Creation of emboli in the aortic root and changes in flow distribution between supra-aortic arteries and descending aorta can lead to stroke and perfusion related tissue damage during cardiopulmonary bypass. A thorough understanding of how the angle of cannulation affects the overall success of cardiopulmonary bypass during cannulation of the ascending aorta is needed. Previous simulation research has observed the effect of outflow cannula position by changing the location of the cannulation site to the subclavian artery and other vessels, as well as positions for innovative cannula designs. The purpose of this study is to evaluate the success of the procedure while using a straight cannula, modulating the angle of cannulation below horizontal in the frontal plane. A simplified geometry of the aorta was used. The success of the procedure was quantified by observing wall shear stress, normal stress, intra-fluid shear stress, and flow distribution. A numerical study was performed to solve the Reynolds Averaged Naiver Stokes governing equations, which were used in conjunction with a constant density fluid to simulate blood, and a realizable two-layer k-ε turbulence model
Innovations in Percutaneous Intervention, 1977-2007. Slides created by Simon H. Stertzer, MD, FACC, FAHA, Professor Emeritus, Stanford University School of Medicine.
Innovations in Percutaneous Intervention, 1977-2007. Slides created by Simon H. Stertzer, MD, FACC, FAHA, Professor Emeritus, Stanford University School of Medicine.
Study on viscosity induced contrast in ultrasound color flow imaging of carot...IJECEIAES
Efficient imaging of blood flow disturbances resulted from carotid atherosclerosis plays a vital role clinically to predict brain stroke risk. Carotid atherosclerosis and its development is closely linked with raised blood viscosity. Therefore, study of viscosity changing hemodynamic effect has importance and it might be useful for improved examination of carotid atherosclerosis incorporating the viscosity induced contrast in conventional ultrasound imaging. This work considered the design of realistic models of atherosclerotic carotid artery of different stages and solved to compute the hemodisturbances using computational fluid dynamics (CFD) by finite element method (FEM) to investigate viscosity changes effect. Ultrasound color flow image of velocities of blood have been constructed using phase shift information estimated with autocorrelation of Hilbert transformed simulated backscattered radiofrequency (RF) signals from moving blood particles. The simulated ultrasound images have been compared with CFD simulation images and identified a good match between them. The atherosclerosis stages of the models have been investigated from the estimated velocity data. It has been observed that the blood velocities increase noticeably in carotid atherosclerotic growths and velocity distribution changes with viscosity variations. It is also found importantly that the viscosity induced contrast associated to atherosclerosis is detectable in ultrasound color flow imaging. The findings of this work might be useful for better investigation of carotid atherosclerosis as well as prediction of its progression to reduce the stroke risk.
An elderly diabetic and hypertensive male presented with acute renal failure and rhabdomyolysis. He experienced cardiac arrest with moderate hyperkalemia despite medical treatment and hemodialysis. Telemetry changes were retrospectively studied and found to have significant rhythm changes that occurred just less than 10 minutes prior to the cardiac arrest.
PHYSIOLOGICAL NON-NEWTONIAN BLOOD FLOW THROUGH SINGLE STENOSED ARTERYIwate University
Abstract. A numerical simulation to investigate the Non-Newtonian modeling effects on physiological flows in a three dimensional idealized artery with a single stenosis of 85% severity is given. The wall vessel is considered to be rigid. Oscillatory physiological and parabolic velocity profile has been imposed for inlet boundary condition. Determination of the physiological waveform is performed using a Fourier series with sixteen harmonics. The investigation has a Reynolds number range of 96 to 800. Low Reynolds number k − ω model is used as governing equation. The investigation has been carried out to characterize two Non-Newtonian constitutive equations of blood, namely, (i) Carreau and (ii) Cross models. The Newtonian model has also been investigated to study the physics of fluid. The results of Newtonian model are compared with the Non-Newtonian models. The numerical results are presented in terms of velocity, pressure, wall shear stress distributions and cross sectional velocities as well as the streamlines contour. At early systole pressure differences between Newtonian and Non-Newtonian models are observed at pre-stenotic, throat and immediately after throat regions. In the case of wall shear stress, some differences between Newtonian and Non-Newtonian models are observed when the flows are minimum such as at early systole or diastole. In general, the velocities at throat regions are highest at all-time phase. However, at pick systole higher velocities are observed at post-stenotic region. Downstream flow of all models creates some recirculation regions at diastole.
Although the risks of coronary angiography have declined over the years by increased clinical experience and advanced technologies, it still requires attention, knowledge and experience due to being an interventional diagnostic method. A safe coronary angiography begins with the selection of the appropriate catheter for the anatomical structure of the patient and the evaluation of the pressure when the catheter is placed in the coronary ostium. Coronary pressure waves are complementary requirements of angiography. The recognition, evaluation and precautions to be taken for abnormal pressure waves directly affect the mortality of the patient. One of the first clues to the presence of stenosis in the left main coronary artery (LMCA) is abnormal changes in pressure when the catheter is seated in the ostial LMCA. This often occurs as a “ventricularization” or “damping”. For decades, ventricularization was mostly experienced as a stenosis by invasive cardiologists [1]. Recognition of abnormal changes in pressure and precautions to be taken prevent catastrophic outcomes in patients
https://crimsonpublishers.com/ojchd/fulltext/OJCHD.000518.pdf
For more open access journals in Crimson Publishers
please click on https://crimsonpublishers.com/
For more articles in open journal of Cardiology & Heart Diseases
please click on https://crimsonpublishers.com/ojchd/
Simulation of Physiological Non-Newtonian Blood Flow through 3-D Geometry of ...Iwate University
Abstract: A numerical simulation has been performed to investigate blood flow behavior of three dimensional idealized carotid arteries. Non-Newtonian flow has been taken for the simulation. The wall of the vessel is considered to be rigid. Physiological and parabolic velocity profile has been imposed for inlet boundary condition. Reynolds number at the inlet has been ranged approximately from 86to 966 for the investigation. Low Reynolds number k-w model has been used as governing equation. The investigations have been carried out to characterize the flow behavior of blood. The numerical results have been presented in terms of wall shear stress distributions, streamlines contours and axial velocity contours. However, highest wall shear stress has been observed in the bifurcation area. Unexpectedly, transient or unstable flow has created flow disturbance regions in the arteries. Moreover, the disturbance of flow has risen as the severity of stenosis in the artery has been increased.
Study on viscosity induced contrast in ultrasound color flow imaging of carot...IJECEIAES
Efficient imaging of blood flow disturbances resulted from carotid atherosclerosis plays a vital role clinically to predict brain stroke risk. Carotid atherosclerosis and its development is closely linked with raised blood viscosity. Therefore, study of viscosity changing hemodynamic effect has importance and it might be useful for improved examination of carotid atherosclerosis incorporating the viscosity induced contrast in conventional ultrasound imaging. This work considered the design of realistic models of atherosclerotic carotid artery of different stages and solved to compute the hemodisturbances using computational fluid dynamics (CFD) by finite element method (FEM) to investigate viscosity changes effect. Ultrasound color flow image of velocities of blood have been constructed using phase shift information estimated with autocorrelation of Hilbert transformed simulated backscattered radiofrequency (RF) signals from moving blood particles. The simulated ultrasound images have been compared with CFD simulation images and identified a good match between them. The atherosclerosis stages of the models have been investigated from the estimated velocity data. It has been observed that the blood velocities increase noticeably in carotid atherosclerotic growths and velocity distribution changes with viscosity variations. It is also found importantly that the viscosity induced contrast associated to atherosclerosis is detectable in ultrasound color flow imaging. The findings of this work might be useful for better investigation of carotid atherosclerosis as well as prediction of its progression to reduce the stroke risk.
An elderly diabetic and hypertensive male presented with acute renal failure and rhabdomyolysis. He experienced cardiac arrest with moderate hyperkalemia despite medical treatment and hemodialysis. Telemetry changes were retrospectively studied and found to have significant rhythm changes that occurred just less than 10 minutes prior to the cardiac arrest.
PHYSIOLOGICAL NON-NEWTONIAN BLOOD FLOW THROUGH SINGLE STENOSED ARTERYIwate University
Abstract. A numerical simulation to investigate the Non-Newtonian modeling effects on physiological flows in a three dimensional idealized artery with a single stenosis of 85% severity is given. The wall vessel is considered to be rigid. Oscillatory physiological and parabolic velocity profile has been imposed for inlet boundary condition. Determination of the physiological waveform is performed using a Fourier series with sixteen harmonics. The investigation has a Reynolds number range of 96 to 800. Low Reynolds number k − ω model is used as governing equation. The investigation has been carried out to characterize two Non-Newtonian constitutive equations of blood, namely, (i) Carreau and (ii) Cross models. The Newtonian model has also been investigated to study the physics of fluid. The results of Newtonian model are compared with the Non-Newtonian models. The numerical results are presented in terms of velocity, pressure, wall shear stress distributions and cross sectional velocities as well as the streamlines contour. At early systole pressure differences between Newtonian and Non-Newtonian models are observed at pre-stenotic, throat and immediately after throat regions. In the case of wall shear stress, some differences between Newtonian and Non-Newtonian models are observed when the flows are minimum such as at early systole or diastole. In general, the velocities at throat regions are highest at all-time phase. However, at pick systole higher velocities are observed at post-stenotic region. Downstream flow of all models creates some recirculation regions at diastole.
