Procoagulant Properties of Flow Fields in Stenotic and Expansive Orifices


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.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.




mechanical heart valve


St. Jude medical


digital particle image velocimetry


laser Doppler velocimetry


thrombin–antithrombin III


platelet factor 4


principle Reynolds stress


shear-induced platelet activation


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


  1. 1.

    Affeld K., K. Schichl, A. Yoganathan Investigation of the flow in a centrifugal blood pump. ASAIO Trans. 32(1):269–273, 1986

  2. 2.

    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

  3. 3.

    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

  4. 4.

    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

  5. 5.

    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

  6. 6.

    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

  7. 7.

    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

  8. 8.

    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]

  9. 9.

    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

  10. 10.

    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

  11. 11.

    Gorman M. W., E. O. Feigl, C. W. Buffington Human plasma ATP concentration. Clin. Chem. 53(2):318–325, 2007

  12. 12.

    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

  13. 13.

    Hellums J. D. 1993 Whitaker Lecture: biorheology in thrombosis research. Ann. Biomed. Eng. 22(5):445–455, 1994

  14. 14.

    Jen C. J., L. V. McIntire Characteristics of shear-induced aggregation in whole blood. J. Lab. Clin. Med. 103(1):115–124, 1984

  15. 15.

    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

  16. 16.

    O’Brien J. R. Effects of adenosine diphosphate and adrenaline on mean platelet shape. Nature 207(994):306–307, 1965

  17. 17.

    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

  18. 18.

    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

  19. 19.

    Pope S. B. Turbulent Flows. Cambridge, UK: University Press, 2000

  20. 20.

    Ruggeri Z. M. Mechanisms initiating platelet thrombus formation. Thromb. Haemost. 78(1):611–616, 1997

  21. 21.

    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

  22. 22.

    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

  23. 23.

    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

  24. 24.

    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

  25. 25.

    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

  26. 26.

    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

  27. 27.

    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

Download references


The authors gratefully acknowledge the generous financial support of Tom and Shirley Gurley.

Author information

Correspondence to Ajit P. Yoganathan.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Rights and permissions

Reprints 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) doi:10.1007/s10439-007-9398-3

Download citation


  • Mechanical heart valves
  • Shear-induced platelet activation
  • Shear-induced platelet aggregation
  • Thrombosis
  • Blood
  • Coagulation