UNIT II

BIOFLUID MECHANICS

 Intrinsic fluid properties

 Density
 Viscosity
 Compressibility
 Surface Tension
 Viscometers
 Capillary
 Coaxial cylinder
 cone and plate
 Rheological properties of blood
 Pressure-flow relationship for Non-Newtonian Fluids
 Fluid mechanics in straight tube
 Steady Laminar flow
 Turbulent flow
 Flow development, Viscous and Turbulent Sheer Stress
 Effect of pulsatility,
 Boundary Layer Separation
 Structure of blood vessels
 Material properties and modeling of Blood vessels
 Heart
 Cardiac muscle characterisation
 Native heart valves
 Mechanical properties and valve dynamics
 Prosthetic heart valve fluid dynamics.

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 LIST OF IMPORTANT QUESTIONS

PART A

1. What is the most important distinction between the mechanics of solids

and fluids? (N/D 19)
2. State an expression for the Reynolds number governing the flow regime
in a pipe. (N/D 19)
3. What is viscosity? (A/M 19) (M/J 2016)
4. Identify the four types of heart valves. Give their functions. (A/M 19)
5. Write the Hagen Poiseuille equation. (N/D 18) Or What is Hagen-
Poiseuille equation?
6. Is bone weakest when subjected to tension, compression or shear
stress? (N/D 18)
7. Explain Coquette flow (or) what is coquette flow? (A/M 2017) (A/M 2018)
8. How blood vessel can be modeled? (A/M 2018)
9. Write the difference between laminar and turbulent flow. (N/D 2017)
10. Give any two examples of tissue valve. (N/D 2017)
11. List the mechanical property of mitral valve. (A/M 2017)
12. What is called a non-Newtonian fluid?(N/D 2016)
13. Calculate the Reynolds number for plasma flowing in a 1.5 mm artery at
a velocity of 45 cm/s, and state the flow regime for a viscosity of 0.012
g/cms.(N/D 2016)

2
 PART B

1. Write the difference between laminar and turbulent flow. And

physiological conditions under which turbulent flow might arise in the
body. (N/D 2019)
2. Explain the rheological properties of blood. (A/M 19). Or Discuss the
rheological properties of blood. (N/D 19) or What is Rheology? Discuss
about Rheological properties of blood. Or Discuss about the elements
of blood and its characteristics.(N/D 2015)(N/D 2016) (A/M 2018)
3. Describe the applications of mechanics with respect to cardiovascular
dynamics. (A/M 19)
4. With a neat diagram explain how viscosity is measured using
Poiseuilles law. (N/D 18)
5. A patient has a cardiac output of 5 L/min. the systolic ejection period is
358 ms with a heart rate of 70 beats per minute. The mean aortic
gradient as measured by echocardiography is 81 mm Hg. Find the aortic
valve area as estimated by the Gorlin equation. What is the average flow
rate across the aortic valve during ejection? (N/D 18)
6. When the blood is said to be Newtonian? Explain with necessary
equations. (A/M 2017) (A/M 2018)
7. Prove that the velocity profile of blood in the blood vessel is parabola.
(A/M 2017) (A/M 2018)

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 PART A

1. What is the most important distinction between the mechanics of solids

and fluids? (N/D 19)
For a solid, the strain is a function of the applied stress, providing that
the elastic limit is not exceeded. The strain in a solid is independent of the
time over which the force is applied and, if the elastic limit is not exceeded,
the deformation disappears when the force is removed.
For a fluid, the rate of strain is proportional to the applied stress. A
fluid continues to flow as long as the force is applied and will not recover its
original form when the force is removed.

2. State an expression for the Reynolds number governing the flow regime in
a pipe. (N/D 19)
The Reynolds number (Re) of a flowing fluid is calculated by
multiplying the fluid velocity by the internal pipe diameter (to obtain the
inertia force of the fluid) and then dividing the result by the kinematic
viscosity (viscous force per unit length).
Re= v*d/

3. What is viscosity?(A/M 19)(M/J 2016)

 Viscosity is a measure of a fluid's resistance to flow.

 It describes the internal friction of a moving fluid.

 Viscosity is a property arising from collisions between neighboring

particles in a fluid that are moving at different velocities.

 For example, honey has a much higher viscosity than water.

4. Identify the four types of heart valves. Give their functions. (A/M 19)
 The mitral valve and tricuspid valve, which control blood flow from
the atria to the ventricles.
 The aortic valve and pulmonary valve, which control blood flow out of
the ventricles.

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5. Write the Hagen Poiseuille equation. (N/D 18) What is Hagen-Poiseuille
equation?
 Hagen–Poiseuille equation also known as the Hagen–Poiseuille law.
 Physical law that gives the pressure drop in an incompressible and
Newtonian fluid in laminar flow flowing through a long cylindrical pipe
of constant cross section.

6. Is bone weakest when subjected to tension, compression or shear stress?

(N/D 18)
Bone is strongest in compression, weakest in shear, intermediate

in tension.

7. Explain Coquette flow (or) what is coquette flow? (A/M 2017) (A/M 2018)
 Coquette flow is the laminar flow of a viscous fluid in the space
between two parallel plates, one of which is moving relative to the
other.

 The flow is driven by virtue of viscous drag force acting on the fluid
and the applied pressure gradient parallel to the plates.
 Coquette flow is frequently used in undergraduate physics and
engineering courses to illustrate shear-driven fluid motion.

8. How blood vessel can be modeled? (A/M 2018)

The blood vessel of the human cardiovascular system
is modeled through the fractal vascular tree like structure is shown below.

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 [3, 4, 12] . The basic idea of fractal is that breaking down an object into
smaller parts and each of which resembles the whole has been invoked for
the blood vessels.

9. Write the difference between laminar and turbulent flow. (N/D 2017)

S.NO LAMINAR FLOW TURBULENT FLOW

1. It is a fluid flow in which the fluid It is a fluid flow in which the fluid layers
layers move parallel to each cross each other and do not move
other and do not cross each parallel to each other.
other.
2. The laminar flow generally The turbulent flow occurs when the
occurs in the fluid flowing with fluid flows with high velocity.
low velocity.
3. The fluid flow is laminar when The fluid flow is turbulent when the
the value of Reynolds number value of Reynolds number is greater
(Re) is less than 2000. than 4000.
4. The fluid flow is very orderly i.e. The fluid flow is not orderly i.e. there is
there is no mixing of adjacent mixing of adjacent layers of fluid with
layers of the fluid and they each other and they do not move
move parallel to each other and parallel to each other and also with the
also with the walls of the pipe. walls of the pipe.

