Abstract
In the United States, over 125,000 mechanical heart valves (MHVs) are implanted each year. Flow through the MHV hinge can cause thromboemboli formation. The purpose of this study was to examine various orifice geometries representing the MHV hinge region and how these geometries may contribute to platelet activation and thrombin generation. We also characterized these flow fields with digital particle image velocimetry (DPIV). Citrated human blood at room temperature was forced through the orifices (400 and 800 μm ID) with a centrifugal bypass pump, continuously infusing calcium chloride to partially reverse the citrate anticoagulant. Blood samples were tested for the presence of thrombin–antithrombin complex (TAT) and platelet factor 4 (PF4). Velocity and shear stress were measured with DPIV using a blood analog fluid seeded with fluorescent microbeads. The results indicate that small changes in geometry, although they do not affect the bulk flow, change the coagulation propensity as blood flows through the orifices. A more abrupt geometry allows more stagnation to occur resulting in more thrombin generation. PF4 measurements indicated similar levels of platelet activation for all orifices. DPIV showed differences in the jets with respect to entrainment of stagnant fluid. These results help to pinpoint the important parameters that lead to flow stasis and subsequent thrombus formation.
Similar content being viewed by others
Abbreviations
- MHV:
-
mechanical heart valve
- SJM:
-
St. Jude medical
- DPIV:
-
digital particle image velocimetry
- LDV:
-
laser Doppler velocimetry
- TAT:
-
thrombin–antithrombin III
- PF4:
-
platelet factor 4
- PReS:
-
principle Reynolds stress
- SIPAct:
-
shear-induced platelet activation
- SIPA:
-
shear-induced platelet aggregation
- V :
-
average centerline velocity
- Y :
-
location of velocity measurement in jet
- Y o :
-
jet origin (orifice plate location)
- V c :
-
average centerline velocity at Y o
- D :
-
orifice diameter
- a :
-
a constant for the type of jet
References
Affeld K., K. Schichl, A. Yoganathan Investigation of the flow in a centrifugal blood pump. ASAIO Trans. 32(1):269–273, 1986
Alevriadou B. R., J. L. Moake, N. A. Turner, Z. M. Ruggeri, B. J. Folie, M. D. Phillips, et al. Real-time analysis of shear-dependent thrombus formation and its blockade by inhibitors of von Willebrand factor binding to platelets. Blood 81(5):1263–1276, 1993
Alkhamis T. M., R. L. Beissinger, J. R. Chediak Artificial surface effect on red blood cells and platelets in laminar shear flow. Blood 75(7):1568–1575, 1990
Butchart E. G. Thrombogenicity, thrombosis and embolism. In: Butchart E. G., Bodnar E. eds. Thrombosis, Embolism and Bleeding. United Kingdom: ICR Publishers, 1992, pp. 172–205
Chang B. C., S. H. Lim, D. K. Kim, J. Y. Seo, S. Y. Cho, W. H. Shim, et al. Long-term results with St. Jude Medical and CarboMedics prosthetic heart valves. J. Heart Valve Dis. 10(2):185–194 2001; discussion 95
Chhabra S., T. N. Shipman, A. K. Prasad The entrainment behavior of a turbulent axisymmetric jet in a viscous host fluid. Exp. Fluid. 38(1):70–79, 2005
Christy J. R., N. Macleod The role of stasis in the clotting of blood and milk flows around solid objects. Cardiovasc. Res. 23(11):949–959, 1989
Fallon, A. M., U. M. Marzec, S. R. Hanson, and A. P. Yoganathan. Thrombin formation in vitro in response to shear-induced activation of platelets. Thromb. Res. 2007 May 25 [Epub ahead of print]
