1 Computational haemodynamics for clinical applications Sergey Simakov Moscow Institute of Physics and Technology Moscow, INM, The British Council Reseacher Links Workshop “Mathematical and Computational Modelling in Cardiovascular Problems”

2 Review Global blood flow Closed 1D model Elasticity modeling Physiological reactions: gravity, autoregulation Applications Sport: stride frequency optimization Vascular surgery: stenosis treatment, cava filters Enhanced external counterpulsation (EECP) Arterio-venous malformation (AVM) Patient specific fitting Multi-touch sensor panel 1D core graph reconstruction

3 Global blood flow

4 1) Mass balance 2) Momentum balance 3) Boundary conditions at junctions Compatibility conditions along outgoing characteristics 3.3 equations

5 Boundary conditions at junctions

6

7

8 equations

9 Heart model Isovolumetric contraction (0.08 s), Ejection (0.293 с), Isovolumetric relaxation (0.067 с), Filling (0.56 с) Mass conservation Volume averaged chamber motion Left auricle Left ventricle

10 Boundary conditions at heart junctions Arteries: Veins: Discretisation of compatibility conditions

11 Next step with 1D Boundary conditions at heart junctions

12 Elasticity modeling 4) Vessel wall elasticity Pedley, Luo, 1998 Modelling Analytic approximation Toro, Muller Favorsky, Mukhin. Sosnin Kholodov

13 Elasticity modeling 1) Tension in deformable fiber 2) Density of elasticity force 3) Tansmural pressure for collagen fibers for the others Peskin, Rosar 2001 Will be reported later today by V.Salamatova

14 Elasticity modelling

15 Elasticity modelling

16 Physiological reactions: gravity Ориентация сосуда 4) Right part of momentum balance: gravity - space orientation

17 Wall elasticity adaptation T T Physiological reactions: autoregulation

18 Physiological reactions: gravity and autoregulation S S Head Leg Auotregulation Collapsible tube

19 Physiological reactions: gravity and autoregulation 1 Ed VanBavel, Jos P.M. Wesselman, Jos A.E. Spaan Myogenic, Activation and Calcium Sensitivity of Cannulated Rat Mesenteric Small Arteries. Circ. Research,1998 Rat artery response to static pressure load 1

20 Patient specific fitting

21 Patient specific fitting

22 Patient specific fitting: multi-touch sensor panel

23 Patient specific fitting: multi-touch sensor panel

24 Patient specific fitting Normal PlaquePlaque with bypass

25 1D Core grpah reconstruction Reported yesterday by Yu. Ivanov

26 Sport: stride frequency optimization

27 Skeletal-muscle pumping Wall state: Venous valves in the leg

28 Кровоток через ноги Skeletal-muscle pumping Right shin Left shin Right thigh Left thigh Pressure

29 Skeletal-muscle pumping Venous pressure in the leg Time «Human Physiology» Schmidt, Thews Simulations

30 Height, cm Stride frequency Skeletal-muscle pumping SSSSSSSSS Simulations Competition data

31 Vascular surgery: stenosis treatment

32 Vascular surgery: atherosclerosis treatment

33 Vascular surgery: atherosclerosis treatment Patient-specific MRI and Doppler ultrasound data thanks to I.M. Sechenov First Moscow State Medical University (Ph.Kopylov, A.Tagiltsev)

34 Vascular surgery: endovascular implants

35 Endovascular implants: cava filters 1D netwrok – placement, throbmus capturing, dissolving 3D local blood flow – filter structure opotimisation 3D elasticity – pressure-area relationship, critical stress assesment

36 Endovascular implants: cava filters

37 1D global netwrok 3D flow Multiscale (1D-3D) Will be reported later today by T. Dobroserdova

38 Enhanced External Counterpulsation (EECP)

39 Motivation Ischemia Arterial Hypertension Cardiovascular insufficiency Indications Effect Non-invasive increased collateral perfusion

40 EECP optimization: structural model

41 EECP procedure

42 A B C EECP model Wall state equation Cardiac cycle 0 1 systole diastole

43 EECP optimization Terminal coronary artery Pressure averaged over cardiac cycle (kPa) Continuous pulsations (standard procedure) 1 sec pulsation + 1 sec pause 10 sec pulsations + 10 sec pause 10 sec pulsations sec pause Will be reported later today by T. Gamilov

44 Arterio-Venous Malformation treatment (AVM)

45 Motivation

46 Motivation

47 Motivation

48 AVM

49

50 Pressure embolisation quality Velocity embolisation quality

51 Pressure embolisation quality

52 Velocity embolisation quality

53 Arteries Before surgery Before After V-P Q-E

54 Arteries After surgery Before After V-P Q-E

55 In collaboration with Lavrentyev Institute of Hydrodynamics RAS

56 Discussion

57 Fast patient-specific vascular network skeletonization Reference geometry and patient-specific fitting Fast simulations with automatic or semi- automatic decision making process Current problems

58 Acknowledgements Kholodov A.S., RAS corresponding member (MIPT, Institute of computer-aided design RAS) Vassilevski Yu.V. D.Sc. (Institute of numerical mathematics RAS, MIPT) Chupakhin A.P. D.Sc. (Lavrentyev Institute of Hydrodynamics RAS, NSU) Mynbaev O.A. MD (New European Surgical Academy, MIPT) Rezvan V.V. MD (N.V.Sklifosovsky Research Institute of Emergency Medicine) Kopylov Ph.Yu. MD (1st Moscow State Medical University) Salamatova V. (MIPT), Dobroserdova T. (INM, MSU), Gamilov T. (MIPT), Khe A. (LIH, NSU), Cherevko A. (LYH, NSU), Ivanov Yu. (INM, MSU), Kramarenko V. (MIPT), Gorodnova N. (MIPT), Golov A. (MIPT), Pryamonosov R. (MSU), Zavodaev P. (MIPT)

59 Thank You! General outlines of this work are presented at