Altered blood flow due to larger aortic diameters in patients with transcatheter heart valve thrombosis

Figures

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  FIG. 1.. Normalized aortic dimensions (normalized to the annulus diameter) seen in the THVT patients (blue) and the controls (red) pooled for all THVT patients and all control patients, respectively. The bottom and top edge of the boxes indicate the 25th and 75th percentiles, respectively. The median is marked with a black dot within a white circle. The red circle symbol indicates outliers. Normalized diameters of (a) the sinotubular junction (STJ) and the ascending aorta (AAo), and (b) the sinus portions corresponding to the right coronary cusp (RCC), non-coronary cusp (NCC) and the left coronary cusp (LCC). (c) Normalized heights (distance to annulus) of the right coronary artery (RCA) and the left coronary artery (LCA) and the normalized height of the sinus portion (distance between annulus and STJ).

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  FIG. 2.. Difference between the normalized dimensions of the THVT patients compared to their specific controls (0%) for each valve type and size for all aortic and sinus dimensions. Calculated as 100. (Patient value − control value)/control value. Difference in (a) aortic diameters, (b) sinus diameters, (c) heights of the coronary arteries (distance from annulus) and the sinus portion (distance between annulus and STJ), and (d) ellipticity of the different aortic cross sections. STJ, sinotubular junction; AAo, ascending aorta; NCC, non-coronary cusp; RCC, right coronary cusp; LCC, left coronary cusp; RCA, right coronary artery; LCA, left coronary artery.

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  FIG. 3.. The average velocity field from the computational analysis in the (a) control and (b) the THVT aortic models, seen from two different views normal to the main flow direction, and for three perpendicular cross sections at (1) the sinotubular junction, (2) in the ascending aorta and (3) in the bend toward the aortic arch.

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  FIG. 4.. Velocity profiles at three different cross sections in the ascending aorta: (a) plane 1 at the sinotubular junction, (b) plane 2 in the ascending aorta, and (c) plane 3 in the bend toward the aortic arch (see Fig. 3). The flow velocity is taken perpendicular ( uf,⊥¯) to the cross-sectional plane. (d) Histogram for distribution of the velocity magnitudes within the sinus portions for the control model and the THVT model. The vertical lines indicate the mean velocity magnitude in the control (red) and THVT (blue) model.

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  FIG. 5.. Instantaneous wall shear stress (τ) magnitude on the valve leaflets at three different leaflet positions during systole for the control (a) and THVT model (b).

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  FIG. 6.. Pre-operative MDCT images of a control patient indicating the measures of maximum and minimum diameter of the different aortic and sinus dimensions. (a) Measures of the annulus diameter (at 0 mm distance from the annulus). (b) Measures of the three sinus portions (at 8 mm distance from the annulus at maximum diameter). (c) Measures of the ascending aorta diameter (at 40 mm distance from the annulus). (d) Schematic of the different measured aortic dimensions. RC, right coronary; NC, non-coronary; LC, left coronary; STJ, sinotubular junction; AAo, ascending aorta.

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  FIG. 7.. (a) Schematic representation of the parameterized idealized aortic geometry with bioprosthetic valve. The geometry was parameterized relative to the annulus diameter ( dA=22 mm), and the two aortic dimensions sinotubular junction (STJ) diameter ( dSTJ) and ascending aorta (AAo) diameter ( dAAo) were used to create a THVT model and a control model. (b) Inner fluid volumes of the AAo and sinus used to calculate total systolic turbulent dissipation rate.