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Methodological inaccuracies in clinical aortic valve severity assessment: insights from computational fluid dynamic modeling of CT-derived aortic valve anatomy

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Abstract

Aortic stenosis is the most common valvular heart disease. Assessing the contribution of the valve as a portion to total ventricular load is essential for the aging population. A CT scan for one patient was used to create one in vivo tricuspid aortic valve geometry and assessed with computational fluid dynamics (CFD). CFD simulated the pressure, velocity, and flow rate, which were used to assess the Gorlin formula and continuity equation, current clinical diagnostic standards. The results demonstrate an underestimation of the anatomic orifice area (AOA) by Gorlin formula and overestimation of AOA by the continuity equation, using peak velocities, as would be measured clinically by Doppler echocardiography. As a result, we suggest that the Gorlin formula is unable to achieve the intended estimation of AOA and largely underestimates AOA at the critical low-flow states present in heart failure. The disparity in the use of echocardiography with the continuity equation is due to the variation in velocity profile between the outflow tract and the valve orifice. Comparison of time-averaged orifice areas by Gorlin and continuity with instantaneous orifice areas by planimetry can mask the errors of these methods, which is a result of the assumption that the blood flow is inviscid.

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Abbreviations

AOA:

Anatomic orifice area

AS:

Aortic stenosis

AV:

Aortic valve

CAS:

Calcific aortic stenosis

cath:

Cardiac catheterization

CO:

Cardiac output

dP:

Clinical pressure gradient

C c :

Coefficient of contraction

C v :

Coefficient of velocity

CFD:

Computational fluid dynamics

CT:

Computed tomography

echo:

Echocardiography

echo/cont.:

Echocardiography/continuity equation

EOA:

Effective orifice area

ECG:

Electrocardiogram

Q :

Flow rate

C :

Gorlin coefficient

HR:

Heart rate

LV:

Left ventricle

LVOT:

Left ventricular outflow tract

LVP:

Left ventricular pressure

LVV:

Left ventricular volume

MRI:

Magnetic resonance imaging

P :

Pressure

STJ:

Sino-tubular junction

SEP:

Systolic ejection period

TVI:

Time–velocity integral

TAVI:

Transcatheter aortic valve implantation

TEE:

Transesophageal echo

TTE:

Transthoracic echo

US:

Ultrasound

V :

Velocity

VC:

Vena contracta

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Authors and Affiliations

  1. Department of Mechanical Engineering, North Dakota State University, Fargo, ND, 58108, USA

    Brad Traeger, Kevin M. Beussman, Yechun Wang & Yildirim B. Suzen

  2. Heart Artery and Vein Center Fresno, Suite# 105, 7206 N Milburn Avenue, Fresno, CA, 93722, USA

    Sanjay S. Srivatsa

  3. The Ohio Heart and Vascular Center, The Christ Hospital, Cincinnati, OH, 45219, USA

    Wojciech Mazur

  4. Applied Imaging Science Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Frank J. Rybicki

  5. Center for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Kraków, Poland

    Tomasz Miszalski-Jamka

  6. Department of Clinical Radiology and Imaging Diagnostics, 4th Military Hospital, Wrocław, Poland

    Tomasz Miszalski-Jamka

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  1. Brad Traeger
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  2. Sanjay S. Srivatsa
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Correspondence to Yechun Wang.

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Communicated by Jeff D. Eldredge.

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Traeger, B., Srivatsa, S.S., Beussman, K.M. et al. Methodological inaccuracies in clinical aortic valve severity assessment: insights from computational fluid dynamic modeling of CT-derived aortic valve anatomy. Theor. Comput. Fluid Dyn. 30, 107–128 (2016). https://doi.org/10.1007/s00162-015-0370-9

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