MODELLING AND NUMERICAL SIMULATION OF FLOW THROUGH

ARTIFICIAL HEART VALVES

Jesus Emanuel Choquepuma Ilaquita
jesus.ilaquita@usp.br
Prof. Dr. Bruno Carmo
bruno.carmo@usp.br

Abstract. The Cardiovascular System is essential for the maintenance of life, because it is responsible for the transport of nutrients
and oxygen for the correct functioning of the cells. Its main organ is the heart, whose primary function is to pump blood through veins
and arteries. Like any organic system, it will occasionally present problems, the main being heart failure and valvular diseases, mainly
in the mitral and aortic valves. Regarding the heart valves, there are currently several types of prostheses available, which can be
classified into mechanical prostheses and biological prostheses. However, common problems associated with these bioprostheses are
the destruction of red blood cells and the formation of thrombosis. Therefore, the modeling and simulation of the blood flow through
these prostheses is valuable tool to improve the implantation of heart valves. The objective of this work is to model and simulate the
flow through cardiac valves and validate the results with data from the literature. First, a literature review is carried out and the
software to be employed in the simulation is selected. Then the valve geometry and parameters for the simulation will be defined.
Later the simulation will be performed and the results will be compared and validated with those available in the literature.

Key words: Cardiac valves, blood flow modeling, numerical simulation

1. Introduction

The cardiovascular system is formed by the set of blood vessels and by the heart. This system is of vital importance
as it carries oxygen, water, nutrients to the tissues, conducts CO2 to make gas exchanges in the lungs, etc. In this system,
the heart is the main organ, because it performs the pumping of blood through the vessels. This vital organ consists of
atria, ventricles, and heart valves (tricuspid, mitral, pulmonary, and aortic).
Among the main problems that arise in the heart we can cite heart failure and valvopathies, which lead to a worsening
in the quality of life of the patient, and reduce life expectancy. The most common valvular diseases occur in the mitral
and aortic valves, because it is on the left side of the heart that the greatest pressures are found (Yoganathan, 2004). In
order to have a solution for this problem, mechanical prostheses can be implanted because they have long durability, but
require the use of anticoagulants, bringing along a risk of thrombosis formation and a non-physiological hydrodynamic
performance (Fonseca & Huebner, 2010).
As an alternative, biological valves can be used, since they eliminate the use of anticoagulants and have excellent
hemodynamic performance. However, these bioprostheses degenerate more rapidly and undergo calcification of their
structure, which alters the mechanical behavior of the valve (Yoganathan, 2004).
Because they are prostheses, these valves can show post-implant clinical complications such as hemolysis,
thrombosis, mechanical fatigue or chemical change, occurrence of cavitation and calcification. Such problems may be
directly or indirectly related to structures present in the flow, so a careful analysis of the blood flow through these
prostheses and their effects on the circulatory system is valuable tool for the development and manufacture of artificial
valves (Yoganathan, 2004).
A literature review shows that the modeling and simulation of the blood flow through these valves reveals the
characteristics of the flow, so that the data obtained can be used for the modification and improvement of such prostheses
in use.

2. Literature Review

2.1. The Cardiovascular system, Valvopaties and Mechanical Heart Valve Implants

Regarding the cardiovascular systema, the heart is important due to its function in the body. The heart is an organ
constituted by four chambers and four valves.

Figure 1. Blood flow path through heart chambers and valves. (Source: Nejadmalayeri, 2007)
 The tricuspid and pulmonary valves on the right side of the heart regulate the flow of blood from the body to the
lungs for oxygenation, while the mitral and aortic valves on the left control the flow of oxygenated blood to the body.The
aortic and pulmonary valves allow the passage of blood from the ventricles to the arteries.
Similarly, the mitral and tricuspid valves control blood flow from the atrium to the left and right ventricle,
respectively. During blood pumping, the pulmonary and aortic valves open during systole when the ventricles contract,
and close in the diastole, as the ventricles fill with blood through the opening of the mitral and tricuspid valves.
While closed, the right side valves support a pressure of approximately 30mm Hg, while the aortic valve supports
pressures of approximately 100mm Hg (Yoganathan, 2004). Because of this extreme cyclic loading, left-side valves are
more prone to develop pathologies such as non-complete closure, leading to regurgitation. Irregardless of the cause of the
problem, a solution is a mechanical valve implant, which basically is commercialized in two ways: mechanical valves
(MV) and bioprosthetic valves (BV). MV's are those that are manufactured from artificial materials, and are made in the
shape of ball or disc, tilting disc or double leaflet based on carbon alloys generally. BV's are made from living tissues like
bovine pericardium.