Although the risks of coronary angiography have declined over the years by increased clinical experience and advanced technologies, it still requires attention, knowledge and experience due to being an interventional diagnostic method. A safe coronary angiography begins with the selection of the appropriate catheter for the anatomical structure of the patient and the evaluation of the pressure when the catheter is placed in the coronary ostium. Coronary pressure waves are complementary requirements of angiography. The recognition, evaluation and precautions to be taken for abnormal pressure waves directly affect the mortality of the patient. One of the first clues to the presence of stenosis in the left main coronary artery (LMCA) is abnormal changes in pressure when the catheter is seated in the ostial LMCA. This often occurs as a “ventricularization” or “damping”. For decades, ventricularization was mostly experienced as a stenosis by invasive cardiologists [1]. Recognition of abnormal changes in pressure and precautions to be taken prevent catastrophic outcomes in patients
https://crimsonpublishers.com/ojchd/fulltext/OJCHD.000518.pdf
For more open access journals in Crimson Publishers
please click on https://crimsonpublishers.com/
For more articles in open journal of Cardiology & Heart Diseases
please click on https://crimsonpublishers.com/ojchd/
Simulation of Physiological Non-Newtonian Blood Flow through 3-D Geometry of ...Iwate University
Abstract: A numerical simulation has been performed to investigate blood flow behavior of three dimensional idealized carotid arteries. Non-Newtonian flow has been taken for the simulation. The wall of the vessel is considered to be rigid. Physiological and parabolic velocity profile has been imposed for inlet boundary condition. Reynolds number at the inlet has been ranged approximately from 86to 966 for the investigation. Low Reynolds number k-w model has been used as governing equation. The investigations have been carried out to characterize the flow behavior of blood. The numerical results have been presented in terms of wall shear stress distributions, streamlines contours and axial velocity contours. However, highest wall shear stress has been observed in the bifurcation area. Unexpectedly, transient or unstable flow has created flow disturbance regions in the arteries. Moreover, the disturbance of flow has risen as the severity of stenosis in the artery has been increased.
Statistical analysis for measuring the effects of stenotic shapes and spiral ...Iwate University
Numerical simulations have been done for a statistical analysis to investigate the effect of stenotic shapes and spiral flows on wall shear stress in the three-dimensional idealized stenotic arteries. Non-Newtonian flow has been taken for the simulations. The wall of the vessel is considered to be rigid. Physiological, parabolic and spiral velocity profile has been imposed for inlet boundary condition. Moreover, the time-dependent pressure profile has been taken for outlet boundary condition. Reynolds number at the inlet has been ranged approximately from 86 to 966 for the investigation. Low Reynolds number k-w model has been used as governing equation. 120 simulations have been performed for getting the numerical results. However, the numerical results of wall shear stress have been taken for the statistical analysis. The simulations and the statistical analysis have been performed by using ANSYS-18.1 and SPSS respectively. The statistical analyses are significant as p-value in all cases are zero. The eccentricity is the most influencing factor for WSSmax. The WSSmin has been influenced only by the flow spirality. The stenotic length has an influence only on the WSSmax whereas the stenotic severity has an influence on the WSSmax and WSSave.
Coronary thrombosis is formation of a blood clot inside a blood vessel of heart. Thrombosis in the heart can pave to a myocardial infarction. Coronary Thrombosis is general in high blood pressure patient, diabetic, and victims of atherosclerosis. The treatment is decreasing pain, improving blood flow to the heart muscle, and preventing irreversible damage to the heart muscle.
Coronary Thrombosis in the heart can pave to a myocardial infarction. Coronary thrombosis and myocardial infarction are sometimes availed as synonyms, although this is technically much inaccurate as the thrombosis refers to the blocking of blood vessels, while the infarction refers to the tissue death due to the consequent loss of blood flow to the heart tissue. The heart comprises many connecting blood vessels, and depending upon the location of the thrombosis, the infarction may cause no symptoms [1, 2] (Fig: 1 &2).
