Abstract: Cardiovascular diseases (CVD) are related to affectations of the heart and blood vessels, within these are pathologies such as coronary or peripheral heart disease, caused by the narrowing of the vessel wall (atherosclerosis), which is related to the accumulation of Low-Density Lipoproteins (LDL) in the arterial walls that leads to a progressive reduction of the lumen of the vessel and alterations in blood perfusion. Currently, the main therapeutic strategy for this type of alteration is drug treatment with statins, which inhibit the enzyme 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG-CoA reductase), responsible for modulating the rate of cholesterol production and other isoprenoids in the mevalonate pathway. This enzyme induces the expression of LDL receptors in the liver, increasing their number on the surface of liver cells, reducing the plasma concentration of cholesterol. On the other hand, when the blood vessel presents stenosis, a surgical procedure with vascular implants is indicated, which are used to restore circulation in the arterial or venous bed. Among the materials used for the development of vascular implants are Dacron® and Teflon®, which perform the function of re-waterproofing the circulatory circuit, but due to their low biocompatibility, they do not have the ability to promote remodeling and tissue regeneration processes. Based on this, the present research proposes the development of a hydrolyzed collagen and polyethylene oxide electrospun membrane reinforced with medium and high-intensity statins, so that in future research it can favor tissue remodeling processes from its microarchitecture.
Abstract: Cardiovascular diseases are one of the most common causes of mortality in developed countries. Coronary artery abnormalities and carotid artery stenosis, also known as silent death, are among these diseases. One of the treatment methods for these diseases is to create a deviatory pathway to conduct blood into the heart through a bypass surgery. The saphenous vein is usually used in this surgery to create the deviatory pathway. Unfortunately, a re-surgery will be necessary after some years due to ignoring the disagreement of mechanical properties of graft tissue and/or applied prostheses with those of host tissue. The objective of the present study is to clarify the viscoelastic behavior of human saphenous tissue. The stress relaxation tests in circumferential and longitudinal direction were done in this vein by exerting 20% and 50% strains. Considering the stress relaxation curves obtained from stress relaxation tests and the coefficients of the standard solid model, it was demonstrated that the saphenous vein has a non-linear viscoelastic behavior. Thereafter, the fitting with Fung’s quasilinear viscoelastic (QLV) model was performed based on stress relaxation time curves. Finally, the coefficients of Fung’s QLV model, which models the behavior of saphenous tissue very well, were presented.
Abstract: Vaginal stenosis is a common side effect associated with pelvic radiotherapy in cervical cancer patients which contributes negatively to woman’s health and prevents adequate vaginal/cervical examination. Vaginal dilation with a dilator is routine practice and is internationally advocated as a prophylactic measure to preserve vaginal patency. This retrospective study was carried out with the aim to know the usefulness of vaginal dilation following pelvic radiation therapy in cervical cancer patients in India. Data from medical records of 183 cervical cancer patients, which met the study criteria, were collected related to the stage of the disease, treatment received, commencement period of dilation post radiation therapy, sexual status and side effects associated to dilation practice. Data related to vaginal dimensions as per the length of insertion of a small, medium and large dilator were collected on regular follow-ups until 36 months and/or more. Vaginal dimensions as measured with the length of medium dilator insertion were used for analysis of dilation therapy results using paired t-test. Patients who underwent vaginal dilation with dilator maintained vaginal patency, also the mean vaginal length significantly increased, from 8.02 cm ± 2.69 to 9.96 ± 2.89 cm with a p value
Abstract: The aim of the present study is to computationally evaluate the hemodynamic factors which affect the formation of atherosclerosis and plaque rupture in the human artery. An increase of atherosclerosis disease in the artery causes geometry changes, which results in hemodynamic changes such as flow separation, reattachment, and adhesion of new cells (chemotactic) in the artery. Hence, geometry plays an important role in the determining the nature of hemodynamic patterns. Influence of stenosis in the non-bifurcating artery, under pulsatile flow condition, has been studied on an idealized geometry. Analysis of flow through symmetric and asymmetric stenosis in the artery revealed the significance of oscillating shear index (OSI), flow separation, low WSS zones and secondary flow patterns on plaque formation. The observed characteristic of flow in the post-stenotic region highlight the importance of plaque eccentricity on the formation of secondary stenosis on the arterial wall.
