Assessment of valve implantation in the descending aorta as an alternative for aortic regurgitation patients not treatable with conventional procedures

Figures

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  Fig. 1. Workflow followed throughout the study. The sections used in the numerical model are: ascending aorta (AA), descending aorta (DA), right subclavian artery (RS), right common carotid artery (RCC), left common carotid artery (LCC), and left subclavian artery (LS)

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  Fig. 2. CAD modeling of the idealized aorta geometry: fluid domain overview with sections and valve implantation site with its corresponding proximal and distal planes for pressure gradient assessment (left). Detail of the valve leaflets in its opening (top-right) and closing (bottom-right) positions

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  Fig. 3. CAD modeling of the bileaflet MHV

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  Fig. 4. Comparison of pressure distribution P with dimensionless time \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\tau $$\end{document}τ over the entire cardiac cycle (basal case and valve implanted case). Small vessels: LCC and LS a and RCC and RS b. Aorta: AA and DA c

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  Fig. 5. Comparison of flow distribution Q with dimensionless time \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\tau $$\end{document}τ over the entire cardiac cycle (basal case and valve implanted case). Aorta: AA and DA a. Small vessels: LCC and LS b and RCC and RS c

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  Fig. 6. Evolution of leaflets excursion angles during a closure and b reopening phases

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  Fig. 7. Proximal and distal pressures computed to obtain TPG for the valve case (left). TPG comparison against pressure drop for the already defined proximal and distal sections on the basal and valve cases (right). Recordings were obtained at systole (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$0 \le \tau \le 0.37$$\end{document}0≤τ≤0.37)

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  Fig. 8. TAWSS (top) and OSI (bottom) comparisons: basal case (left) and valve case (right)

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  Fig. 9. ECAP (top) and RRT (bottom) comparisons: basal case (left) and valve case (right)

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  Fig. 10. WSS values over the valve surfaces at peak systole (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\tau =0.15$$\end{document}τ=0.15)

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  Fig. 11. Values of Turbulent Shear Stress (TSS) on a valve longitudinal plane at peak systole (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\tau =0.15$$\end{document}τ=0.15)

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  Fig. 12. Frank-Starling diagrams of patients with acute severe and chronic severe AR as compared with a normal left ventricle. Data from (Lang et al. 2016) were normalized to the maximum pressures and flow rates measured for a healthy patient, respectively