10. Give any two examples of tissue valve. (N/D 2017)

 Tissue heart valves
 Homograft or allograft (from human)
 Xenograft (from animal)

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 - Bovine (cow)cardiac tissue
- Porcine (pig) heart valves

11. List the mechanical property of mitral valve. (A/M 2017)

 Biaxial testing,

 Histological measurements and

 Theoretical continuum mechanics modeling

12. Calculate the Reynolds number for plasma flowing in a 1.5 mm artery at
a velocity of 45 cm/s, and state the flow regime for a viscosity of 0.012
g/cms.(N/D 2016)

Solution:
𝜌VL
Re = 𝜇

Given: v= 45 cm/s, µ= 0.012 g/cms, L= 1.5 mm, ρ= 1.025g/ml or 1025 kg/m 3

Re = 1.025 x 45 x 1.5 x10-3

0.012

= 0.0691875

0.012

= 5.76

The flow is laminar.

13. What is called a non-Newtonian fluid?(N/D 2016)

 In reality most fluids are non-Newtonian, which means that their viscosity is
dependent on shear rate (Shear Thinning or Thickening) or the deformation
history (Thixotropic fluids).

 In contrast to Newtonian fluids, non-Newtonian fluids display either a non-

linear relation between shear stress and shear rate have a yield stress,
or viscosity that is dependent on time or deformation history

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  Non-Newtonian behavior of fluids can be caused by several factors, all of
them related to structural reorganization of the fluid molecules due to flow. In
polymer melts and solutions, it is the alignment of the highly
anisotropic chains what results in a decreased viscosity. In colloids, it is the
segregation of the different phases in the flow that causes a shear thinning
behavior.

14. State the four most commonly used basic types of heart valve prostheses.
(M/J 2016)
 Caged ball
 Tilting disc
 Heterograft (Porcine or bovine)
 Homograft (Human cadavers)

15. What is Rheology?(N/D 2015)

 A branch of physics that deals with the deformation and flow of matter,
especially the non-Newtonian flow of liquids and the plastic flow of solids.
 Rheological properties can be measured from bulk sample deformation
using a mechanical rheometer or on a micro-scale by using a micro capillary
viscometer or an optical technique such as Micro rheology.

16. State the abnormalities of the blood. (N/D 2015)

Any abnormalities in tests conducted on blood. Some of the blood
abnormalities are the following:
 Bone marrow disease
 Acute lymphocytic leukemia
 Anemia
 Thrombosis
 Deep vein thrombosis
 Thrombocytosis

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17. What is Biofluid Mechanics?
 Biological fluid mechanics, or biofluid mechanics, is the study of both gas
and liquid fluid flows in or around biological organisms.
 An often studied liquid biofluid problem is that of blood flow in the human
cardiovascular system.
 Under certain mathematical circumstances, blood flow can be modeled by
the Navier–Stokes equations.
 Examples of biofluids are Amniotic fluid, CSF etc.

18. Explain Laminar flow

 It is the normal condition for blood flow throughout most of the circulatory
system.
 It is characterized by concentric layers of blood moving in parallel down
the length of a blood vessel.
 The highest velocity (Vmax) is found in the center of the vessel. The
lowest velocity (V=0) is found along the vessel wall.
 The flow profile is parabolic once laminar flow is fully developed. This
occurs in long, straight blood vessels, under steady flow conditions.

9
19. Define Turbulent flow
 Movement of a fluid in which the individual particles of fluid move in
irregular pattern seven though the overall flow is in one direction.
 Turbulent flow is common in non-viscous fluids moving at high
velocities.

20. What is capillary viscometer?

 A capillary viscometer is an instrument used to measure the viscosity,

or thickness, of a liquid.
 The flow, or efflux, time is directly proportional to the liquid's kinematic
viscosity, and may be converted directly to viscosity by use of a
conversion factor unique to each instrument.

 Viscosity is generally temperature dependent, so

the capillary viscometer is usually used in a controlled-temperature
water bath set to a specific temperature.

21. What is Reynolds number?

 Reynolds number is used to check whether the flow is laminar or

turbulent.
 It is denoted by Re. This number got by comparing inertial force with
viscous force.
 Reynolds number formula is used in the problems to find the Velocity
(V), density (ρ), Viscosity (μ) and diameter (L)of the fluid. It is
dimensionless.
Inertial force
Reynolds number = Viscous force

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 𝜌VL
i.e., Re = 𝜇

Where, ρ is the density of the fluid, V is the velocity of the fluid, ρ is the
density of fluid, μ is the viscosity of fluid, L is the length or diameter of the
fluid.

22. Write a brief notes on Artificial Heart Valves.

An artificial heart valve is a device implanted in the heart of a patient

with valvular heart disease. When one of the four heart valves malfunctions,
the medical choice may be to replace the natural valve with an artificial valve.
This requires open-heart surgery. There are two basic types of valves that
can be used for valve replacement.
 Mechanical heart valves
 Caged-ball
 Tilting-disk
 Single leaflet
 Bileaflet.
 Tissue heart valves
 Homograft or allograft (from human)
 Xenograft (from animal)
- Bovine (cow)cardiac tissue
- Porcine (pig) heart valves

23. What is mechanical heart valve?

 Mechanical valves are made completely from man-made materials.

 They have made up of very light weight and long lasting materials.
 The main advantage of mechanical valves is that they last a very long time
in most cases 20 years or more.
 Ex: Caged ball, Tilting disk, Single leaflet, Bileaflet.

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24. What is biological heart valve?

 Biological valves are made from human or animal tissue that has
been specially treated so that your body does not reject the valves.
 After being treated, the valves are attached to man-made materials to
give them support.
 They do not last as long as man-made valves, although they probably
last longer in older people.
 Ex: Homograft or allograft, Xenograft, Bovine, Porcine.

25. What are the materials used in artificial heart valves?

 Metal alloys
 Pyrolytic carbon
 Dacron
 Teflon

26. What is Blood Rheology?

 Hemo rheology, or blood rheology, is the study of flow properties of

blood and its elements of plasma and cells.
 Proper tissue perfusion can occur only when blood's rheological
properties are within certain levels.
 Alterations of these properties play significant roles in disease
processes.
 Blood viscosity is determined by plasma viscosity, hematocrit (volume
fraction of red blood cell, which constitutes 99.9% of the cellular
elements) and mechanical properties of red blood cells.