Fig: 1. Coronary Thrombosis
Fig: 2. Heart with blood clot
Facts of Coronary Thrombosis
Studies in Thrombosis and Hemostasis, Thrombosis and Haemostasis, Arteriosclerosis, Thrombosis, and Vascular Biology, Clinical and Applied Thrombosis/Hemostasis were a key investigation topics and research are carried out to encounter problems in these fields
ANALYSIS OF FLOW CHARACTERISTICS OF THE BLOOD THROUGH CURVED ARTERY WITH MIL...indexPub
Narrowing of the arteries caused by atherosclerosis reduces blood flow to the heart, which results shows ischemia, angina pectoris, cerebral strokes, and other coronary artery disease signs and symptoms. Curvature is seen in blood vessels at various locations. The stenotic surface provides an additional curvature and the point of maximum shear which varies with the cross-section. A cylindrical form of the Navier-Stokes equations in polar coordinate system have been extended to include dynamic curvature along the axial direction. The blood flow behavior of taking different values of blood parameters like viscosity, the radius of the artery, and the thickness of the stenosis has been studied with and without curvature by using an extended blood flow model with dynamic curvature. Moreover, the aspects of blood flow, such as dynamic curvature velocity profile, volumetric flow rate, pressure drop, and shear stress, have been studied in relation to blood flow around curved arteries with stenosis, variations in the radii of the artery, thickness of the stenosis, and viscosity. The information may reveal that by increasing the values of curvature, viscosity, and thickness of stenosis, velocity, and volumetric flow rate can be quickly reduced. Increasing the curvature, viscosity, and thickness of stenosis also results in an increase in shear stress and a pressure drop. The presence of curved stenotic arteries has a significant impact on the flow parameters, and it is crucial to know about these dynamics in order to study the cardiovascular system.
Coronary artery calcification (CAC) results in reduced vascular compliance, abnormal vasomotor responses, and impaired myocardial perfusion.
The presence of CAC is associated with worse outcomes in the general population and in patients undergoing revascularization
Two recognized types of CAC are
Atherosclerotic (Intimal)
Medial artery calcification
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
Endovascular complications: Antiplatelet management for flow diversionbijnnjournal
Up to 3−5% of the general population is affected by cerebral aneurysms that are associated with both modifiable
as well as non-modifiable risk factors ranging from familial to acquired neurovascular conditions. The initial
treatment option was aneurysm clipping and evolved to including primary or adjuvant endovascular treatment.
Aneurysm re-rupture, although rare, can have devastating consequences such as intracranial bleeding and carotidcavernous fistula. Emergent surgery in view of delayed aneurysm rupture in patients maintained on dual antiplatelet
therapy presents with the need to carefully assess the procedure-related risk factors and evaluate the patients’
platelet function. With the advent of novel technology, flow diverters came into play
Similar to EFFECT OF NEGATIVE ANGLE CANNULATION DURING CARDIOPULMONARY BYPASS – A COMPUTATIONAL FLUID DYNAMICS STUDY (20)
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...NelTorrente
In this research, it concludes that while the readiness of teachers in Caloocan City to implement the MATATAG Curriculum is generally positive, targeted efforts in professional development, resource distribution, support networks, and comprehensive preparation can address the existing gaps and ensure successful curriculum implementation.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Group Presentation 2 Economics.Ariana Buscigliopptx
EFFECT OF NEGATIVE ANGLE CANNULATION DURING CARDIOPULMONARY BYPASS – A COMPUTATIONAL FLUID DYNAMICS STUDY
1. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
DOI: 10.5121/ijbes.2017.4201 1
EFFECT OF NEGATIVE ANGLE CANNULATION
DURING CARDIOPULMONARY BYPASS – A
COMPUTATIONAL FLUID DYNAMICS STUDY
Wael Mokhtar1
, Kyle A. Dinger2
, Chetan Madagi2
, and Md Razib Hossain2
School of Engineering, Grand Valley State University, Grand Rapids, USA
ABSTRACT
Creation of emboli in the aortic root and changes in flow distribution between supra-aortic arteries and
descending aorta can lead to stroke and perfusion related tissue damage during cardiopulmonary bypass.
A thorough understanding of how the angle of cannulation affects the overall success of cardiopulmonary
bypass during cannulation of the ascending aorta is needed. Previous simulation research has observed the
effect of outflow cannula position by changing the location of the cannulation site to the subclavian artery
and other vessels, as well as positions for innovative cannula designs. The purpose of this study is to
evaluate the success of the procedure while using a straight cannula, modulating the angle of cannulation
below horizontal in the frontal plane. A simplified geometry of the aorta was used. The success of the
procedure was quantified by observing wall shear stress, normal stress, intra-fluid shear stress, and flow
distribution. A numerical study was performed to solve the Reynolds Averaged Naiver Stokes governing
equations, which were used in conjunction with a constant density fluid to simulate blood, and a realizable
two-layer k-ε turbulence model.
KEYWORDS
Cardiopulmonary Bypass, Cannulation Angle, Blood Flow Simulation, Computational Fluid Dynamics
1. INTRODUCTION
Cardiopulmonary bypass is a routine medical procedure that allows the heart to be stopped while
still delivering oxygenated blood to the body tissues. There are many variables involved that
determine the degree of success of the procedure. If the ascending aorta is being cannulated, the
angle of which the cannula is introduced to the major vessel can mean the difference between a
successful procedure and a procedure that results in a range of post-operative disorders, related to
the nature of the perfusion.