Fallon A. M., N. Shah, U. M. Marzec, J. N. Warnock, A. P. Yoganathan, S. R. Hanson Flow and thrombosis at orifices simulating mechanical heart valve leakage regions. J. Biomech. Eng. 128(1):30–39, 2006
Goodman P. D., E. T. Barlow, P. M. Crapo, S. F. Mohammad, K. A. Solen Computational model of device-induced thrombosis and thromboembolism. Ann. Biomed. Eng. 33(6):780–797, 2005
Gorman M. W., E. O. Feigl, C. W. Buffington Human plasma ATP concentration. Clin. Chem. 53(2):318–325, 2007
Goto S., Y. Ikeda, E. Saldivar, Z. M. Ruggeri Distinct mechanisms of platelet aggregation as a consequence of different shearing flow conditions. J. Clin. Invest. 101(2):479–486, 1998
Hellums J. D. 1993 Whitaker Lecture: biorheology in thrombosis research. Ann. Biomed. Eng. 22(5):445–455, 1994
Jen C. J., L. V. McIntire Characteristics of shear-induced aggregation in whole blood. J. Lab. Clin. Med. 103(1):115–124, 1984
Mustard J. F., D. W. Perry, R. L. Kinlough-Rathbone, M. A. Packham Factors responsible for ADP-induced release reaction of human platelets. Am. J. Physiol. 228(6):1757–1765, 1975
O’Brien J. R. Effects of adenosine diphosphate and adrenaline on mean platelet shape. Nature 207(994):306–307, 1965
Peerschke E. I. Ca+2 mobilization and fibrinogen binding of platelets refractory to adenosine diphosphate stimulation. J. Lab. Clin. Med. 106(2):111–122, 1985
Pelzer H., A. Schwarz, N. Heimburger Determination of human thrombin–antithrombin III complex in plasma with an enzyme-linked immunosorbent assay. Thromb. Haemost. 59(1):101–106, 1988
Pope S. B. Turbulent Flows. Cambridge, UK: University Press, 2000
Ruggeri Z. M. Mechanisms initiating platelet thrombus formation. Thromb. Haemost. 78(1):611–616, 1997
Savage B., E. Saldivar, Z. M. Ruggeri Initiation of platelet adhesion by arrest onto fibrinogen or translocation on von Willebrand factor. Cell 84(2):289–297, 1996
Shah A. B., N. Beamer, B. M. Coull Enhanced in vivo platelet activation in subtypes of ischemic stroke. Stroke J. Cereb. Circ. 16(4):643–647, 1985
Travis B. R., U. M. Marzec, H. L. Leo, T. Momin, C. Sanders, S. R. Hanson, et al. Bileaflet aortic valve prosthesis pivot geometry influences platelet secretion and anionic phospholipid exposure. Ann. Biomed. Eng. 29(8):657–664, 2001
Valles J., M. T. Santos, J. Aznar, A. J. Marcus, V. Martinez-Sales, M. Portoles, et al. Erythrocytes metabolically enhance collagen-induced platelet responsiveness via increased thromboxane production, adenosine diphosphate release, and recruitment. Blood 78(1):154–162, 1991
Wolberg A. S., Z. H. Meng, D. M. Monroe III, M. Hoffman A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J. Trauma. 56(6):1221–1228, 2004
Yoganathan, A. P. and B. R. Travis. Fluid dynamics of prosthetic valves. In: The Practice of Clinical Echocardiography, 2nd ed. edited by C. M. Otto. Philadelphia: WB Saunders, 2000
Zhang J. N., J. Wood, A. L. Bergeron, L. McBride, C. Ball, Q. Yu, et al. Effects of low temperature on shear-induced platelet aggregation and activation. J. Trauma. 57(2):216–223, 2004
Acknowledgments
The authors gratefully acknowledge the generous financial support of Tom and Shirley Gurley.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Fallon, A.M., Dasi, L.P., Marzec, U.M. et al. Procoagulant Properties of Flow Fields in Stenotic and Expansive Orifices. Ann Biomed Eng 36, 1–13 (2008). https://doi.org/10.1007/s10439-007-9398-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10439-007-9398-3