title: Prosthetic heart valves' mechanical loading of red blood cells in patients with hereditary membrane defects.
abstract: Implantable cardiovascular devices such as prosthetic heart valves (PHVs) are widely applied clinical tools. Upon implantation, the patient can suffer from anemia as a result of red cell destruction and hemolysis can be more relevant whenever the patient is also affected by red cell disorders in which erythrocytes are more susceptible to mechanical stress such as hereditary spherocytosis (HS) and hereditary elliptocytosis (HE). Considering the typical morphological alterations observed in HS and HE, a study of the influence of cell geometry on the distribution of the shear stress on red cells in biological fluids was carried out. A numerical simulation of the loading caused by Reynolds shear stresses on a prolate spheroid was performed, with the ellipticity of the particle as the independent parameter. The average shear stress on a particle in the blood stream was found to depend on the particle's geometry, besides the stress field produced by the prosthetic device. The relevance of an increasing particle ellipticity on the global load is discussed. The model was applied to erythrocytes from implanted patients with HE or HS, enabling to explain the occurrence of moderate or severe anemia, respectively. The clinical data support the relevance of the proposed global parameter as erythrocyte trauma predictor with regard to the fluid dynamics of artificial organs.
authors.affiliation: Department of Technology and Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. grigoni@iss.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Grigioni
authors.forename: Patrizia
authors.initials: P
authors.lastname: Caprari
authors.forename: Anna
authors.initials: A
authors.lastname: Tarzia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Avenio
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena / Q000379:methods; D003198:Computer Simulation; D004612:Elliptocytosis, Hereditary / Q000473:pathology* / Q000503:physiopathology*; D004910:Erythrocyte Membrane / Q000473:pathology*; D004913:Erythrocytes, Abnormal / Q000473:pathology*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008560:Membrane Fluidity; D008875:Middle Aged; D008955:Models, Cardiovascular; D033081:Shear Strength; D013103:Spherocytosis, Hereditary / Q000473:pathology* / Q000503:physiopathology*; D013314:Stress, Mechanical