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In the current work, we present a descriptive fluid-structure interaction computational study of the end-to-side radio-cephalic arteriovenous fistula. This allows us to account for the different thicknesses and elastic properties of the radial artery and cephalic vein. The core of the work consists in simulating different arteriovenous fistula configurations obtained by virtually varying the anastomosis angle, i.e. the angle between the end of the cephalic vein and the side of the radial artery. Since the aim of the work is to understand the blood dynamics in the very first days after the surgical intervention, the radial artery is considered stiffer and thicker than the cephalic vein. Our results demonstrate that both the diameter of the cephalic vein and the anastomosis angle play a crucial role to obtain a blood dynamics without re-circulation regions that could prevent fistula failure. When an anastomosis angle close to the perpendicular direction with respect to the radial artery is combined with a large diameter of the cephalic vein, the recirculation regions and the low Wall Shear Stress (WSS) zones are reduced. Conversely, from a structural point of view, a low anastomosis angle with a large diameter of the cephalic vein reduces the mechanical stress acting on the vessel walls. • Fluid-structure interaction analysis for different configurations of the arteriovenous fistula. • Mismatch of the arterial and venous Young's moduli and different vessel thicknesses. • Real reconstruction of the shape of the anastomosis region. • The diameter of the cephalic vein drastically influences the hemodynamics. [ABSTRACT FROM AUTHOR]

We consider a loosely-coupled algorithm for fluid-structure interaction based on a Robin interface condition for the fluid problem (explicit Robin-Neumann scheme). We study the dependence of the stability of this method on the interface parameter in the Robin condition. In particular, for a model problem we find sufficient conditions for instability and stability of the method. In the latter case, we find a stability condition relating the time discretization parameter, the interface parameter, and the fluid and structure densities. Numerical experiments confirm the theoretical findings and highlight optimal choices of the interface parameter that guarantee accurate solutions. [ABSTRACT FROM AUTHOR]

We consider an Extended Finite Elements method to handle the case of composite independent unstructured grids that lead to unfitted meshes. In particular, we address the case of two overlapped meshes, a background and a foreground one, where the thickness of the latter is smaller than the elements of the background mesh. This situation may lead to elements split into several portions, thus generating polyhedral elements. We detail the corresponding discrete formulation for the Poisson problem with discontinuous coefficients. We also provide some technical details for the 3D implementation. Finally, we provide some numerical examples with the aim of showing the effectiveness of the proposed formulation. [ABSTRACT FROM AUTHOR]

We study the effects of transition to turbulence in abdominal aortic aneurysms (AAA). The presence of transitional effects in such districts is related to the heart pulsatility and the sudden change of diameter of the vessels, and has been recorded by means of clinical measures as well as of computational studies. Here we propose, for the first time, the use of a large eddy simulation (LES) model to accurately describe transition to turbulence in realistic scenarios of AAA obtained from radiological images. To this aim, we post-process the obtained numerical solutions to assess significant quantities, such as the ensemble-averaged velocity and wall shear stress, the standard deviation of the fluctuating velocity field, and vortical structures educed via the so-called Q-criterion. The results demonstrate the suitability of the considered LES model and show the presence of significant transitional effects around the impingement region during the mid-deceleration phase. [ABSTRACT FROM AUTHOR]

Coronary artery disease is one of the leading causes of death worldwide. The stenotic coronary vessels are generally treated with coronary artery bypass grafts (CABGs), which can be either arterial (internal mammary artery, radial artery) or venous (saphenous vein). However, the different mechanical properties of the graft can influence the outcome of the procedure in terms of risk of restenosis and subsequent graft failure. In this paper, we perform a computational fluid–structure interaction (FSI) analysis of patient-specific multiple CABGs (Y-grafts) with the aim of better understanding the influence of the choice of bypass (arterial vs venous) on the risk of graft failure. Our results show that the use of a venous bypass results in a more disturbed flow field at the anastomosis and in higher stresses in the vessel wall with respect to the arterial one. This could explain the better long-term patency of the arterial bypasses experienced in the clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: In this paper we continue in investigating the approach we have proposed in a paper recently published, for a reliable estimate of (peak systolic) blood flow rate from velocity Doppler measurements. Basic features of this approach together with some in silico test cases were discussed in that work. Here, we provide more insights of this approach by performing a sensitivity analysis of the formulas relating blood flow rate to velocity. In particular we analyze how our estimates are affected by perturbation or errors in measurements in comparison with a standard method for catheter based estimates based on the assumption of a parabolic velocity profile. A first glance to in vivo clinical applications is given as well. [Copyright &y& Elsevier]

