Blackwell Publishing IncMalden, USAAORArtificial Organs0160-564X 2006, Copyright the Authors; Journal compilation 2006, International Center for

r Artificial Organs and Transplantation? 2006307529538Original ArticleNUMERICAL MODEL OF FLOW IN A SAC-TYPE VADI.
AVRAHAMI ET AL.

Artificial Organs
30(7):529538, Blackwell Publishing, Inc.
2006, Copyright the Authors
Journal compilation 2006, International Center for Artificial Organs and Transplantation

Numerical Model of Flow in a Sac-Type Ventricular

Assist Device

*Idit Avrahami, Moshe Rosenfeld, Sagi Raz, and Shmuel Einav

*Option of Bioengineering, California Institute of Technology, Pasadena, California, U.S.A.; Department of Fluid Mechanics
and Heat Transfer and Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel

Abstract: This article addresses the growing need for com- coupled fluidstructure interaction numerical simulation
prehensive tools to investigate the hemodynamics of ven- and to experimental measurements using continuous digi-
tricular assist devices (VADs) in general and sac-type tal particle image velocimetry. Our results demonstrate
VADs in particular. Numerical simulations can be very that the flexible wall motion is sensitive to changes in pres-
helpful in these efforts. However, full simulation of flow sure distribution inside the chamber. However, small vari-
inside sac-type VADs poses several key problems, among ations in wall motion do not significantly affect the global
them simulation of the mechanical heart valves and calcu- features of flow inside the chamber. Therefore, the simpli-
lation of the motion of flexible walls. We present a sim- fied model can be used to predict the 3D time-dependent
plified three-dimensional (3D) numerical model of a flow field in the VAD. Key Words: Ventricular assist
sac-VAD chamber. The walls in the simplified model are devicePulsatile ventricular assist deviceSac-type ven-
defined to move according to experimental measurements, tricular assist deviceComputational fluid dynamics
and the valves are modeled in fully open or fully closed Fluidstructure interactionMoving boundariesContin-
positions. The model is validated by comparison to a fully uous digital particle image velocimetry.

Recently proven benefits of ventricular assist form pressure distribution in the blood chamber (5).
devices (VADs) for use as destination therapy (1) are However, numerical simulations of the flow inside
spurring the need to reduce complications by improv- sac-type VADs are highly complicated because the
ing their hemodynamics. Experimental investigation flow is unsteady at transitional Reynolds numbers,
of VAD hemodynamics relies primarily on flow visu- and it occurs within a complex 3D geometry. More-
alization techniques to identify flow patterns and over, such simulations pose two challenges: simu-
locate sites at risk of generating hemolysis or throm- lation of the flow across the passively moving
bus formation. Digital particle image velocimetry mechanical heart valves (MHVs), and simulation of
(DPIV) is a nonintrusive visualization technique that the flow inside a flexible chamber whose volume
can also provide quantitative data such as flow veloc- changes with transmural pressure drop.
ity or stress magnitudes (e.g., 2,3). Flow visualization Calculations of flow across MHVs require very
techniques, however, are limited when measuring demanding simulations. The geometry and orienta-
high velocities or three-dimensional (3D) flows inside tion of the MHVs greatly influence VAD hemody-
the VAD chamber (3,4). Numerical simulations may namics, as the flow across MHVs is characterized by
complement the experimental techniques by produc- high disturbances, high shear stresses, and bulk tur-
ing detailed 3D flow field data that can be compared bulence stresses (6,7). Proper simulation of the 3D
to experimental results for validation. flow across even a single valve requires a very fine
Pulsatile VADs with flexible chambers have some mesh model, the use of strongly coupled fluidstruc-
advantages over VADs with rigid chambers. These ture interaction (FSI) algorithms for the large motion
include smooth contacting walls and a relatively uni- of the leaflets (8), and implementation of low-
Reynolds turbulence models (7,9). To date, no simu-
Received August 2005; revised January 2006. lations were reported that incorporate all aspects of
Address correspondence and reprint requests to Dr. Idit Avra- flow and leaflet dynamics for a single MHV, not to
hami, Department of Bioengineering, California Institute of
Technology, 1200 East California Blvd., M/C 301-46, Pasadena, mention a detailed simulation of a flexible chamber
CA 91125, U.S.A. E-mail: idit@caltech.edu with two passively moving MHVs.

