Turbulence and blood washout in presence of mitral regurgitation: a computational fluid-dynamics study in the complete left heart

Abstract

In this work we performed a computational image-based study of blood dynamics in the whole left heart, both in a healthy subject and in a patient with mitral valve regurgitation (MVR). We elaborated dynamic cine-MRI images with the aim of reconstructing the geometry and the corresponding motion of left ventricle, left atrium, mitral and aortic valves, and aortic root of the subjects. This allowed us to prescribe such motion to computational blood dynamics simulations where, for the first time, the whole left heart motion of the subject is considered, allowing us to obtain reliable subject-specific information. The final aim is to investigate and compare between the subjects the occurrence of turbulence and the risk of hemolysis and of thrombi formation. In particular, we modeled blood with the Navier-Stokes equations in the Arbitrary Lagrangian-Eulerian framework, with a Large Eddy Simulation model to describe the transition to turbulence and a resistive method to manage the valve dynamics, and we used a Finite Elements discretization implemented in an in-house code for the numerical solution. Our results highlighted that the regurgitant jet in the MVR case gave rise to a large amount of transition to turbulence in the left atrium resulting in a higher risk of formation of hemolysis. Moreover, MVR promoted a more complete washout of stagnant fiows in the left atrium during the systolic phase and in the left ventricle apex during diastole. NEW & NOTEWORTHYReconstruction from cine-MRI images of geometries and motion of the left heart (left atrium and ventricle, aortic root, aortic and mitral valve) of a healthy and mitral regurgitant patient. Prescription of such motion to a complete subject-specific computational fluid-dynamic simulation of the left heart. Investigation of turbulence in a regurgitant scenario. Study of the mechanisms of prevention from stagnant flows and hemolysis formation in the atrium.