title: Aortic root numeric model: annulus diameter prediction of effective height and coaptation in post-aortic valve repair.
abstract: OBJECTIVE
  The aim of the present study was to determine the influence of the aortic annulus (AA) diameter in order to examine the performance metrics, such as maximum principal stress, strain energy density, coaptation area, and effective height in the aortic valve.
  
  
  METHODS
  Six cases of aortic roots with an AA diameter of 20 and 30 mm were numerically modeled. The coaptation height and area were calculated from 3-dimensional fluid structure interaction models of the aortic valve and root. The structural model included flexible cusps in a compliant aortic root with material properties similar to the physiologic values. The fluid dynamics model included blood hemodynamics under physiologic diastolic pressures of the left ventricle and ascending aorta. Furthermore, zero flow was assumed for effective height calculations, similar to clinical measurements. In these no-flow models, the cusps were loaded with a transvalvular pressure decrease. All other parameters were identical to the fluid structure interaction models.
  
  
  RESULTS
  The aortic valve models with an AA diameter range of 20 to 26 mm were fully closed, and those with an AA diameter range of 28 to 30 mm were only partially closed. Increasing the AA diameter from 20 to 30 mm decreased the averaged coaptation height and normalized cusp coaptation area from 3.3 to 0.3 mm and from 27% to 2.8%, respectively. Increasing the AA diameter from 20 to 30 mm decreased the effective height from 10.9 to 8.0 mm.
  
  
  CONCLUSIONS
  A decreased AA diameter increased the coaptation height and area, thereby improving the effective height during procedures, which could lead to increased coaptation and better valve performance.
authors.affiliation: School of Mechanical Engineering, Tel Aviv University Faculty of Engineering, Tel Aviv, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Marom
authors.forename: Rami
authors.initials: R
authors.lastname: Haj-Ali
authors.forename: Moshe
authors.initials: M
authors.lastname: Rosenfeld
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
mesh_terms: D001011:Aorta / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D001696:Biomechanical Phenomena; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003198:Computer Simulation; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D008955:Models, Cardiovascular; D017711:Nonlinear Dynamics; D009716:Numerical Analysis, Computer-Assisted; D011474:Prosthesis Design; D013314:Stress, Mechanical; D016896:Treatment Outcome