Abstract
Pathologies of the aortic valve such as aortic sclerosis are thought to impact coronary blood flow. Recent clinical investigations have observed simultaneous structural and hemodynamic variations in the aortic valve and coronary arteries due to regional pathologies of the aortic valve. The goal of the present study is to elucidate this observed and yet unexplained phenomenon, in which a local pathology in the aortic valve region could potentially lead to the initiation or progression of coronary artery disease. Results revealed a considerable impact on the coronary flow, velocity profile, and consequently shear stress due to an increase in the aortic wall or aortic leaflet stiffness and thickness which concur with clinical observations. The cutoff value of 0.75 for fractional flow reserve was reached when the values of leaflet thickness and aortic wall stiffness were approximately twice and three times their normal value, respectively. Variations observed in coronary velocity profiles as well as wall shear stress suggest a possible link for the initiation of coronary artery disease.
Similar content being viewed by others
References
Balazs E, Pinter KS, Egyed A, Csanady M, Forster T, Nemes A (2011) The independent long-term prognostic value of coronary flow velocity reserve in female patients with chest pain and negative coronary angiograms (results from the SZEGED study). Int J Cardiol 146(2):259–261
Bech GJW, Droste H, Pijls NHJ, De Bruyne B, Bonnier JJRM, Michels HR, Peels KH, Koolen JJ (2001) Value of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease. Heart 86(5):547–552
Bellhous BJ (1969) Velocity and pressure distributions in aortic valve. J Fluid Mech 37:587
Benson DJ (1992) Computational methods in Lagrangian and Eulerian hydrocodes. Comput Methods Appl Mech Eng 99(2–3):235–394
Bergel DH (1961) The dynamic elastic properties of the arterial wall. J Physiol 156(3):458–469
Boerboom RA, Driessen NJ, Bouten CV, Huyghe JM, Baaijens FP (2003) Finite element model of mechanically induced collagen fiber synthesis and degradation in the aortic valve. Ann Biomed Eng 31(9):1040–1053
Bogren HG, Mohiaddin RH, Klipstein RK, Firmin DN, Underwood RS, Rees SR, Longmore DB (1989) The function of the aorta in ischemic heart-disease: a magnetic-resonance and angiographic study of aortic compliance and blood-flow patterns. Am Heart J 118(2):234–247
Briones AM, Arribas SM, Salaices M (2010) Role of extracellular matrix in vascular remodeling of hypertension. Curr Opin Nephrol Hypertens 19(2):187–194. doi:10.1097/MNH.0b013e328335eec9
Campbell I (2007) A study of coronary flow in the presence of geometric and mechanical abnormalities in a fluid-structure interaction model of the aortic valve. p ix, 83 leaves
Campbell I, Ranga A, Mongrain R, Cartier R (2007) Coronary flow in an FSI model of the aortic valve. In: Proceedings of the 30th canadian medical and biological engineering conference (CMBEC 30) in the festival of international conferences on caregiving, disability, aging and technology (FICCDAT '07), Toronto
Carmody CJ, Burriesci G, Howard IC, Patterson EA (2006) An approach to the simulation of fluid-structure interaction in the aortic valve. J Biomech 39(1):158–169
Cataloglu A, Gould PL, Clark RE (1975) Validation of a simplified mathematical-model for stress analysis of human aortic heart valves. J Biomech 8(5):347–348
Chandran KB (2010) Role of computational simulations in heart valve dynamics and design of valvular prostheses. Cardiovasc Eng Technol 1(1):18–38
Chen Y, Wen C, Tao G, Bi M, Li G (2009) Continuous and noninvasive blood pressure measurement: a novel modeling methodology of the relationship between blood pressure and pulse wave velocity. Ann Biomed Eng 37(11):2222–2233
Chew GG, Howard IC, Patterson EA (1999) Simulation of damage in a porcine prosthetic heart valve. J Med Eng Technol 23(5):178–189
Cunningham KS, Gotlieb AI (2005) The role of shear stress in the pathogenesis of atherosclerosis. Lab Invest 85(1):9–23
