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

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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.

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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

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Acknowledgments

Dr. G. Hundley, MD and Dr. C. Hamilton, PhD are gratefully acknowledged for their help in obtaining the clinical MRI data. The authors would also like to thank Cassie Niebel for her help with image segmentation. This material is based upon work supported under a National Science Foundation Graduate Research Fellowship, National Science Foundation Grant No. 0547434, and a National Institutes of Health R21 Grant No. HL106276-01A1.

Conflict of interest

We confirm that all authors have no conflicts of interest to declare.

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Author notes

  1. Kelley Stewart

    Present address: Department of Mechanical and Aerospace Engineering, The George Washington University, 801 22nd Street NW, Academic Center, Suite 739, Washington, DC, 20052, USA

Authors and Affiliations

  1. Department of Mechanical Engineering, Virginia Tech, 100 Randolph Hall, Blacksburg, VA, 24060, USA

    John J. Charonko, Kelley Stewart & Pavlos P. Vlachos

  2. Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Rahul Kumar & William C. Little

Authors
  1. John J. Charonko
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  2. Rahul Kumar
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Corresponding author

Correspondence to Pavlos P. Vlachos.

Additional information

Associate Editor Aleksander S. Popel oversaw the review of this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 703 kb)

10439_2013_755_MOESM2_ESM.mpg

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

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

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)

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Charonko, J.J., Kumar, R., Stewart, K. et al. Vortices Formed on the Mitral Valve Tips Aid Normal Left Ventricular Filling. Ann Biomed Eng 41, 1049–1061 (2013). https://doi.org/10.1007/s10439-013-0755-0

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