20. What are the different types of blood vessels?

 Arteries
 Arterioles
 Capillaries
 Venules
 Veins
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21. What are the functions of blood?

 Carries oxygen and nutrients to active tissues

 Delivers carbon dioxide to the lungs
 Brings metabolic end products to kidneys
 Blood is a buffering reservoir that controls pH of bio-fluids
 Plays a major role in the body's immune system
 In addition to mass, it also transports heat

22. What are the elements of blood and its characteristics?

 The main elements of blood include RBC, WBC, platelets, and plasma.
 RBC carries O2 from the lungs to all other body tissues and pick up CO2
back to lungs.
 WBC is one of the body‘s defenses against disease.
 Platelets are blood elements that lead to the formation of blood clots in
response to injury.
 Plasma is a yellowish fluid composed of about 92 percent water and 7
percent vital proteins, such as albumin, gamma globulin, anti-hemophilic
factor, and other clotting factors. (55% in blood)

23. What are the testing methods of heart valves?

 In vitro testing of artificial heart valves

 Durability test
 Testing of polymer-based heart-valve prosthesis

24. what are the characteristics of fluid?

One common characteristic of fluids is that they do not have a fixed

shape and are easily deformed. In space, liquids tend to take the form of a
sphere, while gases seem shapeless. Under the influence of gravity, liquids
take on the shape of the container, while gases often flow out of any
container.

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25. What is an intrinsic and extrinsic property? And its examples
 An intrinsic property is a property that an object or a thing has of itself,
independently of other things, including its context.
 An extrinsic (or relational) property is a property that depends on a
thing's relationship with other things.

26. What is boundary layer in fluid mechanics.

Boundary layer, in fluid mechanics, thin layer of a flowing gas or liquid

in contact with a surface such as that of an airplane wing or of the inside of a
pipe. The fluid in the boundary layer is subjected to shearing forces.

27. Why do turbulent boundary layers separates layer?

When a boundary layer separates, a drag force is induced as a result of

differences in pressure upstream and downstream of the wing. Pressure
drag is reduced by turbulent flow by delaying boundary layer separation, but this
increases the skin-friction drag due to higher shear stresses at the wall.

14
 PART B

1. Write the difference between laminar and turbulent flow. And

physiological conditions under which turbulent flow might arise in the
body. (N/D 2019)

S.NO LAMINAR FLOW TURBULENT FLOW

1. It is a fluid flow in which the fluid It is a fluid flow in which the fluid layers
layers move parallel to each cross each other and do not move
other and do not cross each parallel to each other.
other.
2. The laminar flow generally The turbulent flow occurs when the
occurs in the fluid flowing with fluid flows with high velocity.
low velocity.
3. The fluid flow is laminar when The fluid flow is turbulent when the
the value of Reynolds number value of Reynolds number is greater
(Re) is less than 2000. than 4000.
4. The fluid flow is very orderly i.e. The fluid flow is not orderly i.e. there is
there is no mixing of adjacent mixing of adjacent layers of fluid with
layers of the fluid and they each other and they do not move
move parallel to each other and parallel to each other and also with the
also with the walls of the pipe. walls of the pipe.

5. The flow of a fluid when each Irregular flow that is characterized by

particle of the fluid follows a tiny whirlpool regions.
smooth path, paths which never
interfere with one another.

6. Laminar flow is that the velocity The velocity of this fluid is

of the fluid is constant at any definitely not constant at every point.
point in the fluid.

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 Physiological conditions under turbulent flow in the body:
Generally in the body, blood flow is laminar. However, under conditions of
high flow, particularly in the ascending aorta, laminar flow can be disrupted and
become turbulent. When this occurs, blood does not flow linearly and smoothly
in adjacent layers, but instead the flow can be described as being chaotic.
Turbulent flow also occurs in large arteries at branch points, in diseased
and narrowed (stenotic or partially obstructed) arteries (see figure below), and
across stenotic heart valves.

Fig.: laminar flow and turbulent flow

Turbulence increases the energy required to drive blood flow because

turbulence increases the loss of energy in the form of friction, which generates
heat. When plotting a pressure-flow relationship (see figure to right), turbulence
increases the perfusion pressure required to drive a given flow. Alternatively, at a
given perfusion pressure, turbulence leads to a decrease in flow.

Turbulence does not begin to occur until the velocity of flow becomes high
enough that the flow lamina break apart. Therefore, as blood flow velocity
increases in a blood vessel or across a heart valve, there is not a gradual increase
in turbulence. Instead, turbulence occurs when a critical Reynolds number (Re) is
exceeded. Reynolds number is a way to predict under ideal conditions when
turbulence will occur. The equation for Reynolds number is:

Where V = mean velocity, D = vessel diameter, ρ = blood density, and η = blood

viscosity

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 Fig.: perfusion pressure

As can be seen in this equation, Re increases as velocity increases, and

decreases as viscosity increases. Therefore, high velocities and low blood viscosity
(as occurs with anemia due to reduced hematocrit) are more likely to cause
turbulence. An increase in diameter without a change in velocity also increases Re
and the likelihood of turbulence; however, the velocity in vessels ordinarily
decreases disproportionately as diameter increases. The reason for this is that flow
(F) equals the product of mean velocity (V) times cross-sectional area (A), and area
is proportionate to radius squared; therefore, the velocity at constant flow is
inversely related to radius (or diameter) squared. For example, if radius (or
diameter) is doubled, the velocity decreases to one-fourth its normal value, and Re
decreases by one-half.

Under ideal conditions (e.g., long, straight, smooth blood vessels), the
critical Re is relatively high. However, in branching vessels, or in vessels with
atherosclerotic plaques protruding into the lumen, the critical Re is much lower so
that there can be turbulence even at normal physiological flow velocities.

Turbulence generates sound waves (e.g., ejection murmurs, carotid bruits) that
can be heard with a stethoscope. Because higher velocities enhance turbulence,
murmurs intensify as flow increases. Elevated cardiac outputs, even across
anatomically normal aortic valves, can cause physiological murmurs because of
turbulence. This sometimes occurs in pregnant women who have elevated cardiac

17
output and who may also have anemia, which decreases blood viscosity. Both
factors increase the Reynolds number, which increases the likelihood of turbulence.