Davies JE, Parker KH, Francis DP, Hughes AD, Mayet J (2008) What is the role of the aorta in directing coronary blood flow? Heart 94(12):1545–1547
De Bruyne B, Sarma J (2008) Fractional flow reserve: a review. Heart 94(7):949–959
De Hart J, Peters GW, Schreurs PJ, Baaijens FP (2000) A two-dimensional fluid-structure interaction model of the aortic valve [correction of value]. J Biomech 33(9):1079–1088
De Hart J, Baaijens FPT, Peters GWM, Schreurs PJG (2003) A computational fluid-structure interaction analysis of a fiber-reinforced stentless aortic valve. J Biomech 36(5):699–712
De Paulis R, De Matteis GM, Nardi P, Scaffa R, Buratta MM, Chiariello L (2001) Opening and closing characteristics of the aortic valve after valve-sparing procedures using a new aortic root conduit. Ann Thorac Surg 72(2):487–494
Di Martino ES, Guadagni G, Fumero A, Ballerini G, Spirito R, Biglioli P, Redaelli A (2001) Fluid-structure interaction within realistic three-dimensional models of the aneurysmatic aorta as a guidance to assess the risk of rupture of the aneurysm. Med Eng Phys 23(9):647–655
Dimitrow PP, Krzanowski M, Niz˙ankowski R, Szczeklik A, Dubiel JS (2000) Effect of verapamil on systolic and diastolic coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy. Heart 83(3):262–266
Downey JM, Kirk ES (1975) Inhibition of coronary blood flow by a vascular waterfall mechanism. Circ Res 36(6):753–760
Duncker DJ, Bache RJ (2008) Regulation of coronary blood flow during exercise. Physiol Rev 88(3):1009–1086
Garcia D, Kadem L (2006) What do you mean by aortic valve area: geometric orifice area, effective orifice area, or gorlin area?. J Heart Valve Dis 15(5):601–608
Garcia D, Camici PG, Durand LG, Rajappan K, Gaillard E, Rimoldi OE, Pibarot P (2009) Impairment of coronary flow reserve in aortic stenosis. J Appl Physiol 106(1):113–121
Gibson CM, Diaz L, Kandarpa K, Sacks FM, Pasternak RC, Sandor T, Feldman C, Stone PH (1993) Relation of vessel wall shear-stress to atherosclerosis progression in human coronary-arteries. Arterioscler Thromb 13(2):310–315
Guivier-Curien C, Deplano V, Bertrand E (2009) Validation of a numerical 3-D fluid–structure interaction model for a prosthetic valve based on experimental PIV measurements. Med Eng Phys 31(8):986–993
Halcox JPJ, Schenke WH, Zalos G, Mincemoyer R, Prasad A, Waclawiw MA, Nour KRA, Quyyumi AA (2002) Prognostic value of coronary vascular endothelial dysfunction. Circulation 106(6):653–658
Handke M, Heinrichs G, Beyersdorf F, Olschewski M, Bode C, Geibel A (2003) In vivo analysis of aortic valve dynamics by transesophageal 3-dimensional echocardiography with high temporal resolution. J Thorac Cardiovasc Surg 125(6):1412–1419
Hartley CJ, Reddy AK, Michael LH, Entman ML, Taffet GE (2009) Coronary flow reserve as an index of cardiac function in mice with cardiovascular abnormalities. Conf Proc IEEE Eng Med Biol Soc 2009:1094–1097
Hartley CJ, Reddy AK, Michael LH, Entman ML, Chintalagattu V, Khakoo AY, Taffet GE (2010) Coronary flow reserve in mice: effects of age, coronary disease, and vascular loading. Conf Proc IEEE Eng Med Biol Soc 2010:3780–3783
Heineman FW, Grayson J (1985) Transmural distribution of intramyocardial pressure measured by micropipette technique. Am J Physiol Heart Circ Physiol 249(6):H1216–H1223
Hess DS, Bache RJ (1976) Transmural distribution of myocardial blood flow during systole in the awake dog. Circ Res 38(1):5–15
Higashidate M, Tamiya K, Beppu T, Imai Y (1995) Regulation of the aortic-valve opening: in vivo dynamic measurement of aortic-valve orifice area. J Thorac Cardiovasc Surg 110(2):496–503
Kim HJ, Vignon-Clementel IE, Figueroa CA, LaDisa JF, Jansen KE, Feinstein JA, Taylor CA (2009) On coupling a lumped parameter heart model and a three-dimensional finite element aorta model. Ann Biomed Eng 37(11):2153–2169
Kim HJ, Vignon-Clementel IE, Coogan JS, Figueroa CA, Jansen KE, Taylor CA (2010) Patient-specific modeling of blood flow and pressure in human coronary arteries. Ann Biomed Eng 38(10):3195–3209
