Contemporary evaluation and surgical approaches in congenital aortic valve disease have yielded limited success. The ability to evaluate and understand detailed flow characteristics surrounding surgical repair may be beneficial. This study explores the feasibility and utility of echocardiographic-based blood speckle imaging (BSI) in assessing pre- and post-operative flow characteristics in those with non-stenotic congenital aortic root disease undergoing aortic valve repair or valve-sparing root replacement (VSRR) surgery. Transesophageal echocardiogram was performed during the pre-operative and post-operative assessment surrounding aortic surgery for ten patients with non-stenotic congenital aortic root disease. BSI, utilizing block-matching algorithms, enabled detailed visualization and quantification of flow parameters from the echocardiographic data. Post-operative BSI unveiled enhanced hemodynamic patterns, characterized by quantified changes suggestive of the absence of stenosis and no more than trivial regurgitation. Rectification of an asymmetric jet and the reversal of flow on the posterior aspect of the ascending aorta resulted in a reduced oscillatory shear index ((Formula presented.)) of (Formula presented.) (pre-op) vs. (Formula presented.) (post-op) and (Formula presented.), increased peak wall shear stress of (Formula presented.) (pre-op) vs. (Formula presented.) (post-op) and (Formula presented.), and increased time-averaged wall shear stress of (Formula presented.) (pre-op) vs. (Formula presented.) (post-op) and (Formula presented.). This correction potentially attenuates cellular alterations within the endothelium. This study demonstrates that children and young adults with non-stenotic congenital aortic root disease undergoing valve-preserving operations experience significant improvements in flow dynamics within the left ventricular outflow tract and aortic root, accompanied by a reduction in (Formula presented.). These hemodynamic enhancements extend beyond the conventional echocardiographic assessments, offering immediate and valuable insights into the efficacy of surgical interventions.

Patients undergoing aortic valve repair or replacement with associated alterations in stiffness characteristics often develop abnormalities in the aortic sinus vortex, which may impact aortic valve function. The correlation between altered aortic sinus vortex and aortic valve function remains poorly understood due to the complex fluid dynamics in the aortic valve and the challenges in simulating these conditions. The opening and closure mechanism of the aortic valve is studied using fluid–structure interaction (FSI) simulations, incorporating an idealized aortic valve model. The FSI approach models both the interaction between the fluid flow and the valve’s leaflets and the dynamic response of the leaflets during pulsatile flow conditions. Differences in the hemodynamic and vortex dynamic behaviors of aortic valve leaflets with varying stiffness are analyzed. The results reveal that, during the systolic phase, the formation of the sinus vortex is closely coupled with the jet emanating from the aortic valve and the fluttering motion of the leaflets. As leaflet stiffness increases, the peak vorticity of the sinus vortex increases, and the phase space of the vortex core develops a pronounced spiral trajectory. During the diffusion phase, the vortex strength decays exponentially, and the diffusion time is longer for stiffer leaflets, indicating a longer residence time of the sinus vortex that reduces the pressure difference on the leaflet during valve closure. Changes in leaflet stiffness play a critical role in the formation and development of sinus vortices. Furthermore, the dynamic characteristics of vortices directly affect the pressure balance on both sides of the valve leaflets. This pressure difference not only determines the opening and closing processes of the valve but also significantly influences the stability and efficiency of these actions.

Collapsible tubes can be employed to study the sound generation mechanism in the human respiratory system. The goals of this work are (a) to determine the airflow characteristics connected to three different collapse states of a physiological tube and (b) to find a relation between the sound power radiated by the tube and its collapse state. The methodology is based on the implementation of computational fluid dynamics simulation on experimentally validated geometries. The flow is characterized by a radical change of behavior before and after the contact of the lumen. The maximum of the sound power radiated corresponds to the post-buckling configuration. The idea of an acoustic tube law is proposed. The presented results are relevant to the study of self-excited oscillations and wheezing sounds in the lungs.

Background: This article presents the use of blood speckle Imaging (BSI) as an echocardiographic approach for the pre- and post-operative evaluation of subaortic membrane resection and aortic valve repair. Method: BSI, employing block-matching algorithms, provided detailed visualization of flow patterns and quantification of parameters from ultrasound data. The 9-year-old patient underwent subaortic membrane resection and peeling extensions of the membrane from under the ventricular-facing surface of all three aortic valve leaflets. Result: Post-operatively, BSI demonstrated improvements in hemodynamic patterns, where quantified changes in flow velocities showed no signs of stenosis and trivial regurgitation. The asymmetric jet with a shear layer and flow reversal on the posterior aspect of the aorta was corrected resulting in reduced wall shear stress on the anterior aspect and reduced oscillatory shear index, which is considered a contributing element in cellular alterations in the structure of the aortic wall. Conclusion: This proof-of-concept study demonstrates the potential of BSI as an emerging echocardiographic approach for evaluating subaortic and aortic valvar repair. BSI enhances the quantitative evaluation of the left ventricular outflow tract of immediate surgical outcomes beyond traditional echocardiographic parameters and aids in post-operative decision-making. However, larger studies are needed to validate these findings and establish standardized protocols for clinical implementation.