529
530 I. AVRAHAMI ET AL.
As for analysis of the flow in a flexible chamber,
attempts were made to numerically simulate the flow
inside the volume-changing ventricle of the natural
heart (e.g., 1012). In these simulations, the wall
motion is specified by myocardial activation. The
simulation of sac-type VADs, however, requires
coupling of the flow field with the motion of
elastic chamber walls.
Combining these two challenges in the simulation
of a sac-VAD chamber is beyond the routine capa-
bilities of existing computational resources. Conse-
quently, only a few numerical analyses, using only
simple models, were published for pulsating VADs.
The only numerical analysis of VAD that included
valve motion, by Kiris et al. (13), simulated the 3D
pulsatile flow in a rigid pusher-plate chamber during
one cardiac cycle. However, the motion of the rigid
pusher-plate and the two valves was specified accord-
ing to experimental data rather than coupled with the
flow. Chesler and Kamms simulation of a counter-
pulsating VAD (14) included a pusher plate and a
single valveless conduit. To allow the numerical sim-
ulation, the Reynolds number was reduced from
1600 to 36, and the Womersley number used was
reduced from 29 to 4.3. Moreover, the chamber was
divided into only 396 elements and only one pumping
cycle was analyzed to save computational resources.
Konig et al. (15,16) used a simple 3D model to sim-
ulate a sac-type VAD. The flexible walls were simu-
lated using a rigid moving hemispherical plate and
the valves were modeled indirectly as on/off valves.
Shim et al. (17) were the only ones to use a fully
coupled method to compute the flow interacting with
a flexible sac-VAD chamber, but in order to simplify
their model, they also used on/off boundary condi-
tions to simulate the valves. Their model ignored not
only the opening and closing phases of the valves,
but also the effect of the valves on profile and direc-
tion of the entering flow.
The objective of this study was to develop and
validate a numerical model for simulating the flow
inside a sac-type pulsating VAD. In the presented
model, the motion of the flexible wall is specified
according to experiments, and the valve leaflets are
modeled in their fully open or fully closed positions.
This article addresses these simplifications and their
effects on the models accuracy in predicting the flow
field in the chamber. In order to examine the conse-
quences of the model simplifications and assumptions,
the simulation results are compared with those
obtained by an FSI numerical analysis in which the
wall motion is fully coupled with the flow and with
an experimental analysis using continuous digital par-
ticle image velocimetry (CDPIV) measurements col-
Artif Organs, Vol. 30, No. 7, 2006
lected for this study. A more comprehensive study of
the flow field inside the sac-type VAD will be given
elsewhere.
METHODS
Berlin VAD and the experimental system
The model of the VAD chamber was constructed
based on the electrohydraulic Berlin sac-type VAD
(4). It includes a discoid flexible chamber (8 cm in
diameter and 2 cm in width) and two tilting disk
MHVs (2 cm in diameter), placed in S-shape center-
line ducts. The inlet and outlet conduits are parallel
to each other. The flexible walls of the sac are made
of 0.09-cm transparent polyurethane. The mechanical
properties of the polyurethane walls were measured
inside a water tank under strain rate as during pump-
ing. The measured modulus of elasticity is 15 MPa,
Poissons ratio is 0.3, and material density is 1.05 g/
cm3.
The model of the VAD chamber was connected to
a mock-up flow loop that simulated cardiovascular
flow conditions (Fig. 1). The loop contained a com-
pliant chamber to model the arterial compliance,
flow regulator representing afterload conditions,
and reservoir representing preload conditions. The
preload conditions (reservoir height) were set to a
pressure of 35 mm Hg. The afterload conditions (reg-
ulator, compliance, and outlet pressure) were set to
vary between 80 and 100 mm Hg. The VAD chamber
was enclosed inside a transparent rigid pressure con-
tainer filled with transmitter fluid. The pressure in the
container varied by an attached piston pump and
allowed the flexible chamber to expand and com-
press at a rate of 30 bpm, circulating the fluid through
FIG. 1. Illustration of the experimental flow loop.
 NUMERICAL MODEL OF FLOW IN A SAC-TYPE VAD
the flow loop at flow rate of Q = 2 L/min. These
under-physiological flow conditions were chosen to
overcome the limitations of the experimental system
in measuring high velocities in the chamber. Blood
was simulated by a waterglycerin mixture (60:40%
by weight) seeded with 10-m silver-coated glass
microspheres (dotted fill in Fig. 1). This mixture
is a transparent blood analog approximating both
blood viscosity ( = 0.035 g/cm/s) and blood density
( = 1.1 g/cm3). The same solution without particles
was used as a transmitter fluid in the pressure con-
tainer (solid fill in Fig. 1). An electromagnetic flow-
meter (MAGFLO MAG 3000, EMCO Flow Systems,
Longmont, CO, U.S.A.), located downstream from
the outflow valve, measured the instantaneous
and average flow rates, and a pressure transducer
(PX143-05, Omega Engineering, INC., Stamford,
CT, U.S.A.) measured instantaneous pressure in the
pressure container.
The experimental study used CDPIV. CDPIV, a
continuous version of DPIV, is based on a continu-
ous video recording, which is then divided into a
sequence of images at the camera frame rate.
Image pairs are cross-correlated to create a
sequence of instantaneous velocity maps. A
detailed description of the method and system can
be found in Grad and Einav (18). In the CDPIV
system used for this study, a continuous laser light
