose a robust computational framework combining computational fluid dynamics (CFD) and 4D flow MRI to predict the progressive changes in hemodynamics and wall rupture index (RPI) induced by aortic morphological evolutions in patients harboring ascending thoracic aortic aneurysms (ATAAs). An analytical equation has been proposed to predict the aneurysm progression based on age, sex, and body surface area. Parameters such as helicity, wall shear stress (WSS), time‐averaged WSS, oscillatory shear index, relative residence time, and viscosity were evaluated for two patients at different stages of aneurysm growth, and compared with age‐sex‐matched healthy subjects. The study shows that evolution of hemodynamics and RPI, despite being very slow in ATAAs, is strongly affected by morphological alterations and, in turn could impact biomechanical factors and aortic mechanobiology. An aspect of the current work is that the patient‐specific 4D MRI data sets were obtained with a follow‐up of 1 year and the measured time‐averaged velocity maps and flow eccentricity were compared with the CFD simulation for validation. The computational framework presented here is capable of capturing the blood flow patterns and the hemodynamic descriptors during the various stages of aneurysm growth. Further investigations will be conducted in order to verify these results on a larger cohort of patients and with long follow‐up times to finally elucidate the link between deranged hemodynamics, AA geometry, and wall mechanical properties in ATAAs. [ABSTRACT FROM AUTHOR]

Deep learning methods combined with large datasets have recently shown significant progress in solving several medical tasks. However, collecting and annotating large datasets can be a very cumbersome and expensive task. We tackle these problems with a virtual database approach where training data is generated using computer simulations of related phenomena. Specifically, we concentrate on the following problem: can cardiovascular indices such as aortic elasticity, diastolic and systolic blood pressures, and blood flow from heart be predicted continuously using wearable photoplethysmographic sensors? We simulate the blood flow using a haemodynamic model consisting of the entire human circulation. Repeated evaluation of the simulator allows us to create a database of "virtual subjects" with size that is only limited by available computational resources. Using this database, we train neural networks to predict the cardiac indices from photoplethysmographic signal waveform. We consider two approaches: neural networks based on predefined input features and deep convolutional neural networks taking waveform directly as the input. The performance of the methods is demonstrated using numerical examples, thus carrying out a preliminary assessment of the approaches. The results show improvements in accuracy compared with the previous methods. The improvements are especially significant with indices related to aortic elasticity and maximum blood flow. The proposed approach would provide new means to measure cardiovascular health continuously, for example, with a simple wrist device. [ABSTRACT FROM AUTHOR]

In order to reduce the complexity of heart hemodynamics simulations, uncoupling approaches are often considered for the modeling of the immersed valves as an alternative to complex fluid‐structure interaction (FSI) models. A possible shortcoming of these simplified approaches is the difficulty to correctly capture the pressure dynamics during the isovolumetric phases. In this work, we propose an enhanced resistive immersed surfaces (RIS) model of cardiac valves, which overcomes this issue. The benefits of the model are investigated and tested in blood flow simulations of the left heart where the physiological behavior of the intracavity pressure during the isovolumetric phases is recovered without using fully coupled fluid‐structure models and without important alteration of the associated velocity field. [ABSTRACT FROM AUTHOR]

Abstract: The left atrial appendage (LAA) is a complex and heterogeneous protruding structure of the left atrium (LA). In atrial fibrillation patients, it is the location where 90% of the thrombi are formed. However, the role of the LAA in thrombus formation is not fully known yet. The main goal of this work is to perform a sensitivity analysis to identify the most relevant LA and LAA morphological parameters in atrial blood flow dynamics. Simulations were run on synthetic ellipsoidal left atria models where different parameters were individually studied: pulmonary veins and mitral valve dimensions; LAA shape; and LA volume. Our computational analysis confirmed the relation between large LAA ostia, low blood flow velocities and thrombus formation. Additionally, we found that pulmonary vein configuration exerted a critical influence on LAA blood flow patterns. These findings contribute to a better understanding of the LAA and to support clinical decisions for atrial fibrillation patients. [ABSTRACT FROM AUTHOR]

