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Effect of Left and Right Coronary Flow Waveforms on Aortic Sinus Hemodynamics and Leaflet Shear Stress: Correlation with Calcification Locations

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Abstract

Coronary flow induces hemodynamic alterations in the aortic sinus region. The objectives of this study are to: (1) investigate the differences among sinus hemodynamics and leaflet wall shear stresses engendered by the left versus right versus non-coronary flow and (2) correlate respective wall shear stresses with leaflet calcification in patients. A left heart simulator flow loop with a tunable coronary circuit provided physiological coronary flow waveforms corresponding to the left coronary cusp case (LCC), right coronary cusp case (RCC), and non-coronary cusp case (NCC). High spatio-temporal resolution particle image velocimetry was conducted to quantify leaflet wall shear stress and sinus vorticity fields and to measure aortic leaflet tip kinematics. Thirty-one patients with severe calcific aortic valve disease were segmented from CT data for the calcific volumes in their respective left, right, and non-coronary cusps. Leaflet tip position during systole shows the RCC has a wider leaflet opening compared to LCC and NCC. Velocity and vorticity fields combined with leaflet position data show that sinus vorticity is diminished (peak ~ 43 s−1) in the LCC while RCC and NCC maintain high vorticity (~ 1200 and ~ 950 s−1 respectively). WSS magnitudes greater than 0.3 Pa show 20 and 81% greater occurrences in the LCC and RCC respectively compared to NCC. Significant differences [X2 (2, n = 31) = 7.31, p = 0.0258] between the calcification levels in each cusp of the patient population. Coronary flow differences between LCC, RCC, and NCC show significant impact on leaflet kinematics and sinus flow hemodynamics. Clinical data correlations of the coronary flow cases indicate the left coronary cusp has a higher likelihood of calcification compared to the right.

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Acknowledgments

This research was supported by the National Institutes of Health under Award Number 3R01HL118924 and 5R01HL119824 and by the American Heart Association under Award Number.

Conflict of interest

Dr. Dasi reports having a patent application filed on novel polymeric valves. No other conflicts were reported.

Funding

The research done was partly supported by National Institutes of Health (NIH) under Award Number 3R01HL119824 and 5R01HL119824 and by the American Heart Association under award number 19POST34380804.

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Authors and Affiliations

  1. Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA

    Dorma C. Flemister

  2. Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA

    Hoda Hatoum & Lakshmi P. Dasi

  3. Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931, USA

    Hoda Hatoum

  4. Department of Neuroscience, The Ohio State University, Columbus, OH, USA

    Varshini Guhan

  5. Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA

    Banafsheh Zebhi

  6. Department of Pediatric Cardiology, Children’s Hospital of Wisconsin, Milwaukee, WI, USA

    Joy Lincoln

  7. Division of Cardiac Surgery, Mayo Clinic, Rochester, MN, USA

    Juan Crestanello

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  1. Dorma C. Flemister
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  2. Hoda Hatoum
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  3. Varshini Guhan
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  5. Joy Lincoln
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  6. Juan Crestanello
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  7. Lakshmi P. Dasi
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Correspondence to Lakshmi P. Dasi.

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Associate Editor Ender A. Finol oversaw the review of this article.

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Dorma C. Flemister and Hoda Hatoum shared the authorship.

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Flemister, D.C., Hatoum, H., Guhan, V. et al. Effect of Left and Right Coronary Flow Waveforms on Aortic Sinus Hemodynamics and Leaflet Shear Stress: Correlation with Calcification Locations. Ann Biomed Eng 48, 2796–2808 (2020). https://doi.org/10.1007/s10439-020-02677-9

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  • DOI: https://doi.org/10.1007/s10439-020-02677-9

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