Recent Advances in the Application of Computational Mechanics to the Diagnosis and Treatment of Cardiovascular Disease

Abstract

During the last 30 years, research into the pathogenesis and progression of cardiovascular disease has had to employ a multidisciplinary approach involving a wide range of subject areas, from molecular and cell biology to computational mechanics and experimental solid and fluid mechanics. In general, research was driven by the need to provide answers to questions of critical importance for disease management. Ongoing improvements in the spatial resolution of medical imaging equipment coupled to an exponential growth in the capacity, flexibility, and speed of computational techniques have provided a valuable opportunity for numerical simulations and complex experimental techniques to make a contribution to improving the diagnosis and clinical management of many forms of cardiovascular disease. This paper contains a review of recent progress in the numerical simulation of cardiovascular mechanics, focusing on three particular areas: patient-specific modeling and the optimization of surgery in pediatric cardiology, evaluating the risk of rupture in aortic aneurysms, and noninvasive characterization of intraventricular flow in the management of heart failure.

Cardiovascular haemodynamics: Advancement of numerical and experimental diagnostic tools

“…After a few decades of research, the clear anatomic functional and haemodynamic interdependency of cardiovascular assemblies and the use of various simulation tools to analyse such interactions are well recognized and documented. [1][2][3][4] In line with this recent advances in computational fluid dynamics (CFD), laser diagnostics and imagining processing have introduced new methodologies to study the CVDs and the mechanisms underlying their pathology. [5][6][7][8][9][10][11] Knowledge gained from implementing these tools has led to the development of successful therapies and novel tools to characterize these clinical conditions and assist in the development of a precise, preventive and predictive treatment for CVDs.…”

Doppler vortography - Detection and quantification of the vortices in the left ventricle

“…Vortices that form during diastole have specific time varying positions, geometries, and swirling strengths, known as vorticities [47]. The presence of any specific changes in LV shape or contractile capacity, called ventricular remodeling, results in an abnormal intra-ventricular blood flow pattern [47,[53][54][55][56][57][58][59] that is less efficient in blood transportation through the heart cavities [60,61] and may accordingly lead to the progression of heart failure [48].…”

“…In DCM, the posterior part of the vortex is far from the wall and decays at a lower speed than in the normal LV. Hence, the loss of symmetry of the transmitral vortex is delayed due to decreased blood-wall interactions in the left ventricle during diastole [47,63,64].…”

“…Examples of the 2D color Doppler blood velocity mapping of normal, dilated, and severely dilated left ventricles in 3-chamber view are shown in Figure 2 shown in the color bar [47].…”

“…Moreover, the size and strength of the aforementioned abnormal apical vortex increases with respect to the progression and severity of the cardiac disease [47,63]. Formation of these abnormal vortices is associated with higher fluid energy dissipation, which may result in a significant increase in the physical work of the cardiac muscles and oxygen demand and in turn a reduction in the cardiac pumping efficiency [2,47,70,71].…”