Cardiopulmonary bypass (CPB) has been used for decades with success for most patients
undergoing the procedure. However, there is evidence that CPB causes harm to some, including
stroke, brain damage, tissue damage and inflammation, and organ failure [1]. Major factors that
influence the success of the CPB procedure are shear stress and pressure on the walls of the aorta
that lead to mobilization of an atherosclerotic embolism, stagnant blood flow that could lead to
thrombotic embolism, flow distribution that could lead to poor end organ perfusion, and high
intra-fluid shear stress that leads to hemolysis.
2. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
2
The position of the cannula during CPB is a decision made on a case by case basis. Severe
atherosclerosis in the aorta can lead surgeons to have to select a different vessel from the
ascending aorta as a cannulation site. Furthermore, as the style of cannula changes, different
cannulations sites and orientations may be necessary, as the outflow takes on different
characteristics[2]. In this case, a straight outflow cannula was used and a cannulation site, 1 inch
inferior to the brachiocephalic trunk along the right side of the aortic arch was held constant for
the entirety of the study.
1.1 Procedural Complications
The post-operative disorders of concern are synthesis of either thrombotic or atherosclerotic
embolism, damage of vascular tissues, hemolysis of the red blood cells, and retro perfusion of any
of the supra aortic arteries. The major fluid mechanics principles that contribute to these disorders
are low fluid velocity in the volume[3], high wall shear stress on the vascular wall, high normal
pressure on the vascular wall, and high intra-fluid shear stress respectively.
As blood flows through the cannula and is reintroduced into the ascending aorta, the flow
structure changes. Large scale turbulence develops which causes the overall velocity of the flow
to reduce. In areas in the aorta where the flow is not flowing freely, such as the aortic root, the
lower velocity flow can lead to coagulation and thus the creation of a blood borne thrombotic
embolism.
In patients with diagnosis of atherosclerosis, there are deposits of calcified cholesterol that line
the inside of the blood vessels. The shear stress imposed on the vessel walls due to the viscous
nature of blood flow can cause these deposits to separate from the vessel wall, becoming blood
borne atherosclerotic embolisms.
Wall shear stress, defined as pressure causing a force parallel with the surface of the vessel due to
viscous flow, is known to be a contributing factor to atherosclerosis. Wall shearstress is known to
cause a “sandblasting” effect on existing atherosclerotic vessels. The result of that “sandblasting”
is to increase the likelihood of disturbing the calcification and potentially causing an embolism.
This is increasingly significant when considering the disturbance that could have arose from
clamping the ascending aorta to begin the procedure [4]These atherosclerotic emboli can lead to
obstructed blood flow causing stroke and brain damage[5].
Normal stress due to flow stagnation on an area of the aorta could create pressure damage to the
existing calcification. In conjunction with wall shear stresses, increase the likelihood of embolism
mobilization.
The cells that make up the lining of the blood vessels are susceptible to damage from high normal
pressure due to incident flow “jetting” the inside of the vessel. In this application, the flow from
the cannula stagnating on the inside of the aorta is an example of this.
One of the major goals for cardiopulmonary bypass is to perfuse the body in a manner similar to
normal cardiac function. If the distribution of oxygenated blood during cardiopulmonary bypass
is different, it is possible to cause injury. For instance, if the cannula placement induces high
velocity flow below any of the entrances to the supra aortic arteries, it is possible that flow will
induce a Venturi effect, resulting in flow reversal in the brachiocephalic trunk. The lack of
3. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
3
oxygenated blood reaching the brain tissue through that vessel could result in damage to the
tissue and corresponding cognitive damage[6].
1.2 Computational Fluid Dynamics Representation
Stagnant flow patterns in the aorta allow for the synthesis of thrombotic embolism. In the context
of CPB one of the major areas of concern is the root of the ascending aorta where flow can lose
velocity.
Figure 1. CPB case showing loss of fluid velocity in the aortic root in the event of direct injection
Figure 1 shows how even when the blood is injected directly into the ascending aorta a large
amount of its velocity is lost to turbulence at the base of the aortic root. That slow-moving blood
increases the risk for thrombosis in the CPB circuit [7].
During CPB depending on the cannulation site and angle of incidence, the procedure can induce
retrograde perfusion in the brachiocephalic trunk [8]. Flow reversal in the artery that delivers
oxygenated blood to the brain is a major contributor to brain damage during CPB.
Figure.2 Perfusion case showing retrograde perfusion of BCT and LCCA
4. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
4
Figure 2 shows a possible perfusion case when cannulating in the ascending aorta. High velocity
flow below any of the supra aortic arteries leads to a low-pressure area at the opening; this leads
to flow reversal at that outlet. An evenly distributed high-pressure environment is necessary to
ensure proper flow direction and distribution.
