Impact of Pulmonary Venous Locations on the Intra-Atrial Flow and the Mitral Valve Plane Velocity Profile
In this paper we present a three-dimensional computational fluid dynamics (CFD) framework of the left atrium (LA) and its pulmonary veins (PVs). The framework uses magnetic resonance imaging (MRI) to render the subject-specific atrial and venous geometries. The aim was first to investigate the diastolic flow field in an anatomically representative model of the LA and PVs. Second, to investigate the impact of different positions of the PVs on the intra-atrial flow and on the resulting velocity distribution at the mitral valve (MV) plane. Three 3D models with different venous entry locations were created for this purpose. In the model with anatomically based PV positions, the velocity profile at the MV plane showed qualitatively good agreement with the MRI flow measurements. When comparing the flow field in the three models, the results clearly illustrate that the PVs have a significant impact on the intra-atrial flow and the final velocity profile at the MV plane. Because the interpatient variability in PV number and branching patterns is large, the velocity profile at the MV plane should be considered as a subject-specific property. Therefore, we suggest that in order to obtain a physiological correct simulation of ventricular filling and MV opening dynamics, a subject-specific representation of the atrial and venous anatomies should be included in the simulation model.
KeywordLeft atrium Intra-atrial flow Pulmonary veins Mitral valve plane Computational fluid dynamics Magnetic resonance imaging
The authors would like to express their gratitude to MD, PhD Brage Amundsen, Dept. of Circulation and Medical Imaging, NTNU, for performing the MRI recordings at St.Olavs University Hospital, Trondheim, Norway, and to Prof.em. Tor Ytrehus at the Fluids Engineering Group, NTNU, for all the fruitful discussions.
- 3.Calkins, H., S. Y. Ho, J. A. Cabrera, P. D. Bella, J. Farré, J. Kautzner, and P. Tchou. Anatomy of the Left Atrium and Pulmonary Veins. Blackwell Publishing Ltd, Oxford, UK, Ch. 1, 2008.Google Scholar
- 4.Dahl, S. K. 2012. Numerical simulations of blood flow in the left side of the heart. Ph.D. thesis, Norwegian University of Science and Technology.Google Scholar
- 15.Long, Q., R. Merrifield, G. Yang, P. J. Kilner, D. N. Firmin, and X. Y. Xu. The influence of inflow boundary conditions on intra left ventricle flow predictions. J. Biomech. Eng. ASME 125:922–927, 2003.Google Scholar
- 16.Lotz. J., C. Meier, A. Leppert, and M. Galanski. Cardiovascular flow measurement with phase-contrast mr imaging: basic facts and implementation. RadioGraphics 22(3):651–671, 2002.Google Scholar
- 17.Mansour, M., G. Holmvang, D. Sosnovik, R. Migrino, S. Abbara, J. Ruskin, and D. Keane. Assessment of pulmonary vein anatomic variability by magnetic resonance imaging: implications for catheter ablation techniques for atrial fibrillation. J. Cardiovasc. Electrophysiol. 15(4):387–393, 2004.CrossRefGoogle Scholar
- 18.Mihalef, V., R. Ionasec, Y. Wang, Y. Zheng, B. Georgescu, and D. Comaniciu. Patient-specific modeling of left heart anatomy, dynamics and hemodynamics from high resolution 4d ct. In: 2010 IEEE International Symposium on Biomedical Imaging: From Nano to Macro, April 2010, pp. 504 –507.Google Scholar
- 19.Pedrizzetti, G., and F. Domenichini. Nature optimizes the swirling flow in the human left ventricle. Phys. Rev. Lett. 95:108101, September 2005.Google Scholar
- 21.Schmidt, B., S. Ernst, F. Ouyang, K. J. Chun, T. Broemel, D. Bansch, K.-H. Kuck, and M. Antz. External and endoluminal analysis of left atrial anatomy and the pulmonary veins in three-dimensional reconstructions of magnetic resonance angiography: the full insight from inside. J. Cardiovasc. Electrophysiol. 17(9):957–964, 2006.CrossRefGoogle Scholar
- 22.Shibata, M., T. Yambe, Y. Kanke, and T. Hayase. Atrial vortex measurement by magnetic resonance imaging. In: 13th International Conference on Biomedical Engineering. Vol. 23 of IFMBE Proceedings, edited by C. T. Lim, J. C. H. Goh, R. Magjarevic. Berlin: Springer, 2009, pp. 2254–2257.Google Scholar
- 23.Spiegel, K., W. Schiller, T. Schmid, A. Welz, D. Liepsch, and H. Oertel. Numerical simulation of the left ventricle and atrium as reference for pathological hearts. In: Proceedings of the Fifth IASTED International Conference on Biomechanics, 20–22 August 2007, pp. 78–83.Google Scholar
- 25.Tanne, D., E. Bertrand, P. Pibarot, and R. Rieu. Asymmetric flows in an anatomical-shaped left atrium by 2c-3d+t piv measurements. Comput. Methods Biomech. Biomed. Eng. 209–211, 2008.Google Scholar