2. Discuss the rheological properties of blood. (N/D 19). or Explain the

rheological properties of blood. (A/M 19). Or What is Rheology? Discuss
about Rheological properties of blood. Or Discuss about the elements of
blood and its characteristics.(N/D 2015)(N/D 2016) (A/M 2018)
Rheology
 A branch of physics that deals with the deformation and flow of matter,
especially the non-Newtonian flow of liquids and the plastic flow of solids.
 Rheological properties can be measured from bulk sample deformation
using a mechanical rheometer or on a micro scale by using a micro capillary
viscometer or an optical technique such as Microrheology.
 Newtonian fluids can be characterized by a single coefficient of viscosity for
a specific temperature. Although this viscosity will change with temperature,
it does not change with the strain rate. Only a small group of fluids exhibit
such constant viscosity.
 The large class of fluids whose viscosity changes with the strain rate (the
relative flow velocity) are called non-Newtonian fluids.
 Rheology generally accounts for the behaviour of non-Newtonian fluids, by
characterizing the minimum number of functions that are needed to relate
stresses with rate of change of strain or strain rates.
 For example, ketchup can have its viscosity reduced by shaking (or other
forms of mechanical agitation, where the relative movement of different
layers in the material actually causes the reduction in viscosity) but water
cannot.
 Some other non-Newtonian materials show the opposite behaviour.
Viscosity going up with relative deformation, which is called,shear thickening
or dilatant materials. Since Sir Isaac Newton originated the concept of
viscosity, the study of liquids with strain rate dependent viscosity is also
often called Non-Newtonian fluid mechanics.

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  The experimental characterization of a material's rheological behaviour is
known as rheometry, although the term rheology is frequently used
synonymously with rheometry.
 Theoretical aspects of rheology are the relation of the flow/deformation
behaviour of material and its internal structure and the flow/deformation
behaviour of materials that cannot be described by classical fluid mechanics
or elasticity.
 One of the major tasks of rheology is to empirically establish the
relationships between deformations (or rates of deformation) and stresses.
 These experimental techniques are known as rheometry and are concerned
with the determination with well-defined rheological material functions.

Blood Rheology
 Hemorheology, or blood rheology, is the study of flow properties of blood
and its elements of plasma and cells.
 Alterations of these properties play significant roles in disease processes.
 Blood viscosity is determined by plasma viscosity, hematocrit (volume
fraction of red blood cell, which constitutes 99.9% of the cellular elements)
and mechanical properties of red blood cells.
 Red blood cells have unique mechanical behaviour, which can be
discussed under the terms erythrocyte deformability and erythrocyte
aggregation. Because of that, blood behaves as a non-Newtonian fluid.
 The viscosity of blood varies with shear rate. Blood becomes less viscous
at high shear rates like those experienced in peak-systole. Contrarily,
during end-diastole, blood moves more slowly and becomes thicker and
stickier. Therefore, blood is a shear-thinning fluid.
Blood Viscosity
 Blood viscosity is a measure of the resistance of blood to flow.
 It can also be described as the thickness and stickiness of blood.
 This biophysical property makes it a critical determinant of friction against
the vessel walls, the rate of venous return, the work required for the heart to
pump blood, and how much oxygen is transported to tissues and organs.
 These functions of the cardiovascular system are directly related to vascular
resistance, preload, after load, and perfusion, respectively.
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  The primary determinants of blood viscosity are hematocrit, red blood cell
deformability, red blood cell aggregation, and plasma viscosity.
 Plasma's viscosity is determined by water-content
and macromolecular components, so these factors that affect blood viscosity
are the plasma protein concentration and types of proteins in the plasma.
 Nevertheless, hematocrit has the strongest impact on whole blood viscosity.
One unit increase in hematocrit can cause up to a 4% increase in blood
viscosity.
 This relationship becomes increasingly sensitive as hematocrit increases.
When the hematocrit rises to 60 or 70%, which it often does
in polycythemia, the blood viscosity can become as great as 10 times that of
water, and its flow through blood vessels is greatly retarded because of
increased resistance to flow.
 This will lead to decreased oxygen delivery. Other factors influencing blood
viscosity include temperature, where an increase in temperature results in a
decrease in viscosity.
 This is particularly important in hypothermia, where an increase in blood
viscosity will cause problems with blood circulation.

Blood Viscoelasticity
 Viscoelasticity is a property of human blood that is primarily due to
the elastic energy that is stored in the deformation of red blood cells as the
heart pumps the blood through the body.
 The energy transferred to the blood by the heart is partially stored in the
elastic structure, another part is dissipated by viscosity, and the remaining
energy is stored in the kinetic motion of the blood. When the pulsation of the
heart is taken into account, an elastic regime becomes clearly evident.
 It has been shown that the previous concept of blood as a purely viscous
fluid was inadequate since blood is not an ordinary fluid.
 Blood can more accurately be described as a fluidized suspension of elastic
cells (or a sol).
 The red blood cells occupy about half of the volume of blood and possess
elastic properties.

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 This elastic property is the largest contributing factor to the viscoelastic
behaviour of blood.
 The large volume percentage of red blood cells at a normal hematocrit level
leaves little room for cell motion and deformation without interacting with a
neighbouring cell.
 Calculations have shown that the maximum volume percentage of red blood
cells without deformation is 58% which is in the range of normally occurring
levels.
 Due to the limited space between red blood cells, it is obvious that in order
for blood to flow, significant cell to cell interaction will play a key role.
 This interaction and tendency for cells to aggregate is a major contributor to
the viscoelastic behaviour of blood.
 Red blood cell deformation and aggregation is also coupled with flow
induced changes in the arrangement and orientation as a third major factor
in its viscoelastic behaviour.
 Other factors contributing to the viscoelastic properties of blood is the
plasma viscosity, plasma composition, temperature, and the rate of flow or
shear rate. Together, these factors make human blood viscoelastic, non-
Newtonian, and thixotropic.
 When the red cells are at rest or at very small shear rates, they tend to
aggregate and stack together in an energetically favourable manner.
 The attraction is attributed to charged groups on the surface of cells and to
the presence of fibrinogen and globulins.
 This aggregated configuration is an arrangement of cells with the least
amount of deformation. With very low shear rates, the viscoelastic property
of blood is dominated by the aggregation and cell deformability is relatively
insignificant.
 As the shear rate increases the size of the aggregates begins to decrease.
With a further increase in shear rate, the cells will rearrange and orient to
provide channels for the plasma to pass through and for the cells to slide.
 In this low to medium shear rate range, the cells wiggle with respect to the
neighbouring cells allowing flow.
 The influence of aggregation properties on the viscoelasticity diminish and
the influence of red cell deformability begin to increase.
21
  As shear rates become large, red blood cells will stretch or deform and align
with the flow. Cell layers are formed, separated by plasma, and flow is now
attributed to layers of cells sliding on layers of plasma.
 The cell layer allows for easier flow of blood and as such there is a reduced
viscosity and reduced elasticity.
 The viscoelasticity of the blood is dominated by the deformability of the red
blood cells.

