Evaluation of Aortic Valve Pressure Gradients for Increasing Severities of Rheumatic and Calcific Stenosis Using Empirical and Numerical Approaches

Abstract

The evaluation and accurate diagnosis of the type and severity of aortic stenosis relies on the precision of medical imaging technology and clinical correlations and the expertise of medical professionals. The application of the clinical correlation to different aortic stenosis morphologies and severities is investigated. The manner in which numerical techniques can be used to simulate the blood flow through pathological aortic valves was analysed and compared to the ground-truth CFD model. Larger pressure gradients are estimated in all severities of rheumatic aortic valves compared to calcific aortic valves. The zero-dimensional morphology-insensitive model underpredicted the transvalvular pressure gradient with the greatest error. The 1D model underestimated the pressure gradient in rheumatic cases and overestimated the pressure gradient in calcific cases. The pressure gradients estimated by the clinical approach depends on the location of the flow vena contracta and is sensitive to the severity and type of valve lesion. Through the analysis of entropy generation within the flow domain, the dominant parameters and regions driving adverse pressure gradients were identified. It is concluded that sudden expansion is the dominant parameter leading to higher pressure gradients in rheumatic heart valves compared to calcific ones.