sheet (5 W, water-cooled argon ion laser; Coherent
Innova 70, Coherent Inc., Santa Clara, CA, U.S.A.)
was strobed using an electronic light shutter, trig-
gered by a CCD video camera (29.97 fps, 8-Bit,
grayscale, 768 480; Pulnix TM-9701, JAI PULNiX,
Inc., San Jose, CA, U.S.A.) to sample 15 image
pairs per second. Time interval between images in
each image pair was set to t = 2.5 ms. A combina-
tion of mirrors and cylindrical lenses spread the
laser beam to a light sheet with a thickness of 1 mm
and an area that covered the entire mid-cross-
section (XY plane), including the inflow and
outflow MHVs. The total image acquired by the
camera covered an interrogation window of
76 47.5 mm. The subsamples were 16 16 pixels,
with a step size of 8 8 pixels.
The numerical model
Two numerical models of the Berlin VAD were
simulated. The first model, FSI case, was a fully cou-
pled FSI model in which the flexible walls were
moving according to the time-dependent transmural
pressure drop between the calculated internal pres-
sure field and imposed external pressure. The motion
of walls was predefined from the experiments. Both
models included the internal cavity of the VAD
531
chamber, inlet/outlet conduits, and models of the
valves leaflets. In addition, the model of the FSI case
included elastic walls.
Even though the model and boundary condi-
tions are symmetric, nonsymmetric flow may occur
as a result of flow instabilities in transient simula-
tions. Therefore, to avoid nonphysical effects of
the symmetric boundary, complete 3D numerical
models were used to incorporate the entire 3D
flow field.
A time-dependent, incompressible, and laminar
flow was simulated. The blood was assumed Newto-
nian with a constant viscosity. Flow and pressure
fields were calculated numerically by solving the
equations governing continuity and momentum in
the fluid domain:
U=0 (1)
U
r + (U - U g ) U + p = u 2 U (2)
t
where U is the fluid velocity, Ug is the local coordi-
nate velocity, p is the static pressure, t is the time,
is the blood density, and is the dynamic viscosity of
blood.
In the FSI case, the maximal deformation of the
wall was relatively small (up to 6%); therefore the
stressstrain relationship was assumed to be linear:
= E( + 0) + 0 (3)
where E is the wall Youngs elasticity modulus, and
are the instantaneous strain and stress, respectively,
and 0 and 0 are the initial strain and stress, respec-
tively. The dynamics of the flexible wall were calcu-
lated using the linear dynamics response of a system:
+ CS + KS = R (4)
MS
where M, C, and K are the mass, damping, and stiff-
ness matrices, respectively; R is the vector of exter-
nally applied loads; and S, S, and S are the
displacement, velocity, and acceleration vectors of
the structural domain, respectively. The set of equa-
tions was solved numerically using CFD-ACE (CFD
Research Corporation, Huntsville, AL, U.S.A.). The
fluid solver used the finite volume method to dis-
cretize the governing equations and the SIMPLEC
pressure-based method to derive a stable pressure
velocity decoupling formulation. In both simula-
tions, the grid deformation module of CFD-ACE
was used to control the moving/deforming grid,
bases on standard transfinite interpolation (TFI)
scheme to determine the interior nodes movements
based on the motion of boundary nodes. The arbi-
trary Lagrangian-Eulerian approach was used to
Artif Organs, Vol. 30, No. 7, 2006
532 I. AVRAHAMI ET AL.
adjust the momentum equation to the grid motion in
the fluid domain.
For the FSI case, the structural solver used the
finite element method. Small deflections were
assumed for the structure and first-order elements
were used. The structural solver was combined with
the fluid solver using a strong implicit two-way cou-
pling mode, in which the structural solver is called
after each iteration.
Boundary and initial conditions
For consistency with the experiments, similar pre-
load, afterload, and pump frequency were specified
for the simulations. The filling preload was modeled
for both simulations by specifying a fixed pressure of
30 mm Hg in the inflow boundary. Ejection afterload
conditions were modeled by combining a linear flow
resistor set at 10.5 mm Hgmin/L downstream from
the outflow valve and a fixed pressure of 75 mm Hg
at the outlet boundary (Fig. 2). To avoid the influence
of boundary conditions on the flow inside the cham-
ber, the inlet/outlet conduits were longer in the
numerical models than in the real VAD.
The entire VAD-sac chamber was elastic. How-
ever, the actual displacements of circumferential
regions were significantly smaller than in the central
regions. Therefore, to simplify the numerical models,
it was assumed that only the central front and back
regions are mobile, and the other parts of the wall
are fixed (Fig. 2).
For the FSI case (the fully coupled simulation), the
time-dependent hydrostatic pressure acting on the
outlet surface of the VAD walls was specified. Pres-
sure function was approximated from experimental
measurements to the curve shown by the solid line
in Fig. 3. In the base case, the imposed front and back
wall displacements were approximated to paraboloi-
dal shape with the maximal displacement at the cen-
FIG. 2. Boundary conditions during ejection phase (left) and fill-
ing phase (right).
Artif Organs, Vol. 30, No. 7, 2006
140
FSI case
120
Base case
External pressure C
100
pressure (mm Hg)
B
80
60
40
A D
20
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
t n =t/T
FIG. 3. Time-history of imposed external pressure (dark solid
line) and of the pressure at the center of the chamber for the FSI
(light solid line) and base case (dotted line) simulations. The
letters A, B, C, and D define four instants during the pumping
cycle (peak filling, beginning of ejection, peak ejection, and