2.2. Mechanical Valves

The first mitral valve implant in its anatomical position occurred in 1960, when Starr-Edwards developed a ball-
shaped prosthesis contained in a cage. Despite their proven durability, these implants greatly obstruct the blood flow,
resulting in a greater pressure drop across the valve in the open position, and consequently leading to greater mechanical
stress of the implant (Dasi, 2009). Thus, several studies have shown that these valves are related to several postoperative
complications, such as a great drop in pressure and low hemodynamic performance
The second model studied in this paper is the tilting-disk model. The most used is the Medtronic-Hall mechanical
valve, which has a larger and smaller orifice, divided by a tilting disc. Thus, two jets arise in the passage of blood through
the disc, the jet of the larger orifice having a velocity slightly larger than the jet of the smaller orifice.
During flow, the maximum velocities measured 7 mm downstream of the valve are 2.1m/s and 2m/s in the regions of the
largest and smallest hole, respectively, as shown in Fig. 2 (Yoganathan, 2004).

2.a 2.b 2.c

Figure 2. a) Starr - Edwards valve (Mohammadi & Mequanint, 2010), b) Medtronic-Hall Tilting-disc valve
…………(Mohammadi & Mequanint, 2010), c) Bileaflet valve (St. Jude Medical)

The third model consists of a bileaflet valve. This mechanical valve has two semicircular leaflets that divide the area
available for forward flow into three regions: two lateral orifices
, c) and a central orifice. The major part of the flow goes
through the two lateral orifices. The forward flow is characterized by a triple jet pattern, with a maximum velocity of 2.2
m/s and 2 m/s at the lateral and central orifices, respectively (Yoganathan, 2004)
Because all models experience high stresses, patients with mechanical heart valve implants require anti-coagulation
therapy. Bioprosthetics are less prone to develop blood clotting, but the trade-off concerning durability generally favors
their use in patients older than age 65 (Yoganathan, 2004). Therefore, computational simulations are required to study
the effects of mechanical valves on the blood flow and important to improve their design.

3. Numerical Models

Three different geometries are involved in the investigation of the current research: two for the tilting-disk mechanical
heart valve, and one for the bileaflet mechanical heart valve. The first model is a two-dimensional model based on
geometry by Avrahami et al (2000), and Rosenfeld et al (2002). This model is a simplified 2D representation of the tilting-
disk valve in the mitral position.
The second model is based on a three-dimensional model of the Bjork-Shiley valve at the aortic position, which was
analyzed by Shim and Chang (1997, 1994), consisting in a cross section of the three-dimensional model in the plane z=0.
The third model is a bileaflet mechanical heart valve based on the geometry investigated by Khalefa et al (2018) and
Hung et al (2013).
3.1. Model 1 – 2D Tilting-Disk Valve in Mitral Position

This first model was included in this research in order to have a low cost model able to examine the effect of
Newtonian viscosity on overall flow structure, velocity peaks, and shear effects for the pulsatile mitral flow through the
valve using the software Fluent®.
Rosenfeld et al (2002) investigated fixed and moving models of the same geometry, demonstrating that in the case
of physiological pulsatile inflow, the flow field across fixed and moving valves in the fully open position are quite similar.
According to Rosenfeld, the fixed valve case consistently resulted in safe estimations of several critical quantities such
as the force on the valve, the maximal shear stress on the valve or the transvalvular pressure drop. Therefore, fixed valve
simulations will be carried out in this research. The geometry was simplified as a channel with a fixed valve. Different
leaflet thicknesses reported in the literature are present in the Fig. 3. A thickness of 0.65 mm was used in the current
investigation in order to be consistent with Avrahami et al (2000) and Rosenfeld et al (2002).