As CPB is meant to provide a comparably similar flow distribution to normal cardiac function, it
was necessary to get an understanding of what normal cardiac blood-flow distributions look like.
Table 1 shows the flow distribution values gathered from the European Society of Radiology.
Table 1: Normal cardiac function blood flow distribution numbers [9]
Real Blood Flow (European Cardiovascular Group)
Artery Vdot (l/min) % of total flow
ASC 6.67 100%
BCA 1.08 16.2%
LCA 0.45 6.7%
LSA 0.5 7.5%
ARC 4.58 68.7%
Lastly, large areas of viscous shear stress in the blood itself can cause damage to the red blood
cells. The result of large amounts of hemolysis is increased levels of potentially harmful iron and
urea in the blood stream.
2. NUMERICAL PROCEDURE
The simulations were completed using SolidWorks 2016 to generate the CAD and STAR CCM+
v11.04 to perform the CFD studies.
2.1 Geometric Model and Importing to STAR CCM+
A geometrically simple model was prepared in SolidWorks. The model included the ascending
aorta, aortic arch with supra aortic arteries, and the descending aorta. The supra aortic arteries
were left short in the CAD model, and the model was exported as an IGES file. The IGES file
was imported as a surface mesh into STAR CCM+. The resulting geometry served as the fluid
region.
Figure 3. Overall dimensions of aorta CAD (inches)
5. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
5
Table 2. Outlet Dimensions for the CAD data
Outlet Diameter (mm)
Ascending Aorta 80.043
Brachiocephalic Trunk 17.928
Left Common Carotid Artery 14.937
Left Subclavian Artery 14.646
Descending Aorta 33.765
Cannula 8.000
2.2 Meshing
The meshing parameters used were surface wrapper, polyhedral mesher, surface remesher, and
extruder. The wrapper was used to ensure that any discontinuities in the geometry would not
disrupt the meshing of the volume. The polyhedral mesher was the best choice for the smooth
asymmetric walls of the aorta and allowed the use of the extruder.
To limit numerical error in the aortic arch, the supra aortic arteries were extended. That brought
the surfaces with the pressure outlet boundary condition, signifying the continuation of the artery,
further away from the arch. The extruder was set to extrude a 4 in constant profile volume from
the existing surface. This was split into 50 layers of constant thickness during the meshing
process.
Figure 4. Volume meshed geometry showing the extrusion of the supra-aortic arteries
The final surface mesh was comprised of 374606 faces and 1243 edges. The final volume mesh
was comprised of 6,779,394 cells, 32,250,815 interior faces, and 20,678,612 vertices.
6. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
6
Figure 5. Total geometry showing overall mesh density
Figure 6. Section plane geometry showing mesh density in the aortic arch and entrances to the supra-aortic
arteries
7. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
7
2.3 Boundary Conditions
For the cannula simulations, the ascending aorta was treated as a wall. This simulated the effect
of clamping the aorta to separate the aorta from the heart. The end of the cannula external to the
aorta was treated as a mass flow inlet set to a constant value of 0.068 kg/s which corresponds to
roughly 3.7 l/min volumetric flow rate of blood.
The outlets for the supra aortic arteries and the descending aorta were treated as pressure outlets,
but constant resistive pressures were applied at each outlet to better represent the human body.
This was done by simulating normal human cardiac function and iteratively changing the pressure
values of the outlets until the distribution matched the values found by T. Mueller et al within 5%
[9].
2.4 Physics Conditions
The system was modeled as a three-dimensional steady state study. The blood was modeled as
water and the density was modified to 1101.45 kg/m3
to match that of blood.
Turbulence was modeled using the k-ε model. The realizable two-layer k-ε turbulence model
provides new turbulent viscosity equations and new transport equations which allow the model to
better predict flows involving rotation. The two-layer portion of the model separates the
computation into two layers; a layer near the wall boundary, and the layer away from the wall
boundary.
2.5 Testing Levels and Completion Criterion
The simulations were performed with the cannula insertion angle starting at 60° below horizontal
and angled upward in 15° increments to 0°. Each of the simulations were then post-processed and
stored.
3. RESULTS AND DISCUSSION
The simulations were completed using SolidWorks 2016 to generate the CAD and STAR CCM+
v11.04 to perform the CFD studies.
3.1 FlowStructures and Distributions
Successful cardiopulmonary bypass produces flow distributions that closely resemble that of
normal cardiac function. Furthermore, smooth helical flow is desired in the ascending aorta to
create a uniform cross section of pressure prior to the supra aortic arteries.
The 60°, 45°, and 30° simulations produced smooth helical flow structures in the ascending aorta.
The 45° case produced the best results, as the flow struck the inner surface of the aorta,
rebounded off the bottom of the ascending aorta and developed reasonably helical flow upward.
8. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
8
Figure 7. 45° case showing flow structure and fluid velocity from cannula
Whereas the 60° and 30° case showed issues with flow stagnating in the root of the ascending
aorta and some erratic flow injecting directly into the aortic arch, respectively.
Figure 8. 60° case showing flow stagnation in aortic root
9. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
9
Figure 9. 30° case showing erratic flow patterns into the aortic arch
The 15° and 0° simulations resulted in major deviations from the expected flow structure, figures
depicting those can be found in Appendix A.
The distribution of flow can be found in Table 3. 60°, 45°, and 30° produced results absent of
retrograde perfusion. However, 60° and 30° can be seen to have deviations of 22% and 27%
respectively. 15° and 0° indicate retrograde perfusion in the brachiocephalic trunk. That flow
reversal could manifest as brain damage due to poor perfusion of the brain.
Table 3. Blood flow distribution as a function of cannulation angle
Artery
60° 45° (Best Case) 30°
15°
(Retrograde
Perfusion)
0° (Retrograde
Perfusion)
Mass
Flow
(g/s)
%
Disc.
With
Real
Mass
Flow
(g/s)
%
Disc.
With
Real
Mass
Flow
(g/s)
%
Disc.
With
Real
Mass
Flow
(g/s)
%
Disc.
With
Real
Mass
Flow
(g/s)
%
Disc.
With
Real
B
C
17.2 9% 9.3 -3%
0.017
7
10% -6.5 -26% -2.5 -20%
L
C
17.3 19% 4.7 0% 12.8 12% 1.9 -4% 6.5 3%
L
S
1.6 -5% 4.7 -1% 8.9 6% 7.5 4% 29.4 36%
D
A
31.8 -22% 49.3 4% 28.7 -27% 64.9 27% 34.7 -18%
A
A
0.0 n/a 0.0 n/a 0.0 n/a 0.0 n/a 0.0 n/a
C
A
N
-68.0 n/a -68.0 n/a -68.0 n/a -68.0 n/a -68.0 n/a
10. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
10
3.2 Wall Shear Stress
Wall shear stress is the result of viscous flow with respect to a fixed surface. In this instance the
blood flow over the surface of the aorta. The resulting wall shear stress contributes to the
“sandblasting” effect of potential calcification on the inner walls of the aorta. The weakening of
the surface of those deposits increases the likelihood of fatty embolism mobilization, by breaking
a portion of the deposit away from the vessel wall.
The 60° case had the lowest levels of wall shear stress at 4 Pa, while the 15° case had the highest
levels at 20 Pa.
Figure 10. 60° case wall shear stress plot onto aorta walls
The 45° and 30° cases had increases in wall shear stress, at 14 Pa and 19 Pa respectively. In those
instances, the areas most affected are the portions of the aorta around where the blood flow is
striking.
Figure 11. 30° case wall shear stress plot onto aorta walls
11. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
11
Figure x+3 shows how the blood flow strikes at the central area of the arch and then as it diffuses
outward, causes areas of increased wall shear stress.
3.3 Hemolysis
The intra-fluid shear stresses were analyzed and showed that in the 45°, 30°, and 15° simulations
there was a risk of hemolysis. A small area on the aorta at the stagnation point of blood flow
showed an isosurface that met the maximum stress level in the fluid. 600 Pa was the stress level
that was considered damaging to the red blood cells [10].
Figure 12. 15° case showing blue isosurface area of 600 Pa, enough to damage RBC
There is a secondary area within the cannula that shows an area of excessive stress. However, this
area was present in each of the 5 cases and was attributed to flow development within the
cannula, which is beyond the scope of this study. Further information can be found in Appendix
B.
3.4 Normal Stress
The levels of normal stress can be seen in Table 2. Discuss further
Table 4. Max normal shear stress by case
Angle Case (°) Maximum Normal Stress (Pa)
60 215.72
45 547.20
30 1012.10
15 1358.30
0 333.61
The higher levels of normal stress were exhibited in the 30° - 15° range. By avoiding those areas,
the risk of mobilizing an embolism would be attenuated. These results compared within a factor
of 2 to related studies[11].
12. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
12
Figure 13. 30° case normal stress on wall of ascending aorta
Major considerations that create deviations from real world deal primarily with the lack of
atherosclerotic deposition geometries in the aorta. The wall shear stress values would be
significantly different, and a better exhibition of how deposits would react to viscous flow would
be evident, were the deposits present. In this case, ideal geometries were studied.
4. CONCLUSION AND FUTURE RESEARCH
This study provides a general understanding of how modulating the angle of cannulation in the
ascending aorta below the horizontal will affect fluid structure interaction within the aorta and
flow development therein. Due to the variability in cannulation during CPB, general information
of how the process will be affected by outflow cannula position and angulation are critical to
avoid potentially life-threatening post-operative complications.