beginning of filling, respectively).
ter. Time-varying wall displacement was determined
from the experiments. Side view of the VAD was
recorded for 140 time samples during more than
two pump cycles. Marked points on the central
sagittal cross-section were detected, and the distance
between the central points of the walls was mea-
sured. This measured displacement was approxi-
mated to a harmonic function. The imposed velocity
Wwall of each node on the front and back walls for the
base case was therefore:
2p r2
Wwall = A sin (t - t 0 ) 1 - 2 (5)
T R
where A = 2.39 cm/s, T is the pump cycle period, t0 is
the time shift between the beginning of the simula-
tion and start of filling, r is the distance of the node
from the center of the membrane, and R = 3.25 cm
is the radius of the circular moving membranes
(as defined in Fig. 2). The resulting stroke volume
was SV = 56 mL, with a mean flow rate of Q = 1.68 L/
min and a peak ejection rate of Qpe = 4.76 L/min.
Modeling of the valves
This study focuses on the hemodynamics of the
VAD chamber. To make the simulation feasible, the
effect of the MHVs was only approximated. The leaf-
lets were modeled in their fully open or fully closed
positions to create more realistic inflow/outflow con-
ditions on the VAD chamber. The dynamics of the
leaflets during opening and closing were ignored, as
they were shown to have only a secondary effect on
the flow in the chamber (19).
The mesh was built with both leaflets in their fully
open position. To model a closed-valve condition, the
corresponding inlet/outlet boundary was declared as
impenetrable, and the fluid in the corresponding con-
 NUMERICAL MODEL OF FLOW IN A SAC-TYPE VAD
duit distal to the closed-leaflet boundary line was
assigned a very high dynamic viscosity ( = 50 kg/m-
s). Consequently, the fluid in the conduit was blocked
distal to the closed-leaflet boundary line (Fig. 2). The
flow was blocked downstream from the outflow valve
during the filling phase, and upstream from the
inflow valve during the ejection phase. Timing for
closing or opening of the valves was determined from
the calculated moment on the valves. During the two
isovolumetric phases, both valves were designated as
closed, but minor flow (104 cm/s) was allowed to
avoid numerical instabilities.
The simulations started with an initial condition of
zero velocity and a uniform pressure of 30 mm Hg
inside the VAD chamber. The chambers walls were
in their neutral position and all simulations started at
peak filling. As the periodic flow characteristics of the
VAD were investigated, at least two complete pump
cycles with 1000 time steps each were calculated for
each model, and the results were taken from the
second pump cycle. To assure a good convergence of
the solution, a minimum of three orders of mag-
nitude reduction in residuals was defined for all
the cases. A maximum of 300 iterations was set for
each time step in the base case, and a maximum of
500 iterations per time step was set for the FSI
simulation.
The FSI case simulations required 0.166 central
processing unit (CPU) seconds per time step per
mesh node, while the equivalent CPU time required
for the base case is only 0.016 s. These data are for
Pentium PC with 1000 MHz CPU and 512 MB ran-
dom access memory.
Mesh and time step independence tests
The mesh models were built using structured mesh
of hexahedral elements with clustering near the wall
and near the valves (see a sample mesh in Fig. 4). To
FIG. 4. (a) Sample mesh of the VAD chamber and (b) magnified
view of the outlet valve.
533
6.0
128 000
5.0
56 700
4.0
32 100
3.0 Y component
Velocity (cm/s)
16 500
2.0 10 000
1.0
0.0
1.0
2.0 X component
3.0
4.0
1.0 0.8 0.6 0.4 0.2 0.0 0.2 0.4 0.6 0.8 1.0
Xn = x/R
FIG. 5. Velocity distribution along the X centerline for the different
mesh resolutions. The X centerline lies on the mid-plane of the
chamber, parallel to the x-axis.
evaluate the optimal spatial mesh resolution, five
models with an increasing number of mesh nodes
were built (10 000, 16 500, 32 100, 56 700, and 128 000
nodes) for the base case and simulated over 20 time
steps (0.02 T), starting from the same initial flow
conditions of the beginning of the second ejection, at
a nondimensional time of tn = t/T = 1.25 (marked as
B in Fig. 3).
Simulations for all the meshes shared similar flow
patterns. An example of the Cartesian velocity com-
ponents (Ux and Uy) along X centerline (a line par-
allel to the x-axis, passing through the center of the
chamber), are shown in Fig. 5 for the five meshes.
Negligible differences were found between the
meshes. Average relative differences between veloc-
ities of the finest mesh (128 000 nodes) and of the
coarser meshes with 10 000, 16 500, 32 100, and
56 700 nodes were at 3.5, 3, 1.5, and 1%, respectively.
Consequently, a mesh of 56 700 nodes was used for
the base case simulation. To reduce the calculation
effort in the FSI analysis, a coarser mesh of 16 250
nodes was used.
Time step independence tests were also per-
formed. Five simulations using an identical mesh (of
56 700 nodes) were performed using 50, 100, 200,
400, and 1000 steps per cycle (of T = 2 s). All the
simulations started from the same initial conditions
at the peak of the second ejection (at tn = 1.5,
marked as C in Fig. 3), and were compared at the
end of the second ejection (tn = 1.75, marked as D
in Fig. 3).
A comparison of Ux and Uy at the X centerline is
shown in Fig. 6 for the five step intervals. In this case
as well, the simulations with different time steps
showed similar global features. However, the differ-
ences between the cases were more noticeable. The
average relative difference between the simulation
with the smallest time steps (1000 steps/cycle) and
Artif Organs, Vol. 30, No. 7, 2006
534 I. AVRAHAMI ET AL.

