Thrombus Formation CFD Simulations

With the advent of endovascular therapies, a wide array of cardiovascular diseases can now be treated with minimally invasive techniques such as thoracic, abdominal and brain aneurysms, aortic dissection, to name a few. This therapy relies on delivering a medical service, such as a stent-graft to the diseased section of the cardiovascular system under fluoroscopic conditions using a catheter and a guidewire. Although endovascular therapies have drastically reduced the hospital stay for the patients and offer a quick recovery time, one of the most common mid-to-long-term complications associated with them is post-surgical thrombus formation within and around the inserted medical device. If left untreated, this thrombus can break and can cause serious medical complications such as stroke. Hence, endovascular device manufacturers must quantify the risk of thrombosis associated with their device design under varying hemodynamic conditions to ensure patient safety.

Fluid dynamics of blood flow play a critical role in the thrombus formation process. To quantify the potential risk of thrombus formation after an endovascular surgery, it is critical to quantify the velocity, pressure, and wall shear stress (WSS) fields in the post-surgical cardiovascular environment. However, quantifying these flow indices through the traditional bench-top experiments is tedious and very expensive. Computational fluid dynamics (CFD) offers a very lucrative alternative to such bench-top experiments and can quantify all the flow indices of interest with significant accuracy. For example, with recent advances in the CFD world, it is now possible to simulate Multiphysics systems. Thus, blood flow governing equations can be easily coupled with transport equations of blood particles that dictate the thrombus formation cascade. Meaning the user can quantify WSS and residence time for such blood particles and this information can predict the risk of developing potential post-surgical thrombus. For example, blood platelets get activated by high WSS. When these activated platelets are trapped in a flow recirculation zone with low WSS and high residence time, they turn blood into a thrombus. Realizing the scope of such CFD simulations, many research labs and medical device manufacturers routinely use CFD to quantify the cascade of thrombus formation and make the medical devices safer.Once such complications become symptomatic, the doctors typically perform mitral valve surgery either to repair or replace the diseased mitral valve with a bio-prosthetic valve. While planning for such surgeries, physicians typically rely on data and observation made using echocardiography, computed tomography, and magnetic resonance imaging. However, such techniques cannot predict the risk of developing post-surgical complications such as device failure. One of the most effective ways of predicting post-surgical mitral valve complications’ is through clinically realistic fluid-structure interaction (FSI) simulations for the mitral valve. Such FSI simulations can be performed during the surgical planning phase to compare the hemodynamic efficacy of different devices and pick the one with the best overall performance, as decided by the physicians. This approach will also allow the physicians to offer personalized medical care to patients suffering from mitral valve problems on an individual basis.

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