Maxwell Model
If a small cubical volume of blood is considered, with forces being acted upon it
by the heart pumping and shear forces from boundaries. The change in shape of
the cube will have 2 components:
 Elastic deformation which is recoverable and is stored in the structure of the
blood.
 Slippage which is associated with a continuous input of viscous energy.
When the force is removed, the cube would recover partially. The elastic
deformation is reversed but the slippage is not. This explains why the elastic
portion is only noticeable in unsteady flow. In steady flow, the slippage will continue
to increase and the measurements of non time varying force will neglect the
contributions of the elasticity.

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Shear Stress:

Shear Strain:

Shear Rate:

A sinusoidal time varying flow is used to simulate the pulsation of a heart. A

viscoelastic material subjected to a time varying flow will result in a phase variation
between and represented by . If , the material is a purely elastic
because the stress and strain are in phase, so that the response of one caused by
the other is immediate. If = 90°, the material is a purely viscous because strain
lags behind stress by 90 degrees. A viscoelastic material will be somewhere in
between 0 and 90 degrees.

Relating the equations to common viscoelastic terms we get the storage

modulus,G', and the loss modulus,G".

A viscoelastic Maxwell material model is commonly used to represent the

viscoelastic properties of blood. It uses purely viscous damper and a purely elastic
spring connected in series. Analysis of this model gives the complex viscosity in
terms of the dashpot constant and the spring constant.

23
3. Describe the applications of mechanics with respect to cardiovascular
dynamics. (A/M 19)

The cardiovascular system is an internal flow loop with multiple branches

circulating a complex liquid. The hallmarks of blood flow in arteries are pulsatility
and branches, which cause wall stresses to be cyclical and nonuniform. Normal
arterial flow is laminar, with secondary flows generated at curves and branches.
Arteries can adapt to and modify hemodynamic conditions, and unusual
hemodynamic conditions may cause an abnormal biological response. Velocity
profile skewing can create pockets in which the wall shear stress is low and
oscillates in direction. Atherosclerosis tends to localize to these sites and creates a
narrowing of the artery lumen—a stenosis. Plaque rupture or endothelial injury can
stimulate thrombosis, which can block blood flow to heart or brain tissues, causing
a heart attack or stroke. The small lumen and elevated shear rate in a stenosis
create conditions that accelerate platelet accumulation and occlusion. The
relationship between thrombosis and fluid mechanics is complex, especially in the
post-stenotic flow field. New convection models have been developed to predict
clinical occlusion from platelet thrombosis in diseased arteries. Future
hemodynamic studies should address the complex mechanics of flow-induced,
large-scale wall motion and convection of semisolid particles and cells in flowing
blood.

Mechanical properties:

The main constituents of vascular tissue are elastin, collagen _bers and smooth
muscle cells.
Elastin is a biological material with an almost linear stress-strain relationship
(fig.). It has a Young 's modulus of approximately 0.5 MPa and remains elastic up
to stretch ratios of approximately 1.6 . As can be seen from the stress-strain curves
the material shows hardly any hysteresis.

24
 Fig.: Left: Stress-strain relationships of elastin from the
ligamentum nuchae of cattle. Right: Typical stress-strain
relationship of collagen from the rabbit lim
tendon.
Collagen is a basic structural protein in animals. It gives strength and
stability and appears in almost all parts of the body. The collagen molecule consists
of three helically wound chains of amino-acids. These helices are collected
together in micro-fibrils, which in their turn form subfibrils and fibrils. The fibrils have
a diameter of 20-40 nm, depending on species and tissue. Bundles of fibrils form
fibers, with diameters ranging from 0.2 to 12 μm. The fibers are normally arranged
in a wavy form, with typical "wavelengths" of 200 μm . Due to this waviness the
stress-strain relationship shows a very low stiffness at small stretch ratios (fig.). The
stiffness increases fast once the fibers are deformed to straight lines, the Young 's
modulus of the material then reaches approximately 0.5 GPa. At further stretching,
the material _nally fails at 50-100 MPa longitudinal stress.

Smooth muscle cells appear in the inner part of the tunica media and are
oriented longitudinally, circumferentially or helically. The Young's modulus is in the
order of magnitude of the one of elastin (approximately 0.5 MPa). When relaxed it
is about 0.1 MPa and when activated it can increase to 2 MPa. Especially in the
25
smaller arteries and arterioles they strongly determine the mechanical properties of
the arterial wall and are responsible for the ability to regulate local blood flow.

Elastic and Viscoelastic behavior

Due to the properties of its constituents, its specific morphology and its
geometry, the arterial wall exhibits a non-isotropic nonlinear response to cyclic
pressure loads. An important geometrical parameter is the ratio between diameter
and thickness of the arterial wall. This ratio depends on the type of artery but is
O(0.1) in many cases.
Moreover the vessels are thetered mainly longitudinal by the surrounding
tissue. Due to these complex properties it formally is not possible to define a
Young's modulus as can be done in linear elasticity theory. Still in order to obtain a
global idea of the elastic behavior it is possible to lump all properties together as if
the vessel wall was homogeneous. This can be done by measuring the stress
strain relationship and use the result to define an effective Young's modulus. In
figure a typical stress strain relationship of a large artery is shown. The stiffness in
longitudinal direction is higher then in circumferential direction especially at larger
stretch ratios yielding a different effective incremental Young's modulus. Still the
relation is non-linear due to the wavy form of the collagen fibres that consequently
contribute to the stiffness only at higher stretch ratios. It will be clear that linear
elasticity cannot be applied straight forward. Linearization, however, about an
equilibrium state (for instance the mean or diastolic pressure) yields a linearized or
incremantal effective Young's modulus that in many cases is approriate the use in
linear elasticity analysis.

26
Fig.: Typical stress-strain relationship (broken line = longitudinal, solid line

= circumferential) of aortic wall material

Vascular tissue normally is viscoelastic. When a cyclic load is applied to it in an

experiment, the load-displacement curve for loading differs from the unloading
curve: hysteresis due to viscoelasticity is found (see figure). Moreover, the curves
change after several repetitions of the same loading/unloading cycle. After a certain
number of repetitions, the loading-unloading curve doesn't change anymore, and
the loading/unloading curves almost coincide. The state of the specimen then is
called preconditioned.