Kim HJ, Vignon-Clementel IE, Figueroa CA, Jansen KE, Taylor CA (2010) Developing computational methods for three-dimensional finite element simulations of coronary blood flow. Finite Elem Anal Des 46(6):514–525
Koch TM, Reddy BD, Zilla P, Franz T (2009) Aortic valve leaflet mechanical properties facilitate diastolic valve function. Comput Methods Biomech Biomed Engin 13(2):225–234
Krams R, Bambi G, Guidi F, Helderman F, van der Steen AFW, Tortoli P (2005) Effect of vessel curvature on Doppler derived velocity profiles and fluid flow. Ultrasound Med Biol 31(5):663–671
Krishnamurthy G, Itoh A, Bothe W, Swanson JC, Kuhl E, Karlsson M, Craig Miller D, Ingels NB Jr (2009) Stress-strain behavior of mitral valve leaflets in the beating ovine heart. J Biomech 42(12):1909–1916
Kuo L, Chilian WM, Davis MJ (1991) Interaction of pressure- and flow-induced responses in porcine coronary resistance vessels. Am J Physiol Heart Circ Physiol 261(6):H1706–H1715
Levy MN, Pappano AJ (2007) Cardiovascular physiology, Mosby physiology monograph series, 9th edn. Elsevier, Philadelphia
Souli M (2004) LS-DYNA Advanced course in ALE and fluid/structure coupling. Livermore Scientific Technology Corp, Livermore
Marom G, Haj-Ali R, Raanani E, Schäfers H-J, Rosenfeld M (2012) A fluid–structure interaction model of the aortic valve with coaptation and compliant aortic root. Med Biol Eng Comput 50(2):173–182
Mohiaddin RH, Firmin DN, Longmore DB (1993) Age-related-changes of human aortic flow wave velocity measured noninvasively by magnetic-resonance-imaging. J Appl Physiol 74(1):492–497
Morris L, Delassus P, Callanan A, Walsh M, Wallis F, Grace P, McGloughlin T (2005) 3-D numerical simulation of blood flow through models of the human aorta. J Biomech Eng Trans Asme 127(5):767–775
Mowat DHR, Haites NE, Rawles JM (1983) Aortic blood velocity-measurement in healthy-adults using a simple ultrasound technique. Cardiovasc Res 17(2):75–80
Myers JG, Moore JA, Ojha M, Johnston KW, Ethier CR (2001) Factors influencing blood flow patterns in the human right coronary artery. Ann Biomed Eng 29(2):109–120
Nemes A, Forster T, Lengyel C, Csanady M (2005) Elastic modulus characterising the aortic distensibility and coronary flow reserve in diabetes mellitus patients with a negative coronary angiogram. Eur Heart J 26:692
Nemes A, Forster T, Thury A, Kovacs Z, Boda K, Csanady M (2003) The comparative value of the aortic atherosclerosis and the coronary flow velocity reserve evaluated by stress transesophageal echocardiography in the prediction of patients with aortic stenosis with coronary artery disease. Int J Cardiovasc Imaging 19(5):371–376
Nemes A, Forster T, Ungi I, Nagy V, Vass A, Palinkas A, Varga A, Csanady M (2005) The coronary flow velocity reserve measured by stress transoesophageal echocardiography evaluates the success of coronary interventions–results of a 5 year follow-up. Scand Cardiovasc J 39(5):286–292
Nemes A, Forster T, Csanady M (2006) Relationship between coronary flow velocity reserve and aortic stiffness. Am J Physiol Heart Circ Physiol 290(3):H1311
Nemes A, Forster T, Csanady M (2007) Reduction of coronary flow reserve in patients with increased aortic stiffness. Can J Physiol Pharmacol 85(8):818–822
Nemes A, Ungi I, Csanady M, Forster T (2010) Simultaneous improvement in aortic distensibility and coronary flow velocity reserve after successful coronary interventions. Echocardiography 27(3):311–316
Nemes A, Balazs E, Pinter S, Csanady M, Forster T (2010) Long-term prognostic significance of coronary flow velocity reserve in patients with significant coronary artery disease not involving the left anterior descending coronary artery (results from the SZEGED study). Echocardiography 27(3):306–310
Nobari S, Mongrain R, Gaillard E, Leask R, Cartier R (2012) Therapeutic vascular compliance change may cause significant variation in coronary perfusion: a numerical study. Comput Math Methods Med 2012:10
Olsen MH, Wachtell K, Bella JN, Liu JE, Boman K, Gerdts E, Papademetriou V, Nieminen MS, Rokkedal J, Dahlöf B, Devereux RB (2004) Effect of losartan versus atenolol on aortic valve sclerosis (a LIFE substudy). Am J Cardiol 94(8):1076–1080