Abstract: The numerical simulation has made tremendous
advances in investigating the blood flow phenomenon through elastic
arteries. Such study can be useful in demonstrating the disease
progression and hemodynamics of cardiovascular diseases such as
atherosclerosis. In the present study, patient specific case diagnosed
with partially stenosed complete right ICA and normal left carotid
bifurcation without any atherosclerotic plaque formation is
considered. 3D patient specific carotid bifurcation model is generated
based on CT scan data using MIMICS-4.0 and numerical analysis is
performed using FSI solver in ANSYS-14.5. The blood flow is
assumed to be incompressible, homogenous and Newtonian, while
the artery wall is assumed to be linearly elastic. The two-way
sequentially coupled transient FSI analysis is performed using FSI
solver for three pulse cycles. The hemodynamic parameters such as
flow pattern, Wall Shear Stress, pressure contours and arterial wall
deformation are studied at the bifurcation and critical zones such as
stenosis. The variation in flow behavior is studied throughout the
pulse cycle. Also, the simulation results reveal that there is a
considerable increase in the flow behavior in stenosed carotid in
contrast to the normal carotid bifurcation system. The investigation
also demonstrates the disturbed flow pattern especially at the
bifurcation and stenosed zone elevating the hemodynamics,
particularly during peak systole and later part of the pulse cycle. The
results obtained agree well with the clinical observation and
demonstrates the potential of patient specific numerical studies in
prognosis of disease progression and plaque rupture.
Abstract: In the current work, a three-dimensional geometry of a
75% stenosed blood vessel is analyzed. Large eddy simulation (LES)
with the help of a dynamic subgrid scale Smagorinsky model is
applied to model the turbulent pulsatile flow. The geometry, the
transmural pressure and the properties of the blood and the elastic
boundary were based on clinical measurement data. For the flexible
wall model, a thin solid region is constructed around the 75%
stenosed blood vessel. The deformation of this solid region was
modelled as a deforming boundary to reduce the computational cost
of the solid model. Fluid-structure interaction is realized via a twoway
coupling between the blood flow modelled via LES and the
deforming vessel. The information of the flow pressure and the wall
motion was exchanged continually during the cycle by an arbitrary
Lagrangian-Eulerian method. The boundary condition of current time
step depended on previous solutions. The fluctuation of the velocity
in the post-stenotic region was analyzed in the study. The axial
velocity at normalized position Z=0.5 shows a negative value near
the vessel wall. The displacement of the elastic boundary was
concerned in this study. In particular, the wall displacement at the
systole and the diastole were compared. The negative displacement at
the stenosis indicates a collapse at the maximum velocity and the
deceleration phase.
Abstract: The development of double stenosis in an artery can have serious consequences and can disrupt the normal functioning of the circulatory system. It has been realized that various hydrodynamics effects (i.e. wall shear, pressure distribution etc.) play important role in the development of this disease. Generally in the literature, the cross-section of the artery is assumed to be uniform with a single stenosis. However, in real situation the multiple stenosis develops in series along the length of artery whose cross-section varies slowly. Therefore, the flow of blood is laminar through a small diameter artery with axisymmetric identical double stenosis in series.
Abstract: Steady incompressible couple stress fluid flow through two dimensional symmetric channel with stenosis is investigated. The flow consisting of a core region to be a couple stress fluid and a peripheral layer of plasma (Newtonian fluid). Assuming the stenosis to be mild, the equations governing the flow of the proposed model are solved using the slip boundary condition and closed form expressions for the flow characteristics (the dimensionless resistance to flow and wall shear stress at the maximum height of stenosis) are derived. The effects of various parameters on these flow variables have been studied. It is observed that the resistance to flow as well as the wall shear stress increase with the height of stenosis, viscosity ratio and Darcy number. However, the trend is reversed as the slip and the couple stress parameter increase.