In subjects with functionally bicuspid aortic valves (BAVs) with fusion between the coronary leaflets, there is a natural variation of the commissural angle. What is not fully understood is how this variation influences the hemodynamics and tissue biomechanics. These variables may influence valvar durability and function, both in the native valve and following repair, and influence ongoing aortic dilation. A 3D aortic valvar model was reconstructed from a patient with a normal trileaflet aortic valve using cardiac magnetic resonance (CMR) imaging. Fluid–structure interaction (FSI) simulations were used to compare the effects of the varying commissural angles between the non-coronary with its adjacent coronary leaflet. The results showed that the BAV with very asymmetric commissures ((Formula presented.) degree commissural angle) reduces the aortic opening area during peak systole and with a jet that impacts on the right posterior wall proximally of the ascending aorta, giving rise to elevated wall shear stress. This manifests in a shear layer with a retrograde flow and strong swirling towards the fused leaflet side. In contrast, a more symmetrical commissural angle ((Formula presented.) degree commissural angle) reduces the jet impact on the posterior wall and leads to a linear decrease in stress and strain levels in the non-fused non-coronary leaflet. These findings highlight the importance of considering the commissural angle in the progression of aortic valvar stenosis, the regional distribution of stresses and strain levels experienced by the leaflets which may predispose to valvar deterioration, and progression in thoracic aortic dilation in patients with functionally bicuspid aortic valves. Understanding the hemodynamics and biomechanics of the functionally bicuspid aortic valve and its variation in structure may provide insight into predicting the risk of aortic valve dysfunction and thoracic aortic dilation, which could inform clinical decision making and potentially lead to improved aortic valvar surgical outcomes.

The aim of this paper is to assess the association between valve morphology and vortical structures quantitatively and to highlight the influence of valve morphology/orientation on aorta’s susceptibility to shear stress, both proximal and distal. Four-dimensional phase-contrast magnetic resonance imaging (4D PCMRI) data of 6 subjects, 3 with tricuspid aortic valve (TAV) and 3 with functionally bicuspid aortic values (BAV) with right-left coronary leaflet fusion, were processed and analyzed for vorticity and wall shear stress trends. Computational fluid dynamics (CFD) has been used with moving TAV and BAV valve designs in patient-specific aortae to compare with in vivo shear stress data. Vorticity from 4D PCMRI data about the aortic centerline demonstrated that TAVs had a higher number of vortical flow structures than BAVs at peak systole. Coalescing of flow structures was shown to be possible in the arch region of all subjects. Wall shear stress (WSS) distribution from CFD results at the aortic root is predominantly symmetric for TAVs but highly asymmetric for BAVs with the region opposite the raphe (fusion location of underdeveloped leaflets) being subjected to higher WSS. Asymmetry in the size and number of leaflets in BAVs and TAVs significantly influence vortical structures and WSS in the proximal aorta for all valve types and distal aorta for certain valve orientations of BAV. Graphical Abstract: Analysis of vortical structures using 4D PCMRI data (on the left side) and wall shear stress data using CFD (on the right side). [Figure not available: see fulltext.].

