Multiscale simulation of the effects of atrioventricular block and valve diseases on heart performance.

A new mathematical model of the cardiovascular system is proposed. The left ventricle is described by an axisymmetric multiscale model where myocardium is treated as an incompressible transversely isotropic medium with a realistic distribution of fibre orientation. Active tension and its regulation by Ca2+ ions are described by our recent kinetic model. A lumped parameter model is used for the simulation of blood circulation, in which the left and right atria and the right ventricle are described by a system of ordinary differential equations for active pressure-volume relationships. The stress and strain of the left ventricle myocardium were calculated by the finite element method implemented by the authors. The changes in the haemodynamics upon changes in preload of a healthy heart, upon physical exercise, and in case of atrioventricular block with different types of arrhythmias were simulated. To simulate the effect of stenosis or regurgitation of the aortic or mitral valves, the hydraulic and inertial flow resistances of the heart valves were set as functions of their orifice areas. The model reproduced a number of phenomena observed in clinical practice, including the classification of the severity of valve disease.