4. With a neat diagram explain how viscosity is measured using Poiseuilles

law. (N/D 18)

Two parallel plates have the specific fluid between them. The bottom plate is
held fixed, while the top plate is moved to the right, dragging fluid with it. The layer
(or lamina) of fluid in contact with either plate does not move relative to the plate
and so the top layer moves at while the bottom layer remains at rest. Each

27
successive layer from the top down exerts a force on the one below it, trying to
drag it along, producing a continuous variation in speed from to 0 as shown. Care
is taken to insure that the flow is laminar; that is, the layers do not mix. The motion
in [link] is like a continuous shearing motion. Fluids have zero shear strength, but
the rate at which they are sheared is related to the same geometrical
factors and as is shear deformation for solids.

The graphic shows laminar flow of fluid between two plates of area . The
bottom plate is fixed. When the top plate is pushed to the right, it drags the fluid
along with it.

A force is required to keep the top plate in [link] moving at a constant

velocity , and experiments have shown that this force depends on four factors.
First, is directly proportional to (until the speed is so high that turbulence
occurs—then a much larger force is needed, and it has a more complicated
dependence on ). Second, is proportional to the area of the plate. This
relationship seems reasonable, since is directly proportional to the amount of
fluid being moved. Third, is inversely proportional to the distance between the
plates . This relationship is also reasonable; is like a lever arm, and the
greater the lever arm, the less force that is needed. Fourth, is directly
proportional to the coefficient of viscosity. The greater the viscosity, the greater
the force required. These dependencies are combined into the equation

which gives us a working definition of fluid viscosity . Solving for η gives

28
which defines viscosity in terms of how it is measured. The SI unit of viscosity

is .

Viscosity varies from one fluid to another by several orders of magnitude. As

you might expect, the viscosities of gases are much less than those of liquids, and
these viscosities are often temperature dependent. The viscosity of blood can be
reduced by aspirin consumption, allowing it to flow more easily around the body.
(When used over the long term in low doses, aspirin can help prevent heart attacks,
and reduce the risk of blood clotting.)

Laminar Flow Confined to Tubes—Poiseuille’s Law

Pressure difference causes the flow. In fact, there is a very simple relationship
between horizontal flow and pressure. Flow rate is in the direction from high to
low pressure. The greater the pressure differential between two points, the greater
the flow rate. This relationship can be stated as

where and are the pressures at two points, such as at either end of a
tube, and is the resistance to flow. The resistance includes everything, except
pressure, that affects flow rate. For example, is greater for a long tube than for a
short one. The greater the viscosity of a fluid, the greater the value of .
Turbulence greatly increases , whereas increasing the diameter of a tube
decreases .

If viscosity is zero, the fluid is frictionless and the resistance to flow is also zero.
Comparing frictionless flow in a tube to viscous flow, we see that for a viscous fluid,
speed is greatest at midstream because of drag at the boundaries. We can see the
effect of viscosity in a Bunsen burner flame, even though the viscosity of natural
gas is small.

29
 The resistance to laminar flow of an incompressible fluid having
viscosity through a horizontal tube of uniform radius and length, is given by

This equation is called Poiseuille‘s law for resistance , who derived it in an

attempt to understand the flow of blood, an often turbulent fluid.

(a) If fluid flow in a tube has negligible resistance, the speed is the same all
across the tube. (b) When a viscous fluid flows through a tube, its speed at the
walls is zero, increasing steadily to its maximum at the center of the tube. (c) The
shape of the Bunsen burner flame is due to the velocity profile across the tube.

Let us examine Poiseuille‘s expression for to see if it makes good intuitive

sense. We see that resistance is directly proportional to both fluid viscosity and
the length of a tube. After all, both of these directly affect the amount of friction
encountered—the greater either is, the greater the resistance and the smaller the
flow. The radius of a tube affects the resistance, which again makes sense,
because the greater the radius, the greater the flow (all other factors remaining the
same). But it is surprising that is raised to the fourth power in Poiseuille‘s law.
This exponent means that any change in the radius of a tube has a very large effect
on resistance. For example, doubling the radius of a tube decreases resistance by
a factor of 24=16.

30
 The given expression for flow rate:

This equation describes laminar flow through a tube. It is sometimes called

Poiseuille‘s law for laminar flow, or simply Poiseuille‘s law.

5. A patient has a cardiac output of 5 L/min. the systolic ejection period is

358 ms with a heart rate of 70 beats per minute. The mean aortic gradient
as measured by echocardiography is 81 mm Hg. Find the aortic valve area
as estimated by the Gorlin equation. What is the average flow rate across
the aortic valve during ejection? (N/D 18)

31
6. When the blood is said to be Newtonian? Explain with necessary
equations. (A/M 2017) (A/M 2018)
The Newtonian Viscous Fluid

A Newtonian viscous fluid is a fluid for which the shear stress is linearly
proportional to the strain rate. For a Newtonian fluid the stress-strain
relationship is specified by the equation

σij = -pδij + DijklVkl(1)

where σij is the stress tensor,

Vkl is the strain rate tensor,

Dijkl is a tensor of viscosity coefficients of the fluid, and

p is the static pressure.

 The term -pδij represents the state of stress possible in a fluid at rest
(when Vkl= 0).
 The static pressure p is assumed to depend on the density and
temperature of the fluid according to an equation of state. For a
Newtonian fluid we assume that the elements of the tensor Dijkl may
depend on the temperature but not on the stress or the rate of
deformation.
 If the fluid is isotropic, i.e., if the tensor Dijkl has the same array of
components in any system of rectangular cartesian coordinates, then Dijkl
can be expressed in terms of two independent constants λ and µ,

Dijkl = λδijδkl+ µ(δikδjl + δilδjk) (2)

And we obtain

σij = -pδij+ λVkkδij+ 2 µVij(3)

32
 A contraction of Eq. (3) gives

σkk =-3p + (3λ + 2 µ) Vkk(4)

If it is assumed that the mean normal stress 1/3σkk is independent of the rate of
Dilation Vkk then we must set
3 λ + 2 µ = 0; (5)

and the constitutive equation becomes

σij = -pδij+ 2 µVij -2/3 µVkkδij (6)

This is called stokes fluid for which one material constant µ,the coefficient of
viscosity, suffices to define its property.