0.5
0.0
Y component
0.5
1.0
Velocity (cm/s)

1.5
2.0 1000
2.5 400
200
3.0
100
3.5 50
4.0 X component
4.5
FIG. 7. Wall displacement at three time instances of the FSI
1.0 0.8 0.6 0.4 0.2 0.0 0.2 0.4 0.6 0.8 1.0 simulation. Darker colors indicate larger wall displacement.
Xn = x/R

quite flexible, with E = 15 MPa and thickness of

FIG. 6. Velocity distribution along the X centerline for the different
time step intervals. 0.09 cm, relatively small variations in the pressure
inside the chamber caused noticeable deviations
from the theoretical paraboloidal shape, as shown in
the simulations with 50, 100, 200, and 400 time steps Fig. 7 for the three instances tn = 1.2, 1.7, and 1.8. The
per cycle were 18.5, 8, 2, and 0.5%, respectively. deviations are particularly significant at the end of
Therefore, all simulations were performed using 1000 ejection phase and at the beginning of filling phase,
time steps per cycle. as a result of the large pressure variations developed
For comparison, Shim et al. (17) used a mesh of inside the chamber in the vicinity of high-velocity
8677 nodes for their analysis of sac-type chamber. regions.
Konig et al. (15) used a mesh with 58 560 elements Side views with the shapes of the wall and velocity
for a similar case of a sac-type VAD with only one vector at the central sagittal cross-section are shown
moving wall, and reported only a small improvement in Fig. 8 for the ejection and filling phases in the
in results when they examined a simulation with 3200 experimental investigation and both simulation mod-
time steps per cycle over coarser time steps of 32, 64, els. In the left column, the experimental results are
and 100 per cycle. Kiris et al. (13) used a total of shown; the wall shape as obtained by connecting the
239 713 nodes in their Chimera grid model of the detected points on the sagittal cross-section is shown
Penn State pusher-plate VAD, and used only 40 time by dotted lines. Some asymmetry can be seen, espe-
steps per cycle for a relatively low Reynolds number cially in the filling phase. This asymmetry may be
(Re = 900).

