Patient-specific blood flows and vortex formations in patients with hypertrophic cardiomyopathy using computational fluid dynamics

Impact of Aortoseptal Angle Abnormalities and Discrete Subaortic Stenosis on Left-Ventricular Outflow Tract Hemodynamics: Preliminary Computational Assessment

“…The obstructed LVOT exhibited a very contrasted interventricular hemodynamics marked by a larger diastolic interventricular vortex, its migration further toward the apex of the LV chamber, and the formation of several smaller vortices throughout the filling phase. Interestingly, those flow features are qualitatively similar to those reported in a previous study examining outflow obstruction caused by hypertrophic cardiomyopathy, which evidenced the formation of a dominant anterior vortex ring and its migration toward the center of the LV chamber, and the formation of several smaller vortices in the LVOT (Su et al, 2014a).…”

“…Despite the limitations of the 2D approach adopted in the present study, the unobstructed LV models (N-LV and S-LV) were able to capture the diastolic asymmetric interventricular vortex previously reported in vivo and in computational studies (Kilner et al, 2000;Schenkel et al, 2009;Le and Sotiropoulos, 2012;Su et al, 2014a;Bavo et al, 2016). This vortex, which results from the expansion of the mitral jet into the LV chamber and its separation from the anterior leaflet (Khalafvand et al, 2012;Su et al, 2014b), enhances ventricular ejection by redirecting fluid away from the LVOT during ventricular filling (Kilner et al, 2000).…”

“…This meshing strategy resulted in grid sizes of 177,600, 177,510, and 175,359 cells for the N-LV, S-LV and DSS-LV models, respectively. Consistent with previous LV flow simulations (Su et al, 2014a;Doost et al, 2017), blood was approximated as an incompressible, Newtonian fluid (ρ = 1050 kg/m 3 ; µ = 0.0035 kg/m.s). The boundary conditions consisted of transient and spatially uniform velocity profiles at the mitral inlet and aortic outlet of the fluid domain.…”

Application of Patient-Specific Computational Fluid Dynamics in Coronary and Intra-Cardiac Flow Simulations: Challenges and Opportunities

“…A secondary application is to advance the understanding of the effects of myocardial disease and surgery on ventricular flow. Su and colleagues deduced that HCM retarded the formation of vortex ring during diastole because the narrowed LV chamber delayed flow separation and escalated energy dissipation (Su et al, 2014a ). Although various effects of myocardial disease on ventricular flow have been investigated, sample sizes in these numerical studies were too small to provide meaningful insights.…”

“…This is a hurdle to wider adoption of numerical studies. Most studies focus on normal subjects, with relatively few myocardial disease cases, for example, right ventricle (RV) dysfunction (Mangual et al, 2012 ), dilated cardiomyopathy (Mangual et al, 2013 ), hypertrophic cardiomyopathy (HCM) (Su et al, 2014a ), single ventricle (Corsini et al, 2014 ), and myocardial infarction (Khalafvand et al, 2012 ) (Figure 6 ).…”