Abstract: We consider the incompressible Navier–Stokes problem with flow rate boundary conditions. This problem has been investigated in [J. Heywood, R. Rannacher, S. Turek, Artificial boundaries and flux and pressure conditions for the incompressible Navier–Stokes equations, Int. J. Numer. Methods Fluids 22 (1996) 325–352; L. Formaggia, J. F. Gerbeau, F. Nobile, A. Quarteroni, Numerical treatment of defective boundary conditions for the Navier–Stokes equation, SIAM J. Numer. Anal. 40(1) (2002) 376–401; A. Veneziani, C. Vergara, Flow rate defective boundary conditions in haemodynamics simulations, Int. J. Numer. Methods Fluids 47 (2005) 803–816]. In the latter two papers, a feasible numerical formulation of this problem, based on a Lagrange multiplier approach has been investigated. This approach has the drawback of high computational costs. In this paper, we propose an approximate formulation of this problem, yielding a strong reduction of the computational costs. The error analysis shows that the error introduced by this approximate formulation is confined in a small region of the boundary. This is confirmed by the numerical simulations. [Copyright &y& Elsevier]

Abstract: Physically useful measures in current clinical practice refer often to the blood flow rate, that is related to the mean velocity. However, the direct measurement of the latter is currently not possible using a Doppler velocimetry technique. Therefore, the usual approach to calculate the flow rate with this technique consists in measuring the maximum velocity and in estimating the mean velocity, making the hypothesis of parabolic profile that in realistic situations results in strongly inaccurate estimates. In this paper, we propose a different way for estimating the flow rate regarded as a function of maximum velocity and Womersley number. This relation is obtained by fixing a parametrised representation and by evaluating the parameters by means of a least-square approach working on the numerical results of CFD simulations (about 200). Numerical simulations are carried out by prescribing the flow rate, not the velocity profile. In this way, no bias is implicitly induced in prescribing boundary conditions. Validation tests based on numerical simulations show that the proposed relation improves the flow rate estimation. (E-mail: ponzini@cilea.it) [Copyright &y& Elsevier]

We consider the two-dimensional numerical approximation of the fluid-structure interaction problem over unfitted fluid and structure meshes. In particular, we consider a method where the fluid mesh (on the background) is fixed, apart from the interface with the moving immersed structure, where general polygonal elements of arbitrary shape and changing in time are generated. The new idea of this work is to handle the discretization on such polygons by using the Discontinuous Galerkin method on polyhedral grids (PolyDG), which has been recently developed for different differential equations and here adapted for the first time to a heterogeneous problem. We prove a stability result of the proposed semi-discrete formulation and discuss how to deal with the partial or total covering of a fluid mesh element due to the structure movement. We finally present some numerical results with the aim of showing the effectiveness of the proposed method. • We present a new method based on the Discontinuous Galerkin method for polygonal elements for the interaction of a fluid with an immersed structure. • High order approximations are easily obtained by considering a modal basis functions directly in the physical frame configuration. • We provide a stability analysis of the discretized-in-space formulation. • We present several numerical results with the aim of assessing the validity of the proposed method. • These results show the ability of the method even with very small dimension of mesh elements and very anisotropic elements. [ABSTRACT FROM AUTHOR]

Abstract: In this paper we consider the numerical solution of the interaction of an incompressible fluid and an elastic structure in a truncated computational domain. As well known, in this case there is the problem of prescribing realistic boundary data on the artificial sections, when only partial data are available. This problem has been investigated extensively for the rigid case. In this work we start considering the compliant case, by focusing on the flow rate conditions for the fluid. We propose three formulations of this problem, different algorithms for its numerical solution and carry out several 2D numerical simulations with the aim of comparing the performances of the different algorithms. [Copyright &y& Elsevier]

Abstract: In this work, we propose a Robin–Robin preconditioner combined with Krylov iterations for the solution of the interface system arising in fluid–structure interaction (FSI) problems. It can be seen as a partitioned FSI procedure and in this respect it generalizes the ideas introduced in [S. Badia, F. Nobile, C. Vergara, J. Comput. Phys. 227 (2008) 7027–7051]. We analyze the convergence of GMRES iterations with the Robin–Robin preconditioner on a model problem and compare its efficiency with some existing algorithms. The method is shown to be very efficient for many challenging fluid–structure interaction problems, such as those characterized by a large added-mass effect or by enclosed fluids. In particular, the possibility to solve balloon-type problems without any special treatment makes this algorithm very appealing compared to the computationally intensive existing approaches. [Copyright &y& Elsevier]