RESULTS

Pressure distribution and wall motion

The pressure inside the sac chamber was found
to be almost spatially uniform for both the FSI and
base case simulations with a variation of less than
3.5 mm Hg. History of the pressure at the center
of the VAD, together with the external pressure
imposed in the FSI case, is shown in Fig. 3 for both
the FSI and base case simulations. The letters A, B,
C, and D define four specific phases in the cycle
peak filling, beginning of ejection, peak ejection, and
beginning of filling, respectively. A time-periodic
pressure solution is obtained after the second cycle.
The internal pressure in the FSI case follows the
external pressure with a small pressure difference of
less than 3 mm Hg across the wall. Small numerical
oscillations of 5 mm Hg are noticeable mainly dur-
ing the filling phase.
The shape of the wall, as found in the FSI simula-
FIG. 8. Side view of the experimental model (left column), and X
tion, indeed resembles a paraboloidal shape during cross-sections of the FSI case (middle column) and base case
most of the cycle. However, because the walls are (right column) models at two phases of the pump cycle.

Artif Organs, Vol. 30, No. 7, 2006

 NUMERICAL MODEL OF FLOW IN A SAC-TYPE VAD 535

attributed to the asymmetric orientation of the valves

in the experimental model.
The Z-velocity vectors fields at the central YZ
plane are shown for the FSI case and the base case
in the central and right columns, respectively. In both
cases, the velocity field and shape of the wall are
symmetric in the mid-XY-plane, due to symmetric
geometry and boundary conditions. In the FSI simu-
lations, some asymmetry relative to the mid-XZ and
YZ planes could be observed due to the pressure FIG. 10. Comparison of vector velocity field at filling and ejection
variations developed in the vicinity of the valves phases.
(Fig. 8), while in the base case, a fully symmetric
shape of the wall was imposed.
In the base case, the wall velocities are distributed errors and the assumption of a symmetric motion.
according to the imposed parabolic profile. In the FSI Larger discrepancies were obtained with the FSI cal-
case, the wall velocity is calculated from the transmu- culations, where the wall displacement was calcu-
ral pressure gradient and therefore, although the wall lated coupled to the simulation of the flow field. The
shape is approximately parabolic, the wall velocity largest deviation between the experimental and FSI
does not follow a parabolic profile. In both the filling calculations was obtained at the beginning of filling
and ejection phases, larger velocities were calculated (5% relative to the neutral position). These devia-
at the center of the membrane, while at the periph- tions are mainly attributable to differences in the
eral regions of the membrane, small-to-negative pressure distributions in the entrance and exit
velocities were found. In addition, velocity and regions of the main chamber because the valves were
pressure gradients were found to be smaller than in only crudely modeled. The mean deviation, however,
the base case. During the isovolumetric phases, the was less than 3%.
imposed wall velocity in the base case was zero, while
the internal velocity field was nonzero. In the FSI Flow patterns at the mid-XY plane
case, however, although there was no change of Velocity vectors at the mid-XY plane of the VAD
volume, some wall motion was observed. are shown in Fig. 10 for the three cases at ejection
The displacement of the central points of the mem- and filling. The velocity vector fields for the CDPIV
branes for the experimental measurements and both measurement and two simulations are shown for the
simulation models is plotted in Fig. 9. The wall dis- interrogation window used in the CDPIV measure-
placement, as measured from the experiments, was ments. In all three cases, similar global flow features
calculated assuming symmetry along the XY plane. were observed. During filling, two high-velocity jets
The wall displacement for the base case was obtained flowed into the chamber from the inflow valve. A
from a best-fit of a harmonic function to the experi- large rotating vortex formed and grew until it filled
mental results. Deviation between the measured and the entire VAD chamber during the isovolumetric
approximate displacement was relatively small (less phase and at most of the ejection. In each case, at the
than 3%), and was mainly a result of measurement end of the ejection phase, the vortex was washed out
through the outflow valve. No significant stagnant
1.5 regions could be identified throughout the entire car-
diac cycle, an indication of good washout properties
W all displacement (cm)