If a fluid is incompressible, then Vkk= 0, and we have the constitutive equation

for an incompressible viscous fluid:

σij = -pδij+ 2 µVij (7)

If µ= 0, we obtain the constitutive equation of the nonviscous fluid:

σij = -pδij (8)

Newton's concept of viscosity may be explained in the simplest case of a shear

flow with a uniform velocity gradient. Newton proposed the relationship

τ = µdu/dy (9)

for the shear stress τ, where µis the coefficient of viscosity. In the centimeter gram-
second system of units, in which the unit of force is the dyne, the unit of µ is called
a poise, in honor of Poiseuille. In the SI system, the unit of viscosity is newton-
second per square meter (Ns/m2).

33
 Fig.: Newtonian concept of viscosity

The viscosities of air and water are small, being 1.8 x 10- 4 poise for air and
0.01 poise for water at atmospheric pressure and 20°e. At the same temperature
the viscosity of glycerin is about 8.7 poise. The viscosity of liquids decreases as
temperature increases. That of gases increases with increasing temperature.

7. Prove that the velocity profile of blood in the blood vessel is parabola. (A/M
2017) (A/M 2018)

Laminar Flow of Blood in a Tube

 Let us consider the flow of blood in a circular cylindrical tube. Assume the
flow to be laminar, that is, not turbulent.
 Also assume that the tube is long and the flow is steady, so that the
conditions of flow change neither with the distance along the tube, nor with
the time.
 The polar axis coincides with the axis of the cylinder. The flow obeys Navier-
Stokes equations of motion of an incompressible fluid.
 The boundary condition is that blood adheres to the tube wall (the so-called
no-slip condition).
 Since the boundary condition is axis symmetric, the flow is also axis
symmetric and the only non vanishing component of velocity is u(r) in the
axial direction; u(r) is a function of r alone, and not of x.

34
Fig.: Velocity profiles in a steady laminar flow into a circular cylindrical tube.

Fig.: Steady flow in a long circular cylindrical pipe. (a) A free-body

diagram
of a centrally located element on which pressure and shear stresses act. (b)
Relationship between the shear stress rand the radial distance r from the axis
of symmetry.

 Isolate a cylindrical body of fluid of radius r and unit length in the axial
direction. This body is subjected to a pressure P1on the left-hand end, P2on
the right-hand end, and shear stress τ on the circumferential surface.
SinceP1– P2= -1 . (dp/dx) acts on an area πr2 ,and τ acts on an area 1 . 2nr,
we have, for equilibrium, the balance of forces
35
Now we must introduce a constitutive equation that relates the shear
stress τ to the velocity gradient. Let us first consider a Newtonian fluid.
A Newtonian Fluid
By the definition of Newtonian viscosity, we have

The velocity profile of laminar flow of blood in a long circular cylindrical pipe.

A substitution of Eq. (2) into Eq. (1) yields

Since the left-hand side is a function of r, the right-hand side must be also. Hence
dp/dx cannot be a function of x. But since the fluid does not move in the radial
direction, the pressures in the radial direction must be balanced, and p cannot vary
with r. Hence the pressure gradient dp/dx must be a constant. Therefore, we can
integrate Eq. (3) to obtain

36
Where B is an integration constant. B can be determined by the boundary
condition of no-slip:
u=0 when r = a. (5)

Combining Eqs. (4) and (5) yields the solution

which shows that the velocity profile is a parabola.

7. Write a brief note on artificial heart valves or Discuss the mechanical

properties of heart valves (N/D 2015) (N/D 2017)

An artificial heart valve is a device implanted in the heart of a patient with

valvular heart disease. When one of the four heart valves malfunctions, the medical
choice may be to replace the natural valve with an artificial valve. This requires
open-heart surgery.

Valves are integral to the normal physiological functioning of the human

heart. Natural heart valves are evolved to forms that perform the functional
requirement of inducing unidirectional blood flow through the valve structure from
one chamber of the heart to another.

There are two basic types of valves that can be used for valve replacement,

 Mechanical heart valves and

 Tissue heart valves

Mechanical heart valves

 Mechanical valves are made completely from man-made materials.

 They have made up of very light weight and long lasting materials.
 The main advantage of mechanical valves is that they last a very long time
in most cases 20 years or more.
 Anticoagulant should be needed.
 Ex: Caged ball, Tilting disk, Single leaflet, Bileaflet.

37
Tissue heart Valves:

 Biological valves are made from human or animal tissue that has been
specially treated so that your body does not reject the valves.
 After being treated, the valves are attached to man-made materials to give
them support.
 They do not last as long as man-made valves, limited lifespan average 15
years.
 No need of anticoagulant.
 Ex: Homograft or allograft, Xenograft, Bovine, Porcine.
Their main weakness however, is their

Types of mechanical heart valve:

The major types of mechanical valves are ,

 Caged-ball
 Tilting-disk
 Single leaflet
 Bileaflet.

Caged-ball

 The first artificial heart valve was the caged-ball, which utilizes a metal cage
to house a silicone elastomer ball.
 When blood pressure in the chamber of the heart exceeds that of the
pressure on the outside of the chamber the ball is pushed against the cage
and allows blood to flow.
 At the completion of the heart's contraction, the ball moves back against the
base of the valve forming a seal.
 The first human implant consisted of a silicone ball enclosed in a cage
formed by wires originating from the valve housing.
 Caged ball valves have a high tendency to forming blood clots, so the
patient must have a high degree of anti-coagulation.

38
Advantage:

 Very simple design, only moving part is the ball.

 Poor hemodynamic, blood must flow around the ball making the heart work
harder
 Higher rate of thromboembolism.

Tilting Disc Valve:

 In the mid-1970s, a new valve was introduced: the tilting disc valve. The
purpose in creating the titling-disc valve was to restore the central blood flow
that was lost with the ball valve design.
 These valves consist of a single circular disc restrained by two metal struts
and a metal ring. The struts are attached to the metal ring. The struts
prevent the disc from escaping the device in either direction.
 The disc opens and closes based on the same principles used in the ball
valve design, except a disc is used instead of a ball.
 Tilting disc valves can open at an angle of 60° and at a rate of 70 beats per
minute. The angular opening of this valve reduces damage to blood cells.
 These are major improvements over the ball design but the struts of the
tilting disc valves tend to fatigue and fracture over long periods of time.

39
 Advantages:

 Improved hemodynamic.
 Lower rates of thromboembolism.

