Turbulent blood flow is often associated with some sort of cardiovascular disease, e.g. sharp bends and/or sudden constrictions/expansions of the vessel wall. The energy losses associated with the turbulent flow may increase the heart workload in order to maintain cardiac output (CO). In the present study, the amount of turbulent kinetic energy (TKE) developed in the vicinity of an aortic coarctation was estimated pre-intervention and in a variety of post-intervention configurations, using scale-resolved image-based computational fluid dynamics (CFD). TKE can be measured using magnet resonance imaging (MRI) and have also been validated with CFD simulations [1], i.e. a parameter that not only can be quantified using simulations but can also be measured by MRI.
Patient-specific geometry and inlet flow conditions were obtained using contrast-enhanced MR angiography and 2D cine phase-contrast MRI, respectively. The intervention procedure was mimicked using an inflation simulation, where six different geometries were obtained. A scale-resolving turbulence model, large eddy simulation (LES), was utilized to resolve the largest turbulent scales and also to capture the laminar-to-turbulent transition. All cases were simulated using baseline CO and with a 20% CO increase to simulate a possible flow adaption after intervention.
For this patient, results shows a non-linear decay of the total amount of TKE integrated over the cardiac phase as the stenotic cross-sectional area is increased by the intervention. Figure 1 shows the original segmented geometry and two dilated coarctation with corresponding volume rendering of the TKE at peak systole. Due to turbulent transition at a kink upstream the stenosis further dilation of the coarctation tends to restrict the TKE to a plateau, and continued vessel expansion may therefore only induce unnecessary stresses onto the arterial wall.
This patient-specific non-invasive framework has shown the geometrical impact on the TKE estimates. New insight in turbulence development indicates that the studied coarctation can only be improved to a certain extent, where focus should be on the upstream region, if further TKE reduction is motivated. The possibility of including MRI in a combined framework could have great potential for future intervention planning and follow-up studies.
[1] J. Lantz, T. Ebbers, J. Engvall and M. Karlsson, Numerical and Experimental Assessment of Turbulent Kinetic Energy in an Aortic Coarctation, Journal of Biomechnics, 2013. 46(11): p. 1851-1858.