Computational modeling of cardiac hemodynamics including chordae tendineae, papillaries, and valves dynamics.

In the context of dynamic image-based computational fluid dynamics (DIB-CFD) modeling of cardiac system, the role of sub-valvular apparatus (chordae tendineae and papillary muscles) and the effects of different mitral valve (MV) opening/closure dynamics, have not been systemically determined. To provide a partial filling of this gap, in this study we performed DIB-CFD numerical experiments in the left ventricle, left atrium and aortic root, with the aim of highlighting the influence on the numerical results of two specific modeling scenarios: (i) the presence of the sub-valvular apparatus, consisting of chordae tendineae and papillary muscles; (ii) different MV dynamics models accounting for different use of leaflet reconstruction from imaging. This is performed for one healthy subject and one patient with mitral valve regurgitation. Specifically, a systolic wall motion is reconstructed from dynamic Cine-MRI images and imposed as boundary condition for the CFD numerical simulation. Analyzing the numerical results, we found that sub-valvular apparatus do not affect the global fluid dynamics quantities, although it creates local variations, such as the developing of vortexes or flow disturbances, which lead to different stress distributions on cardiac structures. Moreover, different MV dynamics are considered starting from Cine-MRI MV segmentation at different temporal configurations, and then they are compared and managed numerically through a resistive approach. The obtained results highlight the importance of including a sophisticated diastolic model of MV dynamics, which accounts for MV geometries during diastasis and A-wave, in terms of describing the disturbed flow and ventricular turbulence.