Olsen MH, Wachtell K, Bella JN, Gerdts E, Palmieri V, Nieminen MS, Smith G, Ibsen H, Devereux RB (2005) Aortic valve sclerosis relates to cardiovascular events in patients with hypertension (a LIFE substudy). Am J Cardiol 95(1):132–136
O’Rourke MF (2008) How stiffening of the aorta and elastic arteries leads to compromised coronary flow. Heart 94(6):690–691
Otto CM (2004) Why is aortic sclerosis associated with adverse clinical outcomes? J Am Coll Cardiol 43(2):176–178
Otto CM, Shovelle DM (2000) Aortic stenosis. In: Crawford MH, Dimarco JP (eds) Cardiology. Mosby, London
Pijls N, van Son J, Kirkeeide R, De Bruyne B, Gould K (1993) Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation 87(4):1354–1367
Ranga A, Mongrain R, Mendes Galaz R, Biadillah Y, Cartier R (2004) Large-displacement 3D structural analysis of an aortic valve model with nonlinear material properties. J Med Eng Technol 28(3): 95–103, discussion 104
Robicsek F, Thubrikar MJ, Cook JW, Fowler B (2004) The congenitally bicuspid aortic valve: how does it function? Why does it fail? Ann Thorac Surg 77(1):177–184
Schilt S, Moore JE Jr, Delfino A, Meister J–J (1996) The effects of time-varying curvature on velocity profiles in a model of the coronary arteries. J Biomech 29(4):469–474
Shadden SC, Astorino M, Gerbeau J-F (2010) Computational analysis of an aortic valve jet with Lagrangian coherent structures. Chaos Interdiscip J Nonlinear Sci 20(1):017512–017610
Siebes M, Verhoeff BJ, Meuwissen M, de Winter RJ, Spaan JAE, Piek JJ (2004) Single-wire pressure and flow velocity measurement to quantify coronary stenosis hemodynamics and effects of percutaneous interventions. Circulation 109(6):756–762
Sripathi VC, Kumar RK, Balakrishnan KR (2004) Further insights into normal aortic valve function: role of a compliant aortic root on leaflet opening and valve orifice area. Ann Thorac Surg 77(3):844–851
Stefanadis C, Stratos C, Boudoulas H, Vlachopoulos C, Kallikazaros I, Toutouzas P (1994) Distensibility of the ascending aorta in coronary artery disease and changes after nifedipine administration. Chest 105(4):1017–1023
Stefanadis C, Dernellis J, Tsiamis E, Stratos C, Diamantopoulos L, Michaelides A, Toutouzas P (2000) Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischaemic heart disease. Eur Heart J 21(5):390–396
Thubrikar M, Piepgrass WC, Bosher LP, Nolan SP (1980) The elastic modulus of canine aortic valve leaflets in vivo and in vitro. Circ Res 47(5):792–800
Thubrikar M, Carabello BA, Aouad J, Nolan SP (1982) Interpretation of aortic root angiography in dogs and in humans. Cardiovasc Res 16(1):16–21
Turner SP (2006) The pathophysiology of the coronary slow flow phenomenon, PhD Thesis, The University of Adelaide, Adelaid, South Australia
Versluis JP, Heslinga JW, Sipkema P, Westerhof N (2001) Microvascular pressure measurement reveals a coronary vascular waterfall in arterioles larger than 110 μm. Am J Physiol Heart Circ Physiol 281(5):H1913–H1918
Watanabe J, Maruyama Y, Satoh S, Keitoku M, Takishima T (1987) Effects of the pericardium on the diastolic left coronary pressure-flow relationship in the isolated dog heart. Circulation 75(3):670–675
Westerhof N, Boer C, Lamberts RR, Sipkema P (2006) Cross-talk between cardiac muscle and coronary vasculature. Physiol Rev 86(4):1263–1308
Zhang ZD, Svendsen M, Choy JS, Sinha AK, Huo Y, Yoshida K, Molloi S, Kassab GS (2011) New method to measure coronary velocity and coronary flow reserve. Am J Physiol Heart Circ Physiol 301(1):H21–H28
Zou Y, Zhang Y (2011) The orthotropic viscoelastic behavior of aortic elastin. Biomech Model Mechanobiol 10(5):613–625
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nobari, S., Mongrain, R., Leask, R. et al. The effect of aortic wall and aortic leaflet stiffening on coronary hemodynamic: a fluid–structure interaction study. Med Biol Eng Comput 51, 923–936 (2013). https://doi.org/10.1007/s11517-013-1066-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11517-013-1066-1