1.0
B in the present design.
0.5
Distribution of the Ux and Uy velocity components
0.0
at filling and ejection along the X centerline (as
Experiment
Base case A C defined in Fig. 5) is plotted in Fig. 11. A global agree-
-0.5 FSI case
D ment was obtained for all three cases, but differences
-1.0 were noticeable in local features. The largest devia-
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
t n = t/T
tions were found in the FSI simulations at peak ejec-
tion (phase C). The average difference among the
FIG. 9. Wall displacements of the chambers center point as three models, relative to the mean velocity, was less
measured experimentally (solid line), as calculated in the FSI than 26%. However, correlation among velocity pro-
simulation (gray solid line) and as approximated to a harmonic
curve for the base case (dotted line). The letters A, B, C and D files of the three cases was high. The average velocity
correspond to the four instants defined in Figure 3. correlation (the covariance of the data sets divided

Artif Organs, Vol. 30, No. 7, 2006

536 I. AVRAHAMI ET AL.

a by the product of their SD values) between the

Filling CDPIV and base case results was 0.92, and the veloc-
(Phase A)
2.0 ity correlation between the two numerical models
was 0.93.
0.0

2.0
Ux (cm/s)

DISCUSSION
4.0

6.0
CDPIV The objective of this study was to develop a
FSI case numerical model for simulating the flow inside a sac-
8.0 Base case
type pulsatile VAD. The main advantage of the base
10.0
1.0 0.8 0.6 0.4 0.2 0.0 0.2 0.4 0.6 0.8 1.0
case is that it requires less computational effort and
xn = x/R therefore, allows the use of finer mesh. This could
be useful for a comprehensive investigation of the
b
Filling
hemodynamic properties of the VAD chamber and
(Phase A) for optimization of VAD design. The basic model
10.0
includes four times as many nodes as the FSI model,
5.0 and yet the simulations for the FSI case required 10
0.0 times as much CPU time as the base case. However,
Uy (cm/s)

5.0
several simplifications were made in the base model.
CDPIV
Two questionable assumptions are the laminar flow
10.0
FSI case assumption and modeling of the inflow and outflow
15.0 Base case valves.
20.0 The assumption of laminar flow may be relevant
1.0 0.8 0.6 0.4 0.2 0.0 0.2 0.4 0.6 0.8 1.0
mainly because of the under-physiological pumping
xn = x/R
conditions used in this verification study. In the cases
c analyzed, the mean Reynolds number was 560, and
Ejection
(Phase C) the peak filling Reynolds number was less than 1600.
3.0 In such flow conditions, the effect of transitional flow
2.0 CDPIV
FSI case
in the inlet cannula during deceleration phase of fill-
1.0
Base case ing is considered to be negligible (9,20). However,
Ux (cm/s)

0.0
according to Konig et al. (16), sudden expansion of
1.0
the flow as it enters the main chamber might tend to
2.0
3.0
cause transient turbulence even at Reynolds num-
4.0
bers as low as 750. Therefore, assumption of laminar
1.0 0.8 0.6 0.4 0.2 0.0 0.2 0.4 0.6 0.8 1.0 flow may introduce some inaccuracies, especially
xn = x/R
downstream from the valves. When higher flow rates
d are of interest, low-Reynolds turbulence models
Ejection should be employed and a considerably finer mesh
(Phase C)
12.0
should be used (7). In this case, the simplifications of
10.0 the basic model that do not require FSI simulation
8.0 may be useful to make the problem tractable.
6.0
Another simplification in the numerical simula-
Uy (cm/s)

4.0
2.0 CDPIV tions concerns the flow across the valves. A detailed
0.0 FSI case
description of the flow across MHVs is beyond the
2.0 Base case
4.0 scope of this study. Incorporating a 3D detailed FSI
6.0 simulation of two passively moving valves in a model
8.0
1.0 0.8 0.6 0.4 0.2 0.0 0.2 0.4 0.6 0.8 1.0
of a sac-type VAD is beyond the capabilities of rou-
xn = x/R tine simulations. Therefore, the valves were modeled
mainly to provide a more realistic entrance flow into
FIG. 11. X and Y velocity components along the X centerline at the VADs chamber in order to assess their contribu-
peak filling (phase A; a, b) and peak ejection (phase C; c, d).
tion to the flow inside the VAD chamber. Two prom-
inent simplifications were made regarding the valves:
(i) the passively moving leaflets were modeled as
either fully open or fully closed; and (ii) a relatively