Subjects with bicuspid aortic valves (BAV) are at risk of developing valve dysfunction and need regular clinical imaging surveillance. Management of BAV involves manual and time-consuming segmentation of the aorta for assessing left ventricular function, jet velocity, gradient, shear stress, and valve area with aortic valve stenosis. This paper aims to employ machine learning-based (ML) segmentation as a potential for improved BAV assessment and reducing manual bias. The focus is on quantifying the relationship between valve morphology and vortical structures, and analyzing how valve morphology influences the aorta’s susceptibility to shear stress that may lead to valve incompetence. The ML-based segmentation that is employed is trained on whole-body Computed Tomography (CT). Magnetic Resonance Imaging (MRI) is acquired from six subjects, three with tricuspid aortic valves (TAV) and three functionally BAV, with right–left leaflet fusion. These are used for segmentation of the cardiovascular system and delineation of four-dimensional phase-contrast magnetic resonance imaging (4D-PCMRI) for quantification of vortical structures and wall shear stress. The ML-based segmentation model exhibits a high Dice score (0.86) for the heart organ, indicating a robust segmentation. However, the Dice score for the thoracic aorta is comparatively poor (0.72). It is found that wall shear stress is predominantly symmetric in TAVs. BAVs exhibit highly asymmetric wall shear stress, with the region opposite the fused coronary leaflets experiencing elevated tangential wall shear stress. This is due to the higher tangential velocity explained by helical flow, proximally of the sinutubal junction of the ascending aorta. ML-based segmentation not only reduces the runtime of assessing the hemodynamic effectiveness, but also identifies the significance of the tangential wall shear stress in addition to the axial wall shear stress that may lead to the progression of valve incompetence in BAVs, which could guide potential adjustments in surgical interventions.

Sound generation in human phonation and the underlying fluid–structure–acoustic interaction that describes the sound production mechanism are not fully understood. A previous experimental study, with a silicone made vocal fold model connected to a straight vocal tract pipe of fixed length, showed that vibroacoustic coupling can cause a deviation in the vocal fold vibration frequency. This occurred when the fundamental frequency of the vocal fold motion was close to the lowest acoustic resonance frequency of the pipe. What is not fully understood is how the vibroacoustic coupling is influenced by a varying vocal tract length. Presuming that this effect is a pure coupling of the acoustical effects, a numerical simulation model is established based on the computation of the mechanical-acoustic eigenvalue. With varying pipe lengths, the lowest acoustic resonance frequency was adjusted in the experiments and so in the simulation setup. In doing so, the evolution of the vocal folds’ coupled eigenvalues and eigenmodes is investigated, which confirms the experimental findings. Finally, it was shown that for normal phonation conditions, the mechanical mode is the most efficient vibration pattern whenever the acoustic resonance of the pipe (lowest formant) is far away from the vocal folds’ vibration frequency. Whenever the lowest formant is slightly lower than the mechanical vocal fold eigenfrequency, the coupled vocal fold motion pattern at the formant frequency dominates.

Rotating stall and surge are flow instabilities contributing to the acoustic noise generated in centrifugal compressors at low mass flow rates. Their acoustic generation mechanisms are exposed employing compressible Large Eddy Simulations (LES). The LES data are used for calculating the dominant acoustic sources emerging at low mass flow rates. They give the inhomogeneous character of the Ffowcs Williams and Hawkings (FW-H) wave equation. The blade loading term associated with the unsteady pressure loads developed on solid surfaces (dipole in character) is found to be the major contributor to the aerodynamically generated noise at low mass flow rates. The acoustic source due to the velocity variations and compressibility effects (quadrupole in character) as well as the acoustic source caused by the displacement of the fluid due to the accelerations of the solid surfaces (monopole in character) were found to be not as dominant. We show that the acoustic source associated with surge is generated by the pressure oscillation, which is governed by the tip leakage flow. The vortical structures of rotating stall are interacting with the impeller. These manipulate the flow incidence angles and cause thereby unsteady blade loading towards the discharge. A low-pressure sink between 4 and 6 o'clock causes a halving of the perturbation frequencies at low mass flow rates operating conditions. From two point space-time cross correlation analysis based on circumferential velocity in the diffuser it was found that the rotating stall cell propagation speed increases locally in the low pressure zone under the volute tongue. It was also found that rotating stall can coexist with surge operating condition, but the feature is then seen to operate over a broader frequency interval.

Flow instabilities such as Rotating Stall and Surge limit the operating range of centrifugal compressors at low mass-flow rates. Employing compressible Large Eddy Simulations (LES), their generation mechanisms are exposed. Toward low mass-flow rate operating conditions, flow reversal over the blade tips (generated by the back pressure) causes an inflection point of the inlet flow profile. There, a shear-layer induces vortical structures circulating at the compressor inlet. Traces of these flow structures are observed until far downstream in the radial diffuser. The tip leakage flow exhibits angular momentum imparted by the impeller, which deteriorates the incidence angles at the blade tips through an over imposed swirling component to the incoming flow. We show that the impeller is incapable to maintain constant efficiency at surge operating conditions due to the extreme alteration of the incidence angle. This induces unsteady flow momentum transfer downstream, which is reflected as compression wave at the compressor outlet traveling toward the impeller. There, the pressure oscillations govern the tip leakage flow and hence, the incidence angles at the impeller. When these individual self-exited processes occurs in-phase, a surge limit-cycle establishes.