A three-dimensional computational fluid dynamics study was performed using smooth internal
aorta geometry that included the supra-aortic arteries and the beginning of the descending aorta.
Blood was approximated by simulating water and modifying the density to be within the known
density region of blood. Systemic flow resistances inherent to the human body were estimated by
iteratively solving a standard (non-CPB) flow case and modifying the simulated resistance
pressures at the pressure outlet boundary conditions until the flow distributions met that of
documented cardiac function studies. An 8 mm diameter outflow cannula was used to perfuse the
ascending aorta in the horizontal or 0° case and the angle was decreased in increments of 15° to
60° below horizontal in the frontal plane. Flow rates for the simulation were set to 3.7 l/min.
Turbulence was modeled using a two-layer realizable k-epsilon model. The flow rates of each
supra-aortic artery and descending aorta were monitored, along with wall shear stress, normal
stress, and intra-fluid shear stress.
13. International Journal of Biomedical Engineering and Science (IJBES), Vol. 4, No. 2, April 2017
13
The study showed that 45° to 60° cannulation angles yield acceptable results related to flow
distribution, wall shear stress, intra-fluid shear stress, and vascular normal stress. This does not
factor geometric deviations due to atherosclerosis into account.
Further study of the phenomena would include changing the cannulation angle in the transverse
plane in conjunction with angles in the frontal plane. The fluid used in this study was a water like
fluid with a constant density to match that of blood flow, to study this further, modifications to
viscosity could be made.
REFERENCES
1. G. S. Murphey, E. A. Hessel and R. C. Groom, "Optimal Perfusion during Cardiopulmonary Bypass:
An Evidence-Based Approach," International Anesthesia Research Society, vol. 108, no. 5, pp. 1394-
1417, 2009.
2. M. Minakawa, I. Fukuda, J. Yamazaki, K. Fukui, H. Yanaok and T. Inamura, "Effect of Cannula Shape
on Aortic Wall and Flow Turbulence: Hydrodynamic Study using Extracorporeal Circulation in Mock
Thoracic Aorta," Artificial Organs, vol. 31, no. 12, pp. 880-886, 2007.
3. M. Poullis, "Computation Fluid Dynamics Analysis to Prevent Aortic Root and Valve Clots During
Left Ventricular Assist Device Support," The Journal of ExtraCorporeal Technology, vol. 44, pp. 210-
215, 2012.
4. I. Avrahami, B. Dilmoney, A. Azuri, M. Brand, O. Cohen, L. Shani, R.-R. Nir and G. Bolotin,
"Investigation of Risks for Cerebral Embolism Associated with the Hemodynamics of
Cardiopulmonary Bypass Cannula: A Numeric Model," Artificial Organs, vol. 37, no. 10, pp. 857-865,
2013.
5. S. Demertzis, R. Trunfio, F. von Rotz and F. Siclari, "Surgical Approach in Massive Intraoperative
Atherosclerotic Embolism," Annals of Thoracic Surgery, vol. 81, pp. 2298-2300, 2006.
6. P. G. Menon, J. F. Antaki, A. Undar and K. Pekkan, "Aortic Outflow Cannula Tip Design and
Orientation Impacts Cerebral Perfusion During Pediatric Cardiopulmonary Bypass Procedures,"
Journal of Biometical Engineering, vol. 41, no. 12, pp. 2588-2602, 2013.
7. A. Finley and C. Greenberg, "Heparin Sensitivity and Resistance: Management During
Cardiopulmonary Bypass," Anesthesia and Analgesia, vol. 116, no. 6, pp. 1210-1222, 2013.
8. T. A. Kaufmann and e. al, "The Impact of Aortic/Subclavian Outflow Cannulation for
Cardiopulmonary Bypass and Cardiac Support: A Computational Fluid Dynamics Study," Artificial
Organs, vol. 33, no. 9, pp. 729-732, 2009.
9. M. T. and e. al, "Supra Aortic Flow Distribution Measured with Phase Contrast MR Angiography,"
European Society of Radiology, pp. 1-17, 2012.
10. M. Grigioni, C. Daniele, G. D'Avenio and V. Barbaro, "A Discussion on the Threshold Limit for
Hemolysis Related to Reynolds Shear Stress," Journal of Biomechanics, vol. 32, pp. 1107-1112, 1999.
11. Y. Tokuda, M.-H. Song, Y. Ueda, A. Usui, T. Akita, S. Yoneyama and S. Maruyama, "Three-
Dimensional Numerical Simulation of Blood Flow in the Aortic Arch During Cardiopulmonary
Bypass," European Journal of Cardio-Thoracic Surgery, vol. 33, pp. 164-167, 2008.