Key result
Mitral PVL modeling shows shear stress exceeds 300 Pa but remains unlinked to leak cross-sectional area.
Why the study?
It remains unclear how different properties of mitral paravalvular leak channels contribute to the presence of hemolysis due to shear stress.
Computational modeling demonstrates that the cross-sectional area of mitral paravalvular leaks does not linearly correlate with the volume or duration of high shear stress exposure associated with hemolysis.
Questions PVL area as hemolysis predictor; computational models leave open geometry-specific shear validation in patients.
Paravalvular leaks (PVLs) may lead to hemolysis. In vitro shear stress forces above 300 Pa cause erythrocyte destruction. PVL channel dimensions may determine magnitude of shear stress forces that affect erythrocytes; however, this has not been tested. It remains unclear how different properties of PVL channels contribute to presence of hemolysis. A model of a left ventricle was created based on data from computer tomography with Slicer software PVLs of various shapes and sizes were introduced. Blood flow was simulated using ANSYS Fluent software. The following variables were examined: wall shear stress, shear stress in fluid, volume of PVL channel with shear stress exceeding 300 Pa, and duration of exposure of erythrocytes to shear stress values above 300 Pa. In all models, shear stress forces exceeded 300 Pa. Shear stress increased with blood flow rates and cross-sectional areas of any PVL. There was no linear relationship between cross-sectional area of a PVL and volume of a PVL channel with shear stress > 300 Pa. Blood flow through mitral PVLs is associated with shear stress above 300 Pa. Cross-sectional area of a PVL does not correlate with volume of a PVL channel with shear stress > 300 Pa and duration of exposure of erythrocytes to shear stress > 300 Pa.
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Kozłowski et al. (2021) studied Mitral paravalvular leaks. Paravalvular leak channel dimensions and shapes was evaluated on Wall shear stress, shear stress in fluid, volume of PVL channel with shear stress > 300 Pa, and duration of exposure. Computational fluid dynamics modeling of mitral paravalvular leaks showed shear stress exceeded 300 Pa in all models, but cross-sectional area did not correlate with high shear stress volume.
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