Artif Organs, Vol. 30, No. 7, 2006

 NUMERICAL MODEL OF FLOW IN A SAC-TYPE VAD
coarse mesh was used in the vicinity of the valves
(Fig. 4b). The same order of mesh resolution in the
vicinity of an MHV (15 000 nodes) was used by Kiris
et al. (13), Konig et al. (16), and Shim et al. (17). In
order to simulate properly the detailed flow through
MHV, a grid mesh of 5 106107 nodes would be
required (7,9,19).
In both numerical simulations and in the experi-
mental results, similar wall motion and flow patterns
were observed inside the chamber, including the
formation of a large vortex that filled up the entire
chamber during the end of filling and the beginning
of ejection. Similar large vortexes were identified
in other VAD chambers with discoid chamber and
parallel conduits (13,2123). It was shown that the
characteristics of this vortex strongly affected the
hemodynamics of the VAD (6,24,25).
Some disagreement was found in the fine details
of the flow field between the numerical simulations
and experiments as a result of assumptions and sim-
plifications made in the numerical models and due to
limitations of the experimental system. Main differ-
ences were found in the details of the inflow and
outflow jets across the valves. These differences are
mainly attributable to the limitations of the CDPIV
system to measure velocity larger than 20 cm/s.
According to the numerical simulations, the maximal
velocity across the valves reached 38 cm/s at peak
ejection. Therefore, the CDPIV vector field in the
inflow and outflow regions (Fig. 10) should be inter-
preted with care. However, as long as the flow inside
the chamber is considered (Fig. 11), the CDPIV
results compare reasonably well with the numerical
results.
The differences between specified boundary con-
ditions in the two numerical models led to some dif-
ferences in wall motion. The wall motion in the FSI
case was highly sensitive to internal pressure varia-
tions. Even small variations in pressure inside the
chamber (of the order of 1.75 mm Hg) resulted in
nonparabolic wall shapes. This sensitivity may indi-
cate that the details of the wall motion might change
with even minor changes of the flow conditions. Fur-
thermore, as shown by the experimental model, the
wall motion was found to be very sensitive to in-
herent asymmetry in the model of the valve ori-
entation as well. A similar sensitivity to pressure
distribution and flow conditions in a sac-type cham-
ber was also reported by Clark et al. (21), who
suggested that even device orientation with respect
to gravity or movement of the patient might have
noticeable influence on the motion of the wall.
The specified boundary condition also affected
internal velocity distribution. In the FSI case, the wall
537
velocity was determined indirectly by the specified
external pressure and internal flow field, while in the
base case, internal flow was affected by the specified
wall velocity, resulting in higher internal velocity gra-
dients, especially in the Z-direction (Fig. 8). Similar
observations were reported by Chandran et al. (5),
who found smaller gradients of pressure and velocity
inside a flexible ventricle than in a rigid ventricle with
comparable flow rate conditions.
Bearing in mind the complexity of the flow field
inside the VAD chamber and the assumptions made,
fair agreement was found between the experimental
results and those of the two numerical models. Based
on the calculated results, it may be concluded that
differences in wall motion and Z-velocity field among
the various models do not significantly affect the glo-
bal features of the flow inside the chamber. The main
flow features were dominated by the inlet and outlet
flows and the large vortex inside the chamber. Both
numerical models succeeded well in representing the
detailed 3D time-dependent flow behavior inside the
flexible VAD chamber. Notwithstanding its limita-
tions, the simplified base case model was found to be
as accurate as the more complex FSI case for predict-
ing the flow inside the VAD chamber. Because the
required computational resources are an order of
magnitude less than for the fully coupled FSI simu-
lation, it may be reasonable to use the approximation
of prespecified wall motion when the flow patterns
and velocities in the sac chamber are of interest.
Based on the conclusions of this article, a larger study
of the hemodynamics and design of a sac-type VAD
is being conducted using the simplified model. In
future work, the simplified model will include turbu-
lence model as well. The results of a comprehensive
investigation of chamber hemodynamics in different
VAD designs, comparing MHV type, conduit orien-
tation, and compression mechanism will be given
elsewhere in future publications.
ACKNOWLEDGMENTS
This research was conducted in collaboration with
Prof. Klaus Affeld, Humboldt-University, Berlin. It
was partially supported by a grant from G.I.F., the
German-Israeli Foundation for Scientific Research
and Development and by the Fritz Brann Fellowship,
the Israel Science Foundation, the Joseph Drown
Foundation, and the Berman Trust.
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