Computational modelling of valvular heart disease: haemodynamic insights and clinical implications

Figures

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  FIGURE 1. Overview of computational cardiovascular modelling applications in valvular heart disease research (created with BioRender.com).

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  FIGURE 2. Summary of sub-model components of a closed-loop cardiovascular system model and the inputs which inform their development. Illustration of frequently used models of various cardiovascular processes that are combined to form a multi-compartmental model of a closed-loop cardiovascular system (created with BioRender.com).

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  FIGURE 3. (A) Classic two-element Windkessel model; (B) three-element Windkessel model; (C) four-element Windkessel model and (D) five-element Windkessel model. R is peripheral resistance, ZC is characteristic impedance, L is inertance, C is arterial compliance and C1 + C2 = arterial compliance in the five-element model. (Figure adapted from Zhou et al. (2019)).

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  FIGURE 4. Circuit diagram of a closed-loop cardiovascular system model (created with circuit-diagram.org). Abbreviations: AV, aortic valve; LA, left atrium; LV, left ventricle; MV, mitral valve; PV, pulmonary valve; RA, right atrium; RV, right ventricle; TV, tricuspid valve.

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  FIGURE 5. Simulated impact of concomitant mitral regurgitation on left ventricle and aortic pressures waves and mean pressure gradient for aortic stenosis (aortic valve area = 1.0 cm2).21 (A) = Isolated aortic stenosis, (B) = Aortic stenosis with mild mitral regurgitation, (C) = Aortic stenosis with moderate mitral regurgitation, and (D) = Aortic stenosis with severe mitral regurgitation. MPG indicates transaortic mean pressure gradient; PAo, aortic pressure; and PLV, left ventricular pressure.

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  FIGURE 6. Schematic of left ventricular stroke work and normalized-stroke work in aortic stenosis. AS, aortic stenosis, LV, left ventricle; N-SW, normalized-stroke work. (Figure taken from Keshavarz-Motamed et al. (2014)).

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  FIGURE 7. Schematic representation of the lumped parameter model used to simulate left-sided heart in presence of aortic stenosis and/or left ventricular-aortic conduit. (Figure adapted from Benevento et al. (2015)).

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  FIGURE 8. Predicted haemodynamics in a C3VI patient from baseline to 90 days post-transcatheter aortic valve replacement (TAVR). Pre-TAVR: severe aortic stenosis (effective orifice area (EOA) = 0.5 cm2); mild aortic regurgitation (AR); moderate to severe mitral regurgitation (MR); moderate to severe concentric hypertrophy; LV ejection fraction, 50%; arterial pressures, 115/40 mmHg; forward LV stroke volume, 54 mL. Post-TAVR: aortic valve (EOA = 1.6 cm2); mild to moderate AR; moderate to severe MR; hypertension, moderate to severe concentric hypertrophy; LV ejection fraction, 60%, arterial pressures, 140/45 mmHg; forward LV stroke volume, 53 mL. (Figure adapted from Keshavarz-Motamed (2020)).