Project Summary

According to the World Health Organization (WHO) records, cardiovascular diseases (CVD) rank first, accounting for 32% of total deaths globally (17.9 million people in total) as of 2019. The total percentage of patients diagnosed with heart failure is estimated to reach 2.97% in 2030, up from 2.42% in 2012 (Virani et al., 2020). Most cases of heart failure are associated with cardiac dyssynchrony, resulting in inadequate blood pumping. When the development of heart failure was examined retrospectively, it was observed that a common finding was the functional deterioration of the left ventricle (LV) at a very early stage (Cimino et al., 2012).

Although both the blood hemodynamics within the LV and the exiting aortic blood flow in the left ventricular outflow tract (LVOT) vary depending on morphological factors, the aortic valve and ascending aorta are involved in the nutrition and hemodynamic characterization of the coronary vessels. they play a dominant role. Position-dependent velocity gradients together with the viscosity of the blood create WSS tensions in the inner endothelial membrane of the vessel. While low WSS, which is generally seen in the coronary vessels, often leads to plaque formation, high WSS, which is often seen in the aortic region, causes ballooning or rupture of the inner wall of the vessel. Although many studies have been conducted on the hemodynamics of the aortic valve and coronary arteries, a limited number of studies have combined both structures in a single numerical model. Within the scope of our project, performing a realistic hemodynamic analysis that will include the coronary arteries, sinus of Valsalva, ascending and descending aorta, aortic arch and carotid artery entrances together is of great importance in examining the most critical region of the cardiovascular system. The combined analysis of this holistic system provides multidimensional evaluation of various diseases such as congenital or acquired coronary artery and aortic valve diseases, aortic insufficiency, rupture, ostium abnormality, AF, thrombosis risk and aneurysm.

The complex cardiovascular hemodynamic model that we will develop covers the region where the most problems are experienced in heart diseases due to the high pressure on the left side of the heart and the high blood velocities resulting from strong cardiac contraction and the excessive shear stresses resulting from this, and therefore it covers the region where the most problems are experienced in heart diseases, and therefore it can contribute to the literature in critical and improved hemodynamics. It will be possible for analyzes to create innovative solutions together with innovative systems such as VR/XR virtual immersion. Creating a comprehensive system that can be used effectively in the diagnosis and treatment of Cardiovascular Diseases (CVD) in general, with the VR/XR virtual reality system integrated with hemo-rheological reality-based hemodynamic modeling software to be developed within the scope of the project and the 3D Bio-printer system that will support it. is intended.

In the project, for the first time in the literature, two-phase blood flow will be used under non-Newtonian assumption, with boundary conditions including the two-way FSI coupled model and multi-scale Windkessel and coronary LMP closure models. In addition, by including the contraction and relaxation rights of the heart in the model, the effects of momentum on blood flow will be realistically included. VR/XR virtual immersion environment will be included in the system for obtaining patient data with artificial intelligence and comprehensive analysis of CFD results. The bio-printer will be used to cut the relevant area in VR/XR environment for operative preparation and training purposes, obtain it in STL format and print it. With our cardiovascular model, which will be new in the literature, seven critically selected diseases are;

1. Congenital LVOT, Aorto-septal angle (AoSA) disorders and Discrete subaortic stenosis (DSS) diseases,
2. Analysis of Type A Aortic dissection (rupture), then analysis of Type B dynamics,
3. Thrombogenetic risk factor analysis,
4. Analysis of narrowing of the coronary vessels such as stenosis and atherosclerosis and the resulting ischemia disease,
5. Acute take-off angle with AAOCA and hereditary/congenital disease analysis with different coronary ostium forms,
6. Hemodynamics-based analysis of the relationship between blood flow reduction and irregularity resulting from Atrial Fibrillation (AF) and ischemic disease affecting the coronary vessels,
7. Diagnosis/diagnosis and preoperative preparation for coronary artery stenting (PCI) and bypass (CABG) will be comprehensively analyzed and compared with clinical data.

The results will be evaluated with comprehensive hemodynamic characterizations. These processes are planned to be carried out in our project with one postdoctoral researcher, two doctoral and one master's student within the scope of eight separate work packages.