Annals of Biomedical Engineering

, Volume 41, Issue 5, pp 1049–1061

Vortices Formed on the Mitral Valve Tips Aid Normal Left Ventricular Filling

  • John J. Charonko
  • Rahul Kumar
  • Kelley Stewart
  • William C. Little
  • Pavlos P. Vlachos
Article

DOI: 10.1007/s10439-013-0755-0

Cite this article as:
Charonko, J.J., Kumar, R., Stewart, K. et al. Ann Biomed Eng (2013) 41: 1049. doi:10.1007/s10439-013-0755-0

Abstract

For the left ventricle (LV) to function as an effective pump it must be able to fill from a low left atrial pressure. However, this ability is lost in patients with heart failure. We investigated LV filling by measuring the cardiac blood flow using 2D phase contrast magnetic resonance imaging and quantified the intraventricular pressure gradients and the strength and location of vortices. In normal subjects, blood flows towards the apex prior to the mitral valve opening, and the mitral annulus moves rapidly away after the valve opens, with both effects enhancing the vortex ring at the mitral valve tips. Instead of being a passive by-product of the process as was previously believed, this ring facilitates filling by reducing convective losses and enhancing the function of the LV as a suction pump. The virtual channel thus created by the vortices may help insure efficient mass transfer for the left atrium to the LV apex. Impairment of this mechanism contributes to diastolic dysfunction, with LV filling becoming dependent on left atrial pressure, which can lead to eventual heart failure. Better understanding of the mechanics of this progression may lead to more accurate diagnosis and treatment of this disease.

Keywords

Left ventricle filling Heart failure Vortex formation Phase contrast MRI 

Abbreviations

DCM

Dilated cardiomyopathy

FTLE

Finite time Lyapunov exponents

LA

Left atrium

LCS

Lagrangian coherent structures

LV

Left ventricle

LVDD

Left ventricular diastolic dysfunction

MV

Mitral valve

MRI

Magnetic resonance imaging

pcMRI

Phase contrast MRI

POD

Proper orthogonal decomposition

RV

Right ventricle

SNR

Signal to noise ratio

Supplementary material

10439_2013_755_MOESM1_ESM.doc (703 kb)
Supplementary material 1 (DOC 703 kb)
10439_2013_755_MOESM2_ESM.mpg (645 kb)
Movie S1: Animation of the velocity vectors, relative pressures, and vortical structures for a representative healthy patient. Supplementary material 2 (MPG 645 kb)
10439_2013_755_MOESM3_ESM.mpg (666 kb)
Movie S2: Animation of the velocity vectors, relative pressures, and vortical structures for a representative LVDD patient. Supplementary material 3 (MPG 666 kb)
10439_2013_755_MOESM4_ESM.mpg (648 kb)
Movie S3: Animation of the velocity vectors, relative pressures, and vortical structures for the patient with dilated cardiomyopathy. Supplementary material 4 (MPG 647 kb)

Movie S4: Animation of the FTLE fields for a representative healthy patient, showing LCS and the effect of the vortex pair on the virtual channel. Supplementary material 5 (MPG 349 kb)

Movie S5: Animation of the FTLE fields for a representative LVDD patient, showing LCS and the effect of the vortex pair on the virtual channel. Supplementary material 6 (MPG 372 kb)

Movie S6: Animation of the FTLE fields for the patient with dilated cardiomyopathy, showing LCS and the effect of the vortex pair on the virtual channel. Supplementary material 7 (MPG 350 kb)

Copyright information

© Biomedical Engineering Society 2013

Authors and Affiliations

  • John J. Charonko
    • 1
  • Rahul Kumar
    • 2
  • Kelley Stewart
    • 1
    • 3
  • William C. Little
    • 2
  • Pavlos P. Vlachos
    • 1
  1. 1.Department of Mechanical EngineeringVirginia TechBlacksburgUSA
  2. 2.Department of CardiologyWake Forest School of MedicineWinston-SalemUSA
  3. 3.Department of Mechanical and Aerospace EngineeringThe George Washington UniversityWashingtonUSA

Personalised recommendations