Abstract: The ε4 allele of the ε2, ε3 and ε4 protein isoform polymorphism in the gene encoding apolipoprotein E (Apo E) has previously been associated with increased cardiac artery disease (CAD); therefore to investigate the significance of this polymorphism in pathogenesis of CAD in Iranian patients with stenosis and control subjects. To investigate the association between
Apo E polymorphism and coronary artery disease we performed a comparative case control study of the frequency of Apo E
polymorphism in One hundred CAD patients with stenosis who underwent coronary angiography (>50% stenosis) and 100 control subjects (
Abstract: Human heart valves diseased by congenital heart
defects, rheumatic fever, bacterial infection, cancer may cause stenosis
or insufficiency in the valves. Treatment may be with medication but
often involves valve repair or replacement (insertion of an artificial
heart valve). Bileaflet mechanical heart valves (BMHVs) are widely
implanted to replace the diseased heart valves, but still suffer from
complications such as hemolysis, platelet activation, tissue
overgrowth and device failure. These complications are closely related
to both flow characteristics through the valves and leaflet dynamics. In
this study, the physiological flow interacting with the moving leaflets
in a bileaflet mechanical heart valve (BMHV) is simulated with a
strongly coupled implicit fluid-structure interaction (FSI) method
which is newly organized based on the Arbitrary-Lagrangian-Eulerian
(ALE) approach and the dynamic mesh method (remeshing) of
FLUENT. The simulated results are in good agreement with previous
experimental studies. This study shows the applicability of the present
FSI model to the complicated physics interacting between fluid flow
and moving boundary.
Abstract: Nowadays, cardiac disease is one of the most common
cause of death. Each year almost one million of angioplasty interventions and stents implantations are made all over the world.
Unfortunately, in 20-30% of cases neointimal proliferations leads to
restenosis occurring within the following period of 3-6 months. Three major factors are believed to contribute mostly to the edge
restenosis: (a) mechanical damage of the artery-s wall caused by the
stent implantation, (b) interaction between the stent and the blood constituents and (c) endothelial growth stimulation by small (lower
that 1.5 Pa) and oscillating wall shear stress. Assuming that this last actor is particularly important, a numerical model of restenosis
basing on wall shear stress distribution in the stented artery was elaborated. A numerical simulations of the development of in-stent
restenosis have been performed and realistic geometric patterns of a
progressing lumen reduction have been obtained
Abstract: Cardiovascular disease mostly in the form of atherosclerosis is responsible for 30% of all world deaths amounting to 17 million people per year. Atherosclerosis is due to the formation of plaque. The fatty plaque may be at risk of rupture, leading typically to stroke and heart attack. The plaque is usually associated with a high degree of lumen reduction, called a stenosis. The initiation and progression of the disease is strongly linked to the hemodynamic environment near the vessel wall. The aim of this study is to validate the flow of blood mimic through an arterial stenosis model with computational fluid dynamics (CFD) package. In experiment, an axisymmetric model constructed consists of contraction and expansion region that follow a mathematical form of cosine function. A 30% diameter reduction was used in this study. Particle image velocimetry (PIV) was used to characterize the flow. The fluid consists of rigid spherical particles suspended in waterglycerol- NaCl mixture. The particles with 20 μm diameter were selected to follow the flow of fluid. The flow at Re=155, 270 and 390 were investigated. The experimental result is compared with FLUENT simulated flow that account for viscous laminar flow model. The results suggest that laminar flow model was sufficient to predict flow velocity at the inlet but the velocity at stenosis throat at Re =390 was overestimated. Hence, a transition to turbulent regime might have been developed at throat region as the flow rate increases.
