Effects of stenotic aortic valve on the left heart hemodynamics: a fluid-structure-electrophysiology approach

TL;DR

This study uses a comprehensive multi-physics model to analyze how stenotic aortic valves affect left heart hemodynamics, revealing changes in flow patterns, wall shear stresses, and potential myocardial remodeling, consistent with clinical observations.

Contribution

It introduces a multi-physics simulation approach to study the impact of aortic stenosis on heart hemodynamics, integrating electrophysiology, myocardial contraction, and fluid-structure interaction.

Findings

Increased transvalvular pressure drop and jet velocity with stenosis

Altered wall shear stress distribution over the aortic arch and valve

Model results align with clinical data

Abstract

The aortic valve is a three-leaflet passive structure that, driven by pressure differences between the left ventricle and the aorta, opens and closes during the heartbeat to ensure the correct stream direction and flow rate. In elderly individuals or because of particular pathologies, the valve leaflets can stiffen thus impairing the valve functioning and, in turn, the pumping efficiency of the heart. Using a multi-physics left heart model accounting for the electrophysiology, the active contraction of the myocardium, the hemodynamics and the related fluid-structure-interaction, we have investigated the changes in the flow features for different severities of the aortic valve stenosis. We have found that, in addition to the increase of the transvalvular pressure drop and of the systolic jet velocity, a stenotic aortic valve significantly alters the wall shear stresses and their spatial distribution over the aortic arch and valve leaflets, which may induce a remodelling process of the ventricular myocardium. The numerical results from the multi-physics model are fully consistent with the clinical experience, thus further opening the way for computational engineering aided medical diagnostic.