Excerpt from the Proceedings of the COMSOL Users Conference 2006 Birmingham

Simulation of Blood Flow through the Mitral Valve of the Heart: A Fluid Structure Interaction Model.
Daniel M. Espino*1, Michael A. Watkins1, Duncan E.T. Shepherd1, David W.L. Hukins1 and Keith G. Buchan2 1 Department of Mechanical and Manufacturing Engineering, University of Birmingham, Birmingham, UK, 2Aberdeen Royal Infirmary, Aberdeen, UK
*Corresponding author: Department of Mechanical and Manufacturing Engineering, University of Birmingham, Birmingham, UK, d.m.espino@bham.ac.uk

Abstract: Mitral valve failure causes death if it is not corrected surgically. Such surgical repair can be improved by understanding mitral biomechanics. A two-dimensional FSI model of the mitral valve was generated, using an ALE mesh. A simple approximation of the heart geometry was used, the valve dimensions were based on measurements made. The viscosity of blood and the elastic properties of the valve leaflets were obtained from the literature. Valve closure was simulated using contact equations. The simulation predicted a large vortex behind the anterior leaflet during inflow of blood into the left ventricle, in agreement with MRI scans available in the literature. Leaflet deformations agreed with results from experiments in the literature and with our previous experimental results. In conclusion, a two-dimensional model of the mitral valve has been developed, and will be further developed to investigate heart valve failure and subsequent surgical repair. Keywords: Mitral valve, Interaction, Biomechanics. Fluid-Structure

Several Finite Element (FE) models of the mitral valve have been developed; however, there are fewer that account for the effect of fluid flow through the valve (Einstein et al., 2005a,b; Van Loon et al., 2006; Watton et al., 2006). Of the developed FSI models of the mitral valve, all have simulated the flow of blood through the valve in a conduit and ignored the effect of the left ventricle of the heart on blood flow. Furthermore, one model simulated a polyurethane replacement mitral valve (Watton et al., 2006), and another a single leaflet in a tube (Van Loon et al., 2006). Only one FSI model of an actual mitral valve, with two leaflets has been developed (Einstein et al., 2005a,b). The FSI model of the mitral valve we are developing includes the walls of the left ventricle of the heart, both anterior and posterior leaflets of the valve, and the outflow tract of the aorta.

2. Methods
2.1 Model overview A two-dimensional FSI model of the mitral valve within the heart was generated using Comsol Multiphysics (Version 3.2). Lagrange multipliers have been used to apply the forces exerted on the deforming structure due to the flow of fluid, as has been done for other heart valve FSI simulations (De Hart et al., 2003). Velocity constraints were applied to the fluid on the fluid-structure boundary, to ensure fluid at that location moved at the same velocity as the moving structure, as in other simulations (De Hart et al., 2003). Structural deformation and fluid dynamics are determined simultaneously. An Arbitrary Lagrange Euler (ALE) mesh was used, to allow FSI simulations to be performed.

1. Introduction
Failure of the mitral valve of the heart can be fatal if it is not corrected surgically (Espino et al., 2005, 2006a). Improvement in the understanding of the biomechanics of the mitral valve would aid current knowledge of mitral valve function, its failure and possible surgical correction. Therefore, a Fluid-Structure Interaction (FSI) model of the mitral valve has been generated. The mitral valve is present in the left side of the heart, and functions normally to allow blood to flow into the left ventricle of the heart when it is filling. This valve then closes when blood is pumped out from the heart towards the body. In doing so, it prevents the regurgitation of fluid.

and outflow boundary conditions were applied at the aortic outlet. for inflow during valve opening (diastole. During systole only the stage of outflow of blood was simulated. flow and flow patterns were used to quantitatively validate the prediction of the model.7 mm thick. Table 1. as being elliptical in shape (i.5 Contact simulation Valve closure was simulated using contact equations between the boundaries of the two mitral valve leaflets that come into contact.70 × 10-3 1. The distance between nodes of one boundary on one leaflet and the whole boundary on the other leaflet was determined.. figure 1). and g the distance between the two contacting points. to apply the relevant ventricular pressures. ventricular pressure was applied from the apex of the heart. a) Elliptical model of the left ventricle. Model of the left ventricle geometry used. The dimensions of the valve leaflets were based on measurements made (approximately 20 mm length and 0. . 2.4 Boundary conditions Value 1. The simplified elliptical model has been used to simulate systolic ventricular pressures applied to generate blood flow within the heart chamber.  Pe − gk / P g > 0 F =  P − gk g ≤ 0 1 In equation 1.2 Geometry Two geometries of the left ventricle of the heart have been generated. A geometrically more accurate model has also been generated that matches a study in which measurements of pressure.e. Integration coupling variables were used to allow information regarding the position of the contacting boundaries available to each other all along the boundary of the leaflets. The two contacting boundaries were separated into small segments. During systole. During diastole an inflow velocity was applied at the atrium and a pressure condition was applied at the apex of the heart.0 × 106 1. half an ellipse).s) Leaflet density (kg/m3) Anterior leaflet Young’s modulus (MPa) Posterior leaflet Young’s modulus (MPa) Leaflet Poisson’s ratio 2. with nodes at the end of each small segment. 2. 1980). Reul et al. with part of the heart muscle dissected. and blood flow through the aortic outlet.Excerpt from the Proceedings of the COMSOL Users Conference 2006 Birmingham 2.06 × 103 2. Inflow boundary conditions were applied to simulate valve opening during diastole and valve closure during systole. Initially a simple approximation of the heart was made.06 × 103 2. and applied to equation 1.3 Parameters The viscosity of blood and the elastic properties of the valve leaflets were obtained from the literature (Table 1). F is the resulting contact force at each node. Values of parameters used to describe blood and heart valves during simulations. Parameter Blood density (kg/m3) Blood viscosity (Pa. showing the mitral valve. P is the applied fluid pressure. b) dissected specimen of the mitral valve. k is the stiffness of the contact. causing valve closure.0 × 106 0. figure 1b). the major and minor axis were 70 mm and 24 mm respectively (based on measurements on heart specimens.49 a) b) Figure 1.

