Three-dimensional flow characteristics in ventricular assist devices: Impact of valve design and operating conditions Christoph Benk, MSc, Ramona Lorenz,

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Three-dimensional flow characteristics in ventricular assist devices: Impact of valve design and operating conditions Christoph Benk, MSc, Ramona Lorenz, MSc, Friedhelm Beyersdorf, MD, PhD, Jelena Bock, MSc, Rolf Klemm, MSc, Jan G. Korvink, PhD, Michael Markl, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 5, Pages 1019-1026 (November 2011) DOI: 10.1016/j.jtcvs.2011.01.058 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Schematic representation of measurement setup for in vitro 3D flow analysis via MRI in the VAD. The VAD control unit and pressure monitoring were placed outside the MR scanner room and connected to the VAD flow circuit inside the scanner by long (8-m) tubing. The mock loop used for the adjustment of pre- and afterload conditions was placed on the patient table next to the VAD. MR, Magnetic resonance; VAD, ventricular assist device. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1019-1026DOI: (10.1016/j.jtcvs.2011.01.058) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 VAD geometry and pump chamber volume during maximum filling (diastole) and contraction (systole) for different operating conditions. The gray shaded surface represents the 3D VAD geometry. For the analysis of pump chamber volume for different operating conditions, analysis planes transecting the VAD chamber in horizontal (A) and vertical (B) orientation were used. The maximal diastolic and minimal systolic VAD pump chamber volumes were quantified and used to calculate the VAD EF. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1019-1026DOI: (10.1016/j.jtcvs.2011.01.058) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Three-dimensional flow visualization using time-resolved 3D particle traces in the VAD during a complete pump cycle. The series of images represent the development of flow patterns during 1 VAD cycle for the VAD with the new valve design under optimal operating conditions. The time frame in the VAD cycle is indicated by the numbers in the top left corner of each image, and flow dynamics are depicted with a temporal resolution (time between 2 successive images) of 42.4 ms. The gray shaded iso-surface rendering represents the VAD geometry including pump chamber and valve systems at inlet and outlet. Color coding = local absolute flow velocities. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1019-1026DOI: (10.1016/j.jtcvs.2011.01.058) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Three-dimensional flow characteristics inside the VAD during maximum chamber expansion (end diastole) and peak outflow phase (end systole). The gray shaded area represents an iso-surface rendering of the magnitude data and shows the VAD geometry including pump chamber and valve systems at inlet and outlet. The effect of different operating conditions in the same VAD clearly resulted in considerable differences in VAD function (A-C). Vortex formation proximal to the inlet valve was clearly visible for all operating conditions but absent for the new valve design (D, gray arrows). The comprehensive flow dynamics during the entire VAD cycle are clearly shown in Video 1. Color coding = local absolute flow velocities. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1019-1026DOI: (10.1016/j.jtcvs.2011.01.058) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A, Fluid velocity distribution in analysis planes at the level of the VAD inflow and outflow valves. The individual images show the velocity profiles during peak inflow (diastole) and outflow (systole). B, Quantified time-resolved flow during 1 VAD pump cycle distal to the valve at the inlet (left) and outlet (right). Color coding = local absolute flow velocities. VAD, Ventricular assist device. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1019-1026DOI: (10.1016/j.jtcvs.2011.01.058) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions