The importance of experimental setups able to reproduce cardiac functions was well established in the field of clinical innovations. The mock circulatory loops acquired rising relevance, and the possibility to have a complete reproduction of different and specific fluid dynamic conditions within the setup is pivotal. A system with enough versatility to reproduce the physiologic range of both flows and pressures is required. This study describes the design of a versatile setup composed by a custom pulsatile left ventricular pump system and a 3D-printed mock circulatory loop for the in vitro analysis of a patient-specific case of an aortic complex. The performances of the pump were validated first with a set of test flow profiles. It was demonstrated that the system was able to cover a wide range of aortic and mitral flows. Second, the pump system was inserted within the full mock circulatory loop. A patient-specific case was reproduced, both in terms of flow and pressure profiles. A successful validation of the flow and pressure waveforms was obtained by using patient-specific in vivo data from magnetic resonance analysis.

Cardiovascular diseases are the leading cause of death in the western countries. Robotic surgery recently emerged as a confirmed strategy in the cardiovascular field, especially thanks to the improvement of soft robotics. These techniques have demonstrated their potential in terms of speed of execution and precision. In this context, a deeper knowledge of the material properties of the blood vessels is required, especially for computational soft robotics applications. A constitutive model including the contribution of the collagen fibers families is needed to take hyperelasticity and anisotropy into account. For this purpose, four different models are presented: two fiber families with dispersion (2FFD), two fiber families without dispersion (2FF), four fiber families with dispersion (4FFD), and four fiber families without dispersion (4FF). A set of experimental biaxial data obtained from ex-vivo specimens was used to assess the model performances. Two fitting procedures were imposed: a procedure with no weighting of scores and a procedure with a weight set to enhance the model performances in the contact range. A finite element simulation of a contact procedure was developed to evaluate the effect on the contact pressures and forces according to the different model implementations. In particular, a minimally invasive aortic valve positioning process through a previously designed soft robot was simulated. The results confirmed the overall fitting procedure. The adoption of the weighting process for the fitting was successful, as it permitted an accurate prediction in the region of interest through models with less parameters.

Goal: This work presents the development of a Hybrid Mock Circulatory Loop (HMCL) to simulate hemodynamics at patient-specific level in terms of both 3D geometry and inlet/outlet boundary conditions. Methods: Clinical data have been processed to define the morphological and functional patient-specific settings. A piston pump is used to impose a parametric flow rate profile at the inlet of the hemodynamic circuit. In order to guarantee the physiological pressure and flow conditions, a specific hybrid chamber system including a real-time control has been designed and implemented. The developed system was validated firstly in a single outlet branch model and, secondly, on a 3D printed patient-specific multi-branch phantom. Finally, for the 3D phantom, the outlet flow profiles were compared with the corresponding in-vivo flow data. Results: Results showed that the root mean squared error between the prescribed setpoint and the measured pressures was always below 3 mmHg (about 2.5%) for all cases. The obtained flow profiles for the patient-specific model were in agreement with the related functional in-vivo data. Significance: The capability to reproduce physiological hemodynamics condition, with high-fidelity, plays a significant role in the cardiovascular research. The developed platform can be used to assess the performances of cardiovascular devices, to validate numerical simulations, and to test imaging systems.

The Modified Blalock Taussig Shunt (MBTS) is one of the most common palliative operations in case of cyanotic heart diseases. Thus far, the decision on the position, size, and geometry of the implant relies on clinicians’ experience. In this paper, a Medical Digital Twin pipeline based on reduced order modeling is presented for fast and interactive evaluation of the hemodynamic parameters of MBTS. An infant case affected by complete pulmonary atresia was selected for this study. A three-dimensional digital model of the infant’s MBTS morphology was generated. A wide spectrum of MBTS geometries was explored by introducing twelve Radial Basis Function mesh modifiers. The combination of these modifiers allowed for analysis of various MBTS shapes. The final results proved the potential of the proposed approach for the investigation of significant hemodynamic features such as velocity, pressure, and wall shear stress as a function of the shunt’s morphology in real-time. In particular, it was demonstrated that the modifications of the MBTS morphology had a profound effect on the hemodynamic indices. The adoption of reduced models turned out to be a promising path to follow for MBTS numerical evaluation, with the potential to support patient-specific preoperative planning.

The assessment of cardiovascular hemodynamics with computational techniques is establishing its fundamental contribution within the world of modern clinics. Great research interest was focused on the aortic vessel. The study of aortic flow, pressure, and stresses is at the basis of the understanding of complex pathologies such as aneurysms. Nevertheless, the computational approaches are still affected by sources of errors and uncertainties. These phenomena occur at different levels of the computational analysis, and they also strongly depend on the type of approach adopted. With the current study, the effect of error sources was characterized for an aortic case. In particular, the geometry of a patient-specific aorta structure was segmented at different phases of a cardiac cycle to be adopted in a computational analysis. Different levels of surface smoothing were imposed to define their influence on the numerical results. After this, three different simulation methods were imposed on the same geometry: a rigid wall computational fluid dynamics (CFD), a moving-wall CFD based on radial basis functions (RBF) CFD, and a fluid-structure interaction (FSI) simulation. The differences of the implemented methods were defined in terms of wall shear stress (WSS) analysis. In particular, for all the cases reported, the systolic WSS and the time-averaged WSS (TAWSS) were defined.

The development of accurate replicas of the circulatory and cardiac system is fundamental for a deeper understanding of cardiovascular diseases and the testing of new devices. Although numerous works concerning mock circulatory loops are present in the current state of the art, still some limitations are present. In particular, a pumping system able to reproduce the left ventricle motion and completely compatible with the magnetic resonance environment to permit the four-dimensional flow monitoring is still missing. The aim of this work was to evaluate the feasibility of an actuator suitable for cardiovascular mock circuits. Particular attention was given to the ability to mimic the left ventricle dynamics including both compression and twisting with the magnetic resonance compatibility. In our study, a left ventricle model to be actuated through vacuum was designed. The realization of the system was evaluated with finite element analysis of different design solutions. After the in silico evaluation phase, the most suitable design in terms of physiological values reproduction was fabricated through three-dimensional printing for in vitro validation. A pneumatic experimental setup was developed to evaluate the pump performances in terms of actuation, in particular ventricle radial and longitudinal displacement, twist rotation, and ejection fraction. The study demonstrated the feasibility of a custom pneumatic pump for mock circulatory loops able to reproduce the physiological ventricle movement and completely suitable for the magnetic resonance environment.