Abstract: The definition of a suitable mesh to simulate blood flow in the human carotid bifurcation has been investigated. In this research, a novel mesh generation method is proposed: hexahedral cells at the center of the vessel and a fine grid of tetrahedral cells near the artery wall, in order to correctly simulate the large blood velocity gradients associated with specific locations. The selected numerical examples to show the pertinence of the novel generation method are supported by carotid ultrasound image data of a patient‐specific case. Doppler systolic blood velocities measured during ultrasound examination are compared with simulated velocities using 4 different combinations of hexahedral and tetrahedral meshes and different fluid dynamic simulators. The Lin's test was applied to show the concordance of the results. Wall shear stress–based descriptors and localized normalized helicity descriptor emphasize the performance of the new method. Another feature is the reduced computation time required by the developed methodology. With the accurate combined mesh, different flow rate partitions, between the internal carotid artery and external carotid artery, were studied. The overall effect of the partitions is mainly in the blood flow patterns and in the hot‐spot modulation of atherosclerosis‐susceptible regions, rather than in their distribution along the bifurcation. [ABSTRACT FROM AUTHOR]

Abstract: Endovascular stent graft repair has become a common treatment for complicated Stanford type B aortic dissection to restore true lumen flow and induce false lumen thrombosis. Using computational fluid dynamics, this study reports the differences in flow patterns and wall shear stress distribution in complicated Stanford type B aortic dissection patients after endovascular stent graft repair. Five patients were included in this study: 2 have more than 80% false lumen thrombosis (group 1), while 3 others had less than 80% false lumen thrombosis (group 2) within 1 year following endovascular repair. Group 1 patients had concentrated re‐entry tears around the abdominal branches only, while group 2 patients had re‐entry tears that spread along the dissection line. Blood flow inside the false lumen which affected thrombus formation increased with the number of re‐entry tears and when only small amounts of blood that entered the false lumen exited through the branches. In those cases where dissection extended below the abdominal branches (group 2), patients with fewer re‐entry tears and longer distance between the tears had low wall shear stress contributing to thrombosis. This work provides an insight into predicting the development of complete or incomplete false lumen thrombosis and has implications for patient selection for treatment. [ABSTRACT FROM AUTHOR]

Abstract: In this study, the flow features and device‐associated blood trauma in 4 clinical ventricular assist devices (VADs; 2 implantable axial VADs, 1 implantable centrifugal VAD, and 1 extracorporeal VAD) were computationally analyzed under clinically relevant pulsatile flow conditions. The 4 VADs were operated at fixed pump speed at a mean rate of 4.5 L/min. Mean pressure difference, wall shear stress, volume distribution of scalar shear stress (SSS), and shear‐induced hemolysis index (HI) were derived from the flow field of each VAD and were compared. The computationally predicted mean pressure difference across the 3 implantable VADs was ~70 mmHg, and the extracorporeal VAD was ~345 mmHg, which matched well with their reported pressure‐flow curves. The axial VADs had higher mean wall shear stress and SSS compared with the centrifugal VADs. However, the residence time of the centrifugal VADs was much longer compared with the axial VADs because of the large volume of the centrifugal VADs. The highest SSS was observed in one axial VAD, and the longest exposure time was observed in 1 centrifugal VAD. These 2 VADs generated the highest HI. The shear‐induced HI varied as a function of flow rate within each cardiac cycle. At fixed pump speed, the HI was greatest at low flow rate due to longer exposure time to shear stress compared with at high flow rate. Subsequently, we hypothesize that to reduce the risk of blood trauma during VAD support, shear stress magnitude and exposure time need to be minimized. [ABSTRACT FROM AUTHOR]

This paper presents a novel data assimilation method for patient-specific blood flow analysis based on feedback control theory called the physically consistent feedback control-based data assimilation (PFC-DA) method. In the PFC-DA method, the signal, which is the residual error term of the velocity when comparing the numerical and reference measurement data, is cast as a source term in a Poisson equation for the scalar potential field that induces flow in a closed system. The pressure values at the inlet and outlet boundaries are recursively calculated by this scalar potential field. Hence, the flow field is physically consistent because it is driven by the calculated inlet and outlet pressures, without any artificial body forces. As compared with existing variational approaches, although this PFC-DA method does not guarantee the optimal solution, only one additional Poisson equation for the scalar potential field is required, providing a remarkable improvement for such a small additional computational cost at every iteration. Through numerical examples for 2D and 3D exact flow fields, with both noise-free and noisy reference data as well as a blood flow analysis on a cerebral aneurysm using actual patient data, the robustness and accuracy of this approach is shown. Moreover, the feasibility of a patient-specific practical blood flow analysis is demonstrated. [ABSTRACT FROM AUTHOR]