Figure 3. Computational domain of 2D tilting-disk valve model (Source: Avrahami, 2000) (not scaled)

3.2. Model 2 – 2D Tilting-disk Bjork-Shiley Valve in Aortic Position

A second model was selected in order to investigate the effect of pulsatile waveform on the two-dimensional flow
,structure.
c) The simulation performed was basically an extension of the numerical simulation of the first model. According
to investigations, the aortic valve usually requires replacement (Aliabadi, 2010), and consequently, valve replacements
are more common in the aortic position.
Therefore, to achieve a better realistic simulation, the Valsalva sinuses were included in this second model, which
consists in a cross section of the three-dimensional model studied by Shim and Chang (1994) in the plane z=0. This
simplification was made in order to have a low time-consuming model. Besides that, a rectangular valve was considered
in the geometry. A review of different numerical and experimental studies of 3D models of tilting-disk valves are showed
in Tab. 1

Table 1. Different Leaflet Thicknesses, valve diameters, channel types, opening angles in the Literature

Figure 4. Geometrical model of Bjork-Shiley tilting-disk valve based on data provided by Shim (1987)

3.3. Model 3 – Bileaflet Mechanical Heart Valve

The geometrical model used in this case is a simplified 25-mm St. Jude Medical bileaflet mechanical valve
presented
, c) by Choi (2009). The model comprises an aortic valve with a symmetrical realistic aorta root. For the valve
geometry construction, a length of 12.8 mm and a thickness of 0.65 mm were considered. The valve rotational angle starts
at 25°, which represents the closed position. Due to geometrical and dynamical issues with the software Ansys, a space
of 3mm between the hinges of the valves was established, which is similar to the model investigated by Hung et al (2013).
 5.a 5.b
Figure 5. a) Computational domain for the BMHV (Hung, 2013), b) Computation domain design with DesignModeller
…………(The Author)

)3.4. Grid Generation and General Solution Procedures

Geometrical model of Bjork-Shiley tilting-disk valve based on data provided by Shim (1987)
According to Nejadmalayeri (2007), a independency test for fine grids is not practical (13.4 days for grid of the model
2). Performing this kind of simultaneous time-step and grid independency test among various grids is a high time-
consuming procedure and, therefore, they were not carried out so far in order to simulate a low-cost model. This task
should be carried out in future research. On the other hand, different authors (Nejadmalayeri, Rosenfeld & Aliabadi)
confirm that the three models investigated currently show independency for some parameters such as maximal values of
,shear
c) stress, wall shear stress and velocity components.
Therefore, we will rely on the investigations of the authors. The 2D model mesh was obtained using Ansys Meshing
program. About the sizing, we chose the Curvature option for the size function and the Coarse option for the relevance
center. Besides that, the Edge Sizing tool was used to obtain a better mesh refinement in the volume surrounding the
valve. Following are represented the mesh obtained for each model.

6.a 6.b

6.c
Figure 6. a) Mesh for the computational domain of model 1, b) Mesh obtained for the Model 2, c) Mesh generated for
…………the Model 3.
The commercial software Fluent was used in this research to solve for flow in the fluid domain. In what follows, the
governing equations and solution procedure undertaken in Fluent are explained. For the fluid domain, the unknown
variables solved for are the velocity components u,v,w in the x,y and z directions, respectively, and the pressure forces.
Body forces and energy equation are not considered, resulting in the fact that the governing equations are the continuity
and momentum equations. For an incompressible flow, these equations can be written as:

, c) Eq. 1

Eq. 2
 Where p represents pressure, V is the velocity vector, and t is the stress tensor. The stress tensor is given by:

Eq. 3

Viscous forces and pressure calculated during the flow simulation dominate the movement of the valve. Due to these
forces, the leaflet would rotate about its axis, and the movement would be governed by

Eq. 4

Where M is the total amount, and theta in this case is the opening angle of the leaflet with respect to the initial opening
angle, with I representing the moment of inertia. However, in this research a fixed valve is considered and, therefore, this
last equation is not considered in the simulations.
In this work, blood was assumed initially to be a Newtonian fluid. However, it has been experimentally shown
(Skiadopoulos et al, 2016) that blood exhibits shear-thinning properties in a pulsatile flow case in regions of high shear
stress. Therefore, blood its behavior resembles a non-newtonian fluid. Among different models, the Quemada model has
been used widely and compared with other models (Skiadopoulos et al, 2016). Hence, it was implemented in the current
investigation through a UDF. The Quemada model is expressed as:

Eq. 5

In the Quemada model, the effective viscosity is calculated by:

Eq. 6

is the viscosity of plasma, xx is the hematocrit, and xx , xx and xx are model parameters. The density of blood
is about 1000 kg/m³, which represents the density of the entire mixture of plasma.