Background The use of left ventricular assist devices (LVADs) to treat advanced cardiac heart failure is constantly increasing, although this device leads to high risk for gastrointestinal bleeding. Methods Using in-silico flow analysis, we quantified hemodynamic alterations due to continuous-flow LVAD (HeartWare, Inc., Framingham, MA) in the celiac trunk and major branches of the abdominal aorta, and then explored the relationship between wall shear stress (WSS) and celiac trunk orientation. To assess outflow from the aortic branch, a 3-dimensional-printed patient-specific model of the celiac trunk reconstructed from an LVAD-supported patient was used to estimate echocardiographic outflow velocities under continuous-flow conditions, and then to calibrate computational simulations. Moreover, flow pattern and resulting WSS values were computed for 5 patients with LVAD implantation. Results Peak WSS values were estimated on the 3 branches of the celiac trunk and the LVAD cannula. The mean WSSs demonstrated that the left gastric artery underwent the highest WSS of 9.08 ± 5.45 Pa, with an average flow velocity of 0.57 ± 0.25 m/s compared with that of other vessel districts. The common hepatic artery had a less critical WSS of 4.58 ± 1.77 Pa. A positive correlation was found between the celiac trunk angulation and the WSS stress just distal to the ostium of the celiac trunk ( R = 0.9), which may increase vulnerability of this vessel to bleeding. Conclusions Although further studies are needed to confirm these findings in a larger patient cohort, computational flow simulations may enhance the information of clinical image data and may have an application in clinical investigations of hemodynamic changes in LVAD-supported patients. [ABSTRACT FROM AUTHOR]

Two crucial factors for accurate numerical simulations of cardiac electromechanics, which are also essential to reproduce the synchronous activity of the heart, are: (i) accounting for the interaction between the heart and the circulatory system that determines pressures and volumes loads in the heart chambers; (ii) reconstructing the muscular fiber architecture that drives the electrophysiology signal and the myocardium contraction. In this work, we present a 3D biventricular electromechanical model coupled with a 0D closed-loop model of the whole cardiovascular system that addresses the two former crucial factors. With this aim, we introduce a boundary condition for the mechanical problem that accounts for the neglected part of the domain located on top of the biventricular basal plane and that is consistent with the principles of momentum and energy conservation. We also discuss in detail the coupling conditions behind the 3D and the 0D models. We perform electromechanical simulations in physiological conditions using the 3D–0D model and we show that our results match the experimental data of relevant mechanical biomarkers available in the literature. Furthermore, we investigate different arrangements in cross-fibers active contraction. We prove that an active tension along the sheet direction counteracts the myofiber contraction, while the one along the sheet-normal direction enhances the cardiac work. Finally, several myofiber architectures are analyzed. We show that a different fiber field in the septal area and in the transmural wall affects the pumping functionality of the left ventricle. • 3D electromechanical biventricular model coupled with a 0D hemodynamic closed-loop model. • A novel effective mechanical boundary condition for the biventricular basal plane. • Numerical results on a realistic biventricular model matching the experimental data. • Study of different configurations in cross-fibers active contraction. • Evaluation of the impact of different myofibers architectures on biventricular electromechanics. [ABSTRACT FROM AUTHOR]

Since myocardial fibers drive the electric signal propagation throughout the myocardium, accurately modeling their arrangement is essential for simulating heart electrophysiology (EP). Rule-Based-Methods (RBMs) represent a commonly used strategy to include cardiac fibers in computational models. A particular class of such methods is known as Laplace–Dirichlet-Rule-Based-Methods (LDRBMs) since they rely on the solution of Laplace problems. In this work we provide a unified framework, based on LDRBMs, for generating full heart muscle fibers. First, we review existing ventricular LDRBMs providing a communal mathematical description and introducing also some modeling improvements with respect to the existing literature. We then carry out a systematic comparison of LDRBMs based on meaningful biomarkers produced by numerical EP simulations. Next we propose, for the first time, a LDRBM to be used for generating atrial fibers. The new method, tested both on idealized and realistic atrial models, can be applied to any arbitrary geometries. Finally, we present numerical results obtained in a realistic whole heart where fibers are included for all the four chambers using the discussed LDRBMs. [ABSTRACT FROM AUTHOR]