Fb defines the contact force at any point on the boundary. agreed with results from experiments in the literature (figure 4). Predicted flow through a model of the left ventricle with a geometry that corresponds directly to a heart from which measurements of flow and subsequent flow patterns were made.Excerpt from the Proceedings of the COMSOL Users Conference 2006 Birmingham These contact forces were calculated at each node for both leaflet boundaries that came into contact.. during opening and closure. 1980). in turn altering the flow of blood. Measurements were taken from specific points (figure 3). which had different material properties (table 1). Results The flow of blood caused the valve leaflets to deform. The simulation predicted a large vortex behind the anterior leaflet during inflow of blood into the left ventricle (figure 2). in agreement with MRI scans available in the literature (Bronzino. Large vortex behind anterior leaflet generated during diastole. Results of simulating the closure of the mitral valve leaflets using the contact equations. Figure 2. . 2000). Leaflet deformations. The force acting along the whole boundary was then determined by interpolation between the two nodes at the end of each boundary (equation 2). It was assumed that the force in between two nodes would be continuous. While. During systole. Figure 4. respectively). 2006b). for quantitative comparison with published experimental results (Reul et al. Fb = (r1/r2 × (F2 –F2)) + F1 2 In equation 2. to the whole length of the boundary (r2).. Reasonable agreement was obtained. outflow of blood occurred through the aortic outlet (as reported in the medical literature). F1 is the contact force at node1 and F2 the contact force at node-2 (where node1 and node-2 define the start and end points of a boundary. are shown in figure 5. Little overlap occurred between the two leaflets. r1/r2 defines the ratio of the distance from node-1 to a given point (r1). Figure 3. 3. Simulated closure of the mitral valve of the heart. and mitral valve leaflet closure agreed with our previous experimental results (Espino et al.

2005. b) 6. Fluid mechanics of the natural mitral valve . 36-41 (2006b). Medical Engineering and Physics. Biomedical Engineering Handbook. our predicted results show good agreement with observations available in the literature. De Hart et al. Overall. Simulations performed include the inflow of blood into the left ventricle of the heart. Espino et al. 361-372 (1980). 15. Reul et al. 14. c) close up of leaflet section in contact.. a) Leaflets before application of pressure.Excerpt from the Proceedings of the COMSOL Users Conference 2006 Birmingham a) results (Espino et al. 1980). Mitral valve repair: an in vitro comparison of the effect of surgical repair on the pressure required to cause mitral valve regurgitation.. and general literature (Bronzino et al. Journal of Heart Valve Disease. This model will be used in future. Journal of Heart Valve Disease. Simulated mitral valve leaflet closure. 28. Furthermore. e.. 127. and outflow of blood through the aorta. Conclusions A two-dimensional model of the mitral valve of the heart has been developed. 2006a. The model will be used to investigate heart valve failure and subsequent surgical repair.b). 2000.. 5. The results from simulations agree with observations in the medical literature. Non-linear fluid-coupled computational model of the mitral valve. A more generalized model has been used more extensively. 14. 134-147 (2005a). This has allowed direct quantification of some results. to determine stresses experienced by mitral valves undergoing in vitro testing in our Laboratory to understand the stresses the valve experienced. The relationship of normal and abnormal microstructural proliferation to the mitral valve closure sound. Discussion A two dimensional FSI model of the mitral valve within the heart has been generated.. References Bronzino. Journal of Biomechanics. One of the models simulated was developed to match the geometry of a heart investigated in a study where flow patterns and measurements of flow and pressure were made. CRC Press LLC.. Einstein et al. 14. Journal of Biomechanical Engineering.. 375-381 (2006a). A fluid-structure interaction method with solid-rigid contact for heart valve c) Figure 5. b) leaflet closure position after application of pressure.. Journal of Biomechanics. 4.. Espino et al. 603-609 (2005). Reul et al. Van Loon et al. The role of chordae tendineae in mitral valve competence. 36. but validation is more qualitative. 376-385 (2005b). comparison to our previous experimental . 103-112 (2003)..g. Journal of Heart Valve Disease. it is to be developed into a threedimensional model. Espino et al. Einstein et al. Determination of the pressure required to cause mitral valve failure. Boca Raton (2000). A three-dimensional computational analysis of fluid–structure interaction in the aortic valve. and transient simulations have been performed. The latter simulation has required the use of contact equations to simulate the closure..

Excerpt from the Proceedings of the COMSOL Users Conference 2006 Birmingham dynamics. 806-823 (2006). 7. In Press (2006). Journal of Computational Physics. 217. Watton et al. Acknowledgements The authors thank: The British Heart Foundation for a Junior Fellowship awarded to DME (FS/05/033).. and the Nuffield Foundation for an Undergraduate Research Bursary awarded to MAW. Dynamic modelling of prosthetic chorded mitral valves using the immersed boundary method. . Journal of Biomechanics.