4. Numerical Simulation Setup and Results

4.1. Model 1

At the inlet, both steady inflow and physiological waveform were imposed. For consistency with Rosenfeld et al
(2002) and Nejadmalayeri (2007) the same inflow conditions were specified. For the steady case, two Reynolds numbers
were investigated: 795 and 4241, corresponding to low and high steady velocities of 11.14 cm/s and 59.4 cm/s,
respectively. The physiological velocity profile in the inlet was calculated in the software Excel and then compared to
Avrahami’s waveform.

0.8
Mitral waveform (m/s)

0.6
0.4
0.2
0.0
-0.2
-0.4
-0.6
0.00
0.05
0.09
0.14
0.18
0.23
0.27
0.32
0.36
0.41
0.45
0.50
0.54
0.59

Time (s)
7.a 7.b
Figure 7. a) Physiological waveform for this investigation, b) Inlet flows implanted by Avrahami.

.
 The equation that dictates the inflow was obtained using the software Excel and incorporated to Fluent through a
UDF. The low inflow (v=11.14 cm/s) was used to compare with the investigations from Aliabadi and Rosenfeld.
To be consistent with previous similar work (Aliabadi and Rosenfeld), the velocity profile in the horizontal direction
(Ux) on a line located at a distance of 2.8D from the inlet was compared. Before the numerical simulations the valve was
rotated to its fixed position. The Reynolds number for the first simulation was 795. The plot obtained in this investigation
and the results from Aliabadi are showed next.

0.3 0.28

0.25 0.22
X-Velocity (m/s)
0.2
0.15
0.1
0.05
0
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2 2.25 2.5 2.75
Y (cm)
Aliabadi investigation This study

Figure 8. Ux component at a distance of 2.8D away from the inlet obtained in this investigation and compared to
………..Aliabadi’s results

. The simulation yielded a ~0.27 m/s peak velocity at a y=2.1 cm position, which is similar to results obtained by
Aliabadi, whose model yielded a ~0.22 m/s peak velocity at y=1.8 cm. In general, results are compatible, and possible
divergences between the results can be explained due to differences in mesh and time step. In the second case performed
for the model I, a time varying mitral inflow is specified at the entrance of the channel. Large variations in the mitral
physiological pulse are enforced by the specified inflow waveform (Fig. 7.a). The peak inflow velocity is 60cm/s, while
the mean velocity is only 12.5cm/s. The large variations of the flow field can be also observed in Fig. 10, where a time
sequence of the streamlines and the vorticity is presented for one complete cycle. The global vortical pattern in the vicinity
,ofc)the valve is fairly similar to the steady inflow cases as long as the flow rate is large enough.

0.8
Mitral waveform (m/s)

0.6
0.4
0.2
0.0
-0.2
-0.4
9.a
-0.6
0.00
0.06
0.11
0.17
0.22
0.28
0.33
0.39
0.44
0.50
0.55

Time (s)
9.b
Figure 9. Simulation results for t=0.11s for both investigations: a) this and b) Rosenfeld's
 0.8

Mitral waveform (m/s)

0.6
0.4
0.2
0.0
-0.2
-0.4
10.a
-0.6

0.00
0.06
0.11
0.17
0.22
0.28
0.33
0.39
0.44
0.50
0.55
Time (s)
10.b
Figure 10. Simulation results for t=0.16s

The major weakness of the present study model is in the approximation of the enclosing geometry as a straight
channel affects the flow field, especially in the mitral position and away from the valve.

4.2. Model 2

In order to validate model 2, the results were compared to those obtained by Nejadmalayeri (2007). Direct comparison
with Nejadmalayeri was based on the mitral physiological velocity profile used in his investigation and exhibited in Fig
11. The simulation of the Model 2 assumes a 2D fluid domain with a non-Newtonian flow.
Results from the simulation for model 2 were directly compared with those obtained by Nejadmalayeri. This author
used a similar model for a time step of t=0.0001 s. and monitored the three components of the velocity at a given control
point of (x,y,z) = (3.912, 0 ,0) cm for a mitral physiological waveform in the inlet. In this investigation, the same waveform
was implanted and the results were monitored for the same control point. The comparison between the investigations are
plotted next.
0.75
Y-Velocity (m/s) at Control Point

0.65
0.55
0.45
0.35
0.25
0.15
0.05
-0.05 0 0.1 0.2 0.3 0.4 0.5 0.6
Time (s)
Nejadmalayeri, 2007 This study

Figure 11. Velocity components comparison using mitral inflow.

