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Design of a Cyclic Pressure Bioreactor for the Ex Vivo Study of Aortic Heart Valves

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Experiments and Simulations to Assess Exercise-Induced Pressure Drop Across Aortic Coarctations.

Priya J Nair^1,2, Emanuele Perra^3,4, Doff B McElhinney^5,2

¹Department of Bioengineering, Stanford University, Stanford, CA 94305.

Journal of Biomechanical Engineering

|May 17, 2025

Summary

Assessing blood pressure gradient (ΔP) during exercise in aortic coarctation (CoA) is crucial. A hybrid mock circulatory loop (HMCL) and simulations accurately measured exercise-induced ΔP, revealing patient-specific hemodynamic responses beyond resting values.

Keywords:

aortic coarctation fluid–structure interaction hybrid mock circulatory loop pressure drop

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Area of Science:

Cardiovascular Physiology
Biomedical Engineering
Medical Imaging

Background:

Aortic coarctation (CoA) severity is typically assessed by invasive blood pressure gradient (ΔP) measurements.
Clinical assessments often underestimate the functional burden of CoA by not accounting for exercise-induced hemodynamic changes.

Purpose of the Study:

To evaluate exercise-induced ΔP in patients with CoA using a hybrid mock circulatory loop (HMCL).
To compare HMCL results with fluid-structure interaction (FSI) simulations for noninvasive assessment of CoA hemodynamics.

Main Methods:

Patient-specific aortic phantoms were created from 4D-Flow MRI data.
Phantoms were integrated into an HMCL simulating patient-specific rest and exercise conditions.
FSI simulations using simvascular were performed for comparison with HMCL data.

Main Results:

Mean ΔP increased nonlinearly with cardiac output (CO), showing patient-specific trends.
HMCL and FSI simulations demonstrated excellent agreement in ΔP changes with CO (1.6±1.1 mmHg error).
The study highlights the importance of assessing exercise hemodynamics in CoA.

Conclusions:

HMCL and FSI simulations provide a noninvasive method to assess patient-specific exercise hemodynamics in CoA.
Validated FSI simulations can be used independently for future assessments, reducing the need for complex HMCL experiments.
This approach facilitates a comprehensive evaluation of CoA severity beyond resting measurements.