Abstract: Matrix metalloproteinase-3 (MMP3) is key member
of the MMP family, and is known to be present in coronary
atherosclerotic. Several studies have demonstrated that MMP-3
5A/6A polymorphism modify each transcriptional activity in allele
specific manner. We hypothesized that this polymorphism may play
a role as risk factor for development of coronary stenosis. The aim of
our study was to estimate MMP-3 (5A/6A) gene polymorphism on
interindividual variability in risk for coronary stenosis in an Iranian
population.DNA was extracted from white blood cells and genotypes
were obtained from coronary stenosis cases (n=95) and controls
(n=100) by PCR (polymerase chain reaction) and restriction
fragment length polymorphism techniques. Significant differences
between cases and controls were observed for MMP3 genotype
frequencies (X2=199.305, p< 0.001); the 6A allele was less
frequently seen in the control group, compared to the disease group
(85.79 vs. 78%, 6A/6A+5A/6A vs. 5A/5A, P≤0.001). These data
imply the involvement of -1612 5A/6A polymorphism in coronary
stenosis, and suggest that probably the 6A/6A MMP-3 genotype is a
genetic susceptibility factor for coronary stenosis.
Abstract: The myocardial sintigraphy is an imaging modality which provides functional informations. Whereas, coronarography modality gives useful informations about coronary arteries anatomy. In case of coronary artery disease (CAD), the coronarography can not determine precisely which moderate lesions (artery reduction between 50% and 70%), known as the “gray zone", are haemodynamicaly significant. In this paper, we aim to define the relationship between the location and the degree of the stenosis in coronary arteries and the observed perfusion on the myocardial scintigraphy. This allows us to model the impact evolution of these stenoses in order to justify a coronarography or to avoid it for patients suspected being in the gray zone. Our approach is decomposed in two steps. The first step consists in modelling a coronary artery bed and stenoses of different location and degree. The second step consists in modelling the left ventricle at stress and at rest using the sphercical harmonics model and myocardial scintigraphic data. We use the spherical harmonics descriptors to analyse left ventricle model deformation between stress and rest which permits us to conclude if ever an ischemia exists and to quantify it.
Abstract: Coronary artery bypass grafts (CABG) are widely
studied with respect to hemodynamic conditions which play
important role in presence of a restenosis. However, papers which
concern with constitutive modeling of CABG are lacking in the
literature. The purpose of this study is to find a constitutive model for
CABG tissue. A sample of the CABG obtained within an autopsy
underwent an inflation–extension test. Displacements were
recoredered by CCD cameras and subsequently evaluated by digital
image correlation. Pressure – radius and axial force – elongation
data were used to fit material model. The tissue was modeled as onelayered
composite reinforced by two families of helical fibers. The
material is assumed to be locally orthotropic, nonlinear,
incompressible and hyperelastic. Material parameters are estimated
for two strain energy functions (SEF). The first is classical
exponential. The second SEF is logarithmic which allows
interpretation by means of limiting (finite) strain extensibility.
Presented material parameters are estimated by optimization based
on radial and axial equilibrium equation in a thick-walled tube. Both
material models fit experimental data successfully. The exponential
model fits significantly better relationship between axial force and
axial strain than logarithmic one.
Abstract: Cardiovascular diseases, principally atherosclerosis, are responsible for 30% of world deaths. Atherosclerosis is due to the formation of plaque. The fatty plaque may be at risk of rupture, leading typically to stroke and heart attack. The plaque is usually associated with a high degree of lumen reduction, called a stenosis.It is increasingly recognized that the initiation and progression of disease and the occurrence of clinical events is a complex interplay between the local biomechanical environment and the local vascular biology. The aim of this study is to investigate the flow behavior through a stenosed artery. A physical experiment was performed using an artery model and blood analogue fluid. An axisymmetric model constructed consists of contraction and expansion region that follow a mathematical form of cosine function. A 30% diameter reduction was used in this study. The flow field was measured using particle image velocimetry (PIV). Spherical particles with 20μm diameter were seeded in a water-glycerol-NaCl mixture. Steady flow Reynolds numbers are 250. The area of interest is the region after the stenosis where the flow separation occurs. The velocity field was measured and the velocity gradient was investigated. There was high particle concentration in the recirculation zone. High velocity gradient formed immediately after the stenosis throat created a lift force that enhanced particle migration to the flow separation area.