Evaluating the results for the Uy component, we can see that the mitral physiologic flow proposed and the
bidimensional model are compatible with the literature. At a time of t=0.15s, maximum velocity is 0.64 m/s, which is
similar to the value obtained by Nejadmalayeri. Besides that, the graph format is quite identical in both investigations,
showing that we can use an adapted mitral waveform and the proposed model to study the blood flow pattern across
mechanical heart valves.

4.3. Model 3

For the bileaflet mechanical valve model, the blood pressure is simulated through a UDF, which specifies for the
solver the transient pressure value at the inlet and/or the outlet. The pulsed pressure was defined by the following
equations, which determines the pressure wave at the ventricular.
 Eq. 7

Where w represents a factor in the pulsed wave equation and is equal to 8.72 (Khalefa et at, 2018). The boundary at
the outlet was also modelled with a pulsed pressure at the aorta.

Eq. 8

Where w is equal to 8.438. Regarding other boundaries, all the solid boundaries were specified as wall boundaries,
considering a no slip condition. For this simulation, a blood temperature of 37°C was used and a blood dynamics viscosity
of 1000 kg/m³. It was assumed a fully closed position at the beginning of the simulation (t = 0 s) and a fixed position at
t=0.057 s.
140
120
100
Pressure (mmHg)

80
60
40
20
0
0.0 0.1 0.1 0.2 0.2 0.3 0.3 0.4 0.4 0.5 0.5 0.6
-20
Time (s)
Ventricular Pressure Aortic Pressure

Figure 12. Pressure profile for the boundaries

For the bileaflet mechanical heart valve investigation, the geometrical model from the St. Jude Medical. was
simulated. The imposed inlet and outlet boundaries are governed by the physiological pressure profile, which was
obtained from Khalefa et al (2018). During the simulation, flow is observed to enter the transition region, introducing
solver instability because of the physiological pressure gradient imposed. Hence, the k-w turbulent model is incorporated.
The rigid wall assumption is applied to all wall boundaries for blood vessels with the no-slip condition. The boundaries
between the fluid and structure domains are defined with the FSI boundary conditions.

13.a 13.b

Figure 13. Velocity contour at t=0.057s for a fully open position: a) This investigation’s results, b) Khalefa, 2018
 Given that the computational domain includes aortic root geometry, the results from the simulation showed a
recirculation region occurred in the sinus. In the artificial heart valves, blood clotting formation is more likely to happen
than in native valves. However, the recirculation exhibited in Fig. 13.a would reduce the possibility of blood clotting
within the aortic root (Khalefa, 2018).
To validate the results, a velocity magnitude comparison, as suggested by Hung et al (2013), will be carried out. The
simulation performed in this investigation yielded a maximum velocity of 1.22m/s at t=0.057 s, when the valve is fully
open at 85°, and the maximum velocity for the fully closed valve is 1.22 m/s (Fig. 13).
The maximum velocity of 1.22 m/s at peak systole from the current model is comparable with those reported in the
literature (1.38m/s [Nobili, 2008], 1.25m/s [Choi, 2009] and 1.32 [Liu, 2000]). In addition, given that the distance
between the leaflet hinges is relative large, blood flow was observed between the valve leaflets downstream at t=0.28 s,
which is not the case in other studies (Hung et al, 2013).

14.a 14.b
Figure 14. Comparison at t=0.28s for the fully open position: a) this investigation, b) Hung, 2013

The good agreement between previously numerical results and the results from the current study in axial blood
velocity and flow pattern indicates the developed model can be used with confidence to predict the bileaflet mechanical
heart valve performance in natural conditions.

5. Conclusions

We were able to simulate the flow pattern of a mechanical valve in response to a fixed velocity inlet and a pulsatile
flow. The results look promising and the intention is to apply the current techniques to other pulsatile frequencies,
amplitudes and moving valves. From a comparison between the bidimensional model, it is clear that a tridimensional
model is needed to achieve better results.
To accomplish an accurate evaluation of flow field under physiological waveform, a three-dimensional simulation is
essential. In addition, it is stated in the literature that near the peak of systole, transition to turbulence will unquestionably
occure, which is a 3D phenomenon (Nejadmalayeri, 2007).
Therefore, in order to continue with the validation, further simulations will be carried out and their results shall be
compared with the literature.

6. Acknowledgment

To those who always supported me and always will be there for me, my parents.

7. Bibliographic References

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8. Copyright

The authors are the only responsibles for the content of the material in this work