We present comprehensive particle image velocimetry measurements and direct numerical simulation (DNS) of physiological, pulsatile flow through a clinical quality bileaflet mechanical heart valve mounted in an idealized axisymmetric aorta geometry with a sudden expansion modeling the aortic sinus region. Instantaneous and ensemble-averaged velocity measurements as well as the associated statistics of leaflet kinematics are reported and analyzed in tandem to elucidate the structure of the velocity and vorticity fields of the ensuing flow-structure interaction. The measurements reveal that during the first half of the acceleration phase, the flow is laminar and repeatable from cycle to cycle. The valve housing shear layer rolls up into the sinus and begins to extract vorticity of opposite sign from the sinus wall. A start-up vortical structure is shed from the leaflets and is advected downstream as the leaflet shear layers become wavy and oscillatory. In the second half of flow acceleration the leaflet shear layers become unstable and break down into two von Karman-like vortex streets. The onset of vortex shedding from the valve leaflets is responsible for the growth of significant cycle-to-cycle vorticity oscillations. At peak flow, the housing and leaflet shear layers undergo secondary instabilities and break down rapidly into a chaotic, turbulent-like state with multiple small-scale vortical structures emerging in the flow. During the deceleration and closing phases all large-scale coherent flow features disappear and a chaotic small-scale vorticity field emerges, which persists even after the valve has closed. Probability density functions of the leaflet position during opening and closing phases show that the leaflet position fluctuates from cycle to cycle with larger fluctuations evident during valve closure. The DNS is carried out by prescribing the leaflet kinematics from the experimental data. The computed instantaneous vorticity fields are in very good agreement with the measurements, especially during the accelerating phase when the flow remains coherent and repeatable and instantaneous comparisons are meaningful. The computed results are analyzed to elucidate for the first time the intricate and highly three-dimensional structure of the pulsatile jet through the triple-opening orifice of the bileaflet valve and explain the rich flow phenomena documented in the two-dimensional vorticity measurements.

SUMMARY1. Artificial heart valves have been in use for over five decades to replace diseased heart valves. Since the first heart valve replacement performed with a caged-ball valve, more than 50 valve designs have been developed, differing principally in valve geometry, number of leaflets and material. To date, all artificial heart valves are plagued with complications associated with haemolysis, coagulation for mechanical heart valves and leaflet tearing for tissue-based valve prosthesis. For mechanical heart valves, these complications are believed to be associated with non-physiological blood flow patterns.2. In the present review, we provide a bird's-eye view of fluid mechanics for the major artificial heart valve types and highlight how the engineering approach has shaped this rapidly diversifying area of research.3. Mechanical heart valve designs have evolved significantly, with the most recent designs providing relatively superior haemodynamics with very low aerodynamic resistance. However, high shearing of blood cells and platelets still pose significant design challenges and patients must undergo lifelong anticoagulation therapy. Bioprosthetic or tissue valves do not require anticoagulants due to their distinct similarity to the native valve geometry and haemodynamics, but many of these valves fail structurally within the first 10-15 years of implantation.4. These shortcomings have directed present and future research in three main directions in attempts to design superior artificial valves: (i) engineering living tissue heart valves; (ii) development of advanced computational tools; and (iii) blood experiments to establish the link between flow and blood damage.

Aortic and mitral flow patterns within the two hinges were similar, but with a more dynamic flow during the forward flow phase under aortic conditions. Velocity magnitudes and shear stresses measured under mitral conditions were generally higher than those obtained in the aortic position, which may explain the higher rates of thromboembolism in the mitral implants when compared with the aortic implants.

Polymeric heart valves have the potential to reduce thrombogenic complications associated with current mechanical valves and overcome fatigue-related problems experienced by bioprosthetic valves. In this paper we characterize the in vitro velocity and Reynolds Shear Stress (RSS) fields inside and downstream of three different prototype trileaflet polymeric heart valves. The fluid dynamic differences are then correlated with variations in valve design parameters. The three valves differ in leaflet thickness, ranging from 80 to 120 mum, and commisural design, either closed, opened, or semi-opened. The valves were subjected to aortic flow conditions and the velocity measured using three-dimensional stereo Particle Image Velocimetry. The peak forward flow phase in the three valves was characterized by a strong central orifice jet of approximately 2 m/s with a flat profile along the trailing edge of the leaflets. Leakage jets, with principle RSS magnitudes exceeding 4,500 dyn/cm(2), were observed in all valves with larger leaflet thicknesses and also corresponded to larger leakage volumes. Additional leakage jets were observed at the commissural region of valves with the open and the semi-open commissural designs. The results of the present study indicate that commissural design and leaflet thickness influence valve fluid dynamics and thus the thrombogenic potential of trileaflet polymeric valves.

Thromboembolic complications of bileaflet mechanical heart valves (BMHV) are believed to be due to detrimental stresses imposed on blood elements by the hinge flows. Characterization of these flows is thus crucial to identify the underlying causes for complications. In this study, we conduct three-dimensional pulsatile flow simulations through the hinge of a BMHV under aortic conditions. Hinge and leaflet geometries are reconstructed from the Micro-Computed Tomography scans of a BMHV. Simulations are conducted using a Cartesian sharp-interface immersed-boundary methodology combined with a second-order accurate fractional-step method. Physiologic flow boundary conditions and leaflet motion are extracted from the Fluid–Structure Interaction simulations of the bulk of the flow through a BMHV. Calculations reveal the presence, throughout the cardiac cycle, of flow patterns known to be detrimental to blood elements. Flow fields are characterized by: (1) complex systolic flows, with rotating structures and slow reverse flow pattern, and (2) two strong diastolic leakage jets accompanied by fast reverse flow at the hinge bottom. Elevated shear stresses, up to 1920 dyn/cm2 during systole and 6115 dyn/cm2 during diastole, are reported. This study underscores the need to conduct three-dimensional simulations throughout the cardiac cycle to fully characterize the complexity and thromboembolic potential of the hinge flows.