Abstract: It is sometimes difficult to differentiate between
innocent murmurs and pathological murmurs during auscultation. In
these difficult cases, an intelligent stethoscope with decision support
abilities would be of great value. In this study, using a dog model,
phonocardiographic recordings were obtained from 27 boxer dogs
with various degrees of aortic stenosis (AS) severity. As a reference
for severity assessment, continuous wave Doppler was used. The data
were analyzed with recurrence quantification analysis (RQA) with
the aim to find features able to distinguish innocent murmurs from
murmurs caused by AS. Four out of eight investigated RQA features
showed significant differences between innocent murmurs and
pathological murmurs. Using a plain linear discriminant analysis
classifier, the best pair of features (recurrence rate and entropy)
resulted in a sensitivity of 90% and a specificity of 88%. In
conclusion, RQA provide valid features which can be used for
differentiation between innocent murmurs and murmurs caused by
AS.
Abstract: Segmentation and quantification of stenosis is an
important task in assessing coronary artery disease. One of the main
challenges is measuring the real diameter of curved vessels.
Moreover, uncertainty in segmentation of different tissues in the
narrow vessel is an important issue that affects accuracy. This paper
proposes an algorithm to extract coronary arteries and measure the
degree of stenosis. Markovian fuzzy clustering method is applied to
model uncertainty arises from partial volume effect problem. The
algorithm employs: segmentation, centreline extraction, estimation of
orthogonal plane to centreline, measurement of the degree of
stenosis. To evaluate the accuracy and reproducibility, the approach
has been applied to a vascular phantom and the results are compared
with real diameter. The results of 10 patient datasets have been
visually judged by a qualified radiologist. The results reveal the
superiority of the proposed method compared to the Conventional
thresholding Method (CTM) on both datasets.
Abstract: Phase-Contrast MR imaging methods are widely used
for measurement of blood flow velocity components. Also there are
some other tools such as CT and Ultrasound for velocity map
detection in intravascular studies. These data are used in deriving
flow characteristics. Some clinical applications are investigated
which use pressure distribution in diagnosis of intravascular disorders
such as vascular stenosis. In this paper an approach to the problem of
measurement of intravascular pressure field by using velocity field
obtained from flow images is proposed. The method presented in this
paper uses an algorithm to calculate nonlinear equations of Navier-
Stokes, assuming blood as an incompressible and Newtonian fluid.
Flow images usually suffer the lack of spatial resolution. Our
attempt is to consider the effect of spatial resolution on the pressure
distribution estimated from this method. In order to achieve this aim,
velocity map of a numerical phantom is derived at six different
spatial resolutions. To determine the effects of vascular stenoses on
pressure distribution, a stenotic phantom geometry is considered. A
comparison between the pressure distribution obtained from the
phantom and the pressure resulted from the algorithm is presented. In
this regard we also compared the effects of collocated and staggered
computational grids on the pressure distribution resulted from this
algorithm.
Abstract: In this study, a new and fast algorithm for Ascending
Aorta (AscA) and Descending Aorta (DesA) segmentation is
presented using Computed Tomography Angiography images. This
process is quite important especially at the detection of aortic
plaques, aneurysms, calcification or stenosis. The applied method has
been carried out at four steps. At first step, lung segmentation is
achieved. At the second one, Mediastinum Region (MR) is detected
to use in the segmentation. At the third one, images have been
applied optimal threshold and components which are outside of the
MR were removed. Lastly, identifying and segmentation of AscA and
DesA have been carried out. The performance of the applied method
is found quite well for radiologists and it gives enough results to the
surgeries medically.