Intracardiac flow analysis aims to evaluate blood flow patterns and associated parameters for the assessment of cardiac function. However, there is limited understanding as to how flow parameters are influenced by various sources, such as pressure upstream/downstream and cardiac chamber compliance. The objective of this study was to investigate experimental and computational tissue-mimicking models to be used alongside 2D Blood Speckle Imaging for intracardiac flow analysis. Two geometries, an axisymmetric swell and idealized left ventricle, were utilized. As an initial parameter of interest, the pressure-drop across each geometry was determined from tissue-mimicking phantoms using direct pressure measurements, blood speckle imaging, and 3D computational fluid dynamics simulations with fluid-structure interaction. The results indicate limited quantitative agreement between direct measurements, 2D blood speckle imaging, and 3D computational fluid dynamics, with qualitative agreement capturing a consistent shape of the pressure drop curve between methods. Additionally, the importance of phantom design is demonstrated due to the likely impact of gel thickness on flow patterns and their associated measurements. The findings of this study indicate that future work focusing on the optimization of BSI settings and increasing model complexity with the inclusion of cardiac valves and patient-specific geometries are still required. These models may then allow for further tuning of variables to better understand their effect on various intracardiac flow parameters, and ultimately their clinical applicability.

OBJECTIVE:Bioprosthetic venous valves have yet to achieve long-term patency due to issues with calcification following implantation that is influenced by current xenograft fixation methods, most notably glutaraldehyde. The goal of this study was to investigate the effects of glutaraldehyde fixation on the functional properties of venous tissue to establish a benchmark for the evaluation of alternative fixation methods.METHODS:The degree of crosslinking was evaluated by determining shrink temperature and the stability of tissue with pronase and collagenase digestion.RESULTS:Glutaraldehyde fixation of venous tissue was confirmed by a significant difference in the shrink temperature between fresh and glutaraldehyde treated samples. Significant differences in the amount of tissue remaining following digestion were observed for venous versus cardiac tissue.CONCLUSIONS:This study demonstrates the importance of tissue-specific evaluation in the development of alternative xenograft fixation methods to improve outcomes with bioprosthetic venous valves.

Purpose Flow phantoms are used in experimental settings to aid in the simulation of blood flow. Custom geometries are available, but current phantom materials present issues with degradability and/or mimicking the mechanical properties of human tissue. In this study, a method of fabricating custom wall-less flow phantoms from a tissue-mimicking gel using 3D printed inserts is developed. Methods A 3D blood vessel geometry example of a bifurcated artery model was 3D printed in polyvinyl alcohol, embedded in tissue-mimicking gel, and subsequently dissolved to create a phantom. Uniaxial compression testing was performed to determine the Young’s moduli of the five gel types. Angle-independent, ultrasound-based imaging modalities, Vector Flow Imaging (VFI) and Blood Speckle Imaging (BSI), were utilized for flow visualization of a straight channel phantom. Results A wall-less phantom of the bifurcated artery was fabricated with minimal bubbles and continuous flow demonstrated. Additionally, flow was visualized through a straight channel phantom by VFI and BSI. The available gel types are suitable for mimicking a variety of tissue types, including cardiac tissue and blood vessels. Conclusion Custom, tissue-mimicking flow phantoms can be fabricated using the developed methodology and have potential for use in a variety of applications, including ultrasound-based imaging methods. This is the first reported use of BSI with an in vitro flow phantom.

Fluid Structure Interaction (FSI) models are an essential tool in understanding the complex coupling of blood flow in the heart. The objective of this study is to establish a method of comparing data obtained from FSI models and benchtop measurements from phantoms to identify sources of flow changes for use in intraventricular flow analysis. Two geometries are considered: 1) a vascular model consisting of a straight channel with an ellipsoidal swell and 2) an idealized left ventricle (LV) model representative "acorn" shape. Two phantoms are created for each of the two geometries: 3D printed rigid phantoms from a resin and custom-made tissuemimicking phantoms from a medical gel. Benchtop measurements are made using the phantoms within a custom flow loop setup with pulsatile flow. Computational Fluid Dynamics (CFD) simulations are conducted with a Smoothed Particle Hydrodynamics (SPH) model. The two flow channel geometries utilized in the experiments are replicated for the simulations. The cavity walls are defined by ghost particles that are rigidly fixed. Maximum pressure drops were 57 mmHg and 196 mmHg for the rigid swell and rigid LV, respectively, whereas maximum pressure drops were 155 mmHg for the gel swell and 140 mmHg for the gel LV. Calculations from the simulations resulted in a maximum pressure drop of 55 mmHg for the swell and 110 mmHg for the LV. This data serves as a first step in corroborating our methodology to utilize the information obtained from both methods to identify and better understand mutual sources of changes in flow patterns.

In children with congenital heart defects, Doppler ultrasound is the standard, bedside imaging modality. However, precise characterization of blood flow is challenging due to angle-dependent and one-dimensional velocity estimation. Contrast agent free Vector Flow Imaging is a new ultrasound technology that enables angle-independent visualization of the detailed flow field. Two piglets, one with normal cardiac anatomy and one with congenital heart disease comprised of valvular pulmonary stenosis, a dilated main pulmonary artery, and an incomplete atrioventricular canal defect, were imaged transthoracically and epicardially using a BK Ultrasound bk5000 with built-in vector flow imaging and a 5 MHz linear probe. Subsequently, two children, one with normal cardiac anatomy and one with congenital heart disease comprised of aortic valve stenosis and coarctation of the aorta were imaged transthoracically. Transthoracic two-dimensional echocardiography and vector flow imaging were readily performed in both animals and were limited only by the geometry of the porcine thorax. In addition, transthoracic vector flow imaging was successfully performed in both children, and abnormal flow secondary to cardiac anomalies was visible. Adequate penetration was obtained to a depth of 6.5 cm. Our group has previously demonstrated for the first time that transthoracic vector flow imaging echocardiography is feasible and practicable in pediatric-sized patients, and this paper describes examples of these concepts and in-depth comparisons with traditional imaging modalities. This paper demonstrates that commercially available vector flow imaging technology can be utilized in pediatric cardiac applications as a bedside transthoracic imaging modality, providing advanced detail of blood flow patterns within the cardiac chambers, across valves, and in the great arteries.

OBJECTIVES:The purpose of this study is to test venous valve performance and identify differences between native tissue and replacement devices developed with traditional tissue treatment methods using a new in vitro model with synchronized hemodynamic parameters and high-speed valve image acquisition.METHODS:An in vitro model mimicking the venous circulation to test valve performance was developed using hydrostatic pressure driven flow. Fresh and glutaraldehyde-treated vein segments were placed in the setup and opening/closing of the valves was captured by a high-speed camera. Hemodynamic data were obtained using synchronized hardware and virtual instrumentation.RESULTS:Geometric orifice area and opening/closing time of the valves was evaluated at the same hemodynamic conditions. A reduction in geometric orifice area of 27.2  ± 14.8% (p < 0.05) was observed following glutaraldehyde fixation. No significant difference in opening/closing time following chemical fixation was observed.CONCLUSIONS:The developed in vitro model was shown to be an effective method for measuring the performance of venous valves. The observed decrease in geometric orifice area following glutaraldehyde treatment indicates a decrease in flow through the valve, demonstrating the consequences of traditional tissue treatment methods.

The dynamically formed EAs may be altered to obtain a range of fibrin/platelet to erythrocyte ratios. The proposed methodology for EA formation offers a platform for continued development of retrieval mechanism prototypes.