Single leaflet valve/ kayShiley mitral disc valve:

 Another type of valve is the single leaflet valve. These generally consist of
two parallel metal struts that hold a disc in place over the orifice.
 It is very similar to the ball valve; however it has a flat disc instead of a ball.

Bileaflet valves

 The first bileaflet valves were introduced in 1978. Some bileaflet valves are
shown in Figure.

40
  The bileaflet design consists of two semicircular leaflets which pivot on
hinges. Bileaflet valves have the best central flow – the leaflets open
completely, allowing very little resistance to blood flow.
 These valves correct the problem of central flow and blood cell damage;
however, they allow some backflow.
 This is a serious design flaw: many natural heart valves are replaced with
mechanical valves because the valve became stiff and allowed
backflow. Nevertheless, the majority of mechanical heart valves used today
are bileaflet valves because they allow the least resistance to flow and the
least blood damage.
Advantages:

 Most implanted valve today

 Most improved hemodynamic
 Still a risk for thrombosis
 Allow some backflow

Material used:

One of the major design considerations of any object to be implanted in the

body is the choice of materials. Those used must be able to withstand the harsh
and corrosive environment of the body, they must be inert, and they must be
biocompatible so they do not elicit a rejection response.

Particularly in heart valves, factors to consider are:

 How will the material impact hemodynamic, will it cause platelet aggregation
or thrombosis,
41
  How will the device damage blood cells, and
 How are the mechanical properties sufficient to withstand the repeated
cycles the valve will encounter in its lifetime.

Many different materials are used in the creation of artificial heart valves.

Metal alloys

 Metal alloys consisting of stainless steel or titanium are often used to give
mechanical strength and for their corrosion resistance properties. The struts
on some leaflet valves and the cage on caged-ball models are commonly
made of metal alloys due to their strength and durability requirements.

Pyrolytic carbon

 Pyrolytic carbon is another valuable material for its strength and its ability to
prevent clotting. It is biocompatible, thromboresistant, resistant to wear, and
has high strength and durability.
 It is able to stand up to the repeated opening and closing cycles it must
endure when used in a mechanical heart valve.
 It is commonly used for the inner orifice and the leaflets of bileaflet valves.
The ATS Bi-leaflet valve shown here has leaflets made of pyrolytic carbon.

Dacron

 A material often used for the suture ring (which is used to attach the valve to
the body) is Dacron.
 Dacron is a long chain polyester made from ethylene glycol and terephthalic
acid.
 It is a synthetic fiber that has many uses in industry, including thermal
insulation and sails for boats.

Teflon

 Another material that is commonly used for the suture ring is Teflon.
 Teflon is used in many medical applications because of its signature low
coefficient of friction.

42
  Teflon is relatively inert and highly biocompatible. As with Dacron it is often
used for vascular grafts.

8. Write short notes on current trends in heart valve design (N/D 2016) (N/D
2017)

Tissue-engineered heart valves

Currently, the following approaches are used for developing tissue-engineered
valves :
Decellularized xenogenic tissues for cell seeding or direct implantation
 It has been assumed that the antigenicity of xenogenic tissues, such as
bovine or porcine pericardium, porcine small intestinal submucosa, and
porcine or ovine heart valves is caused by cell debris.
 In addition, porcine aortic valves need to be cross-linked by glutaral dehyde
before implantation, which can cause cytotoxic and other adverse reactions.
 Glutaraldehyde-fixed pericardium was resistant to collagenase degradation
and cell infiltration, but significantly prone to increased calcification.
 Homografts (i.e. allografts), which do not require glutaraldehyde cross-
linking, can last 15-20 years and have better mechanical properties than a
cellularglutaraldehyde-fixed xenografts.
 The decellularization technique has a different impact on tissue preservation
and valve efficiency.
 Aggressive decellularization by enzymes (DNAase,RNAse), detergents, spit
freezing and radiation, used inSyner Graft technology, resulted in
catastrophic failure of decellularized xenogenic heart valves.
 On the other hand, deoxycholic acid completely decellularized heart valves,
while structural proteins were retained and appeared to be intact.
 Implantation of decellularized allograft and xenograft valves induces tissue
regeneration in vivo with efficient repopulation of the matrix by interstitial
cells, but graft end of the lialization is not sufficient.
 When MSC were seeded onto a decellularized porcine pulmonary valve pre-
coated with fetal bovine serum and fibronectin, they colonized the scaffold,
and endothelium lining, and the presence of fibroblasts and myofibroblasts.
 Another approach in engineering heart valves is the use of modified
decellularized bovine.
43
Constructs containing polymerized extracellular matrix and entrapped cells:
 Type I collagen is an important component of the vessel wall, and a major
matrix protein of the bone and other connective tissues.
 Collagen as a biomaterial has a number of useful properties.
 It is biodegradable, biocompatible, non-antigenic, haemostatic, easily
modifiable, acts synergetically with other bioactive components, is
biologically plastic due to its high tensile strength and minimal expressibility,
and is compatible with synthetic polymers.
 Pure collagen, due to its fast degradation, often needs cross linking or
needs to be used in a blend with other polymers.
 Heart valve-shaped collagen scaffolds, prepared from decellularized porcine
pericardium treated with penta-galloyl glucose.
 Collagen scaffolds composed of 1-5 % collagen prepared by rapid
prototyping allowed adhesion, vascular grafts, heart valves, skin substitutes,
or elastic cartilage.
 Elastin and also collagen may serve as nucleation sites for mineralization,
independent of cellular components of the prostheses.
 Calcification can be reduced by treatment with aluminium chloride,
ethanol/EDTA, the presence of glycosaminoglycans, or basic fibroblast
growth factor.
 Scaffolds prepared from insoluble collagen and solubilized elastin induced
angiogenesis, and increased elastic fiber synthesis without inducing
calcification
 Disadvantages of fibrin include its poor mechanical properties, relatively
quick degradation, and shrinkage due to structural changes and contraction
of the newly synthesized collagen bundles.
 Pure collagen had the highest linear modulus and pure fibrin the lowest,
while collagen-fibrin mixtures underwent the highest compaction.
 Dynamic conditioning of molded fibrin-based heart valve seeded with a
mixture of smooth muscle cells and fibroblasts from ovine carotid artery in a
bioreactor increased the cell attach
 In comparison with nature-derived materials, synthetic polymers are of more
defined and controllable properties, and can be more easily reproduced.
44
  The aortic heart valve has a specific shape and undergoes a specific load
during the cardiac cycle.
 Systole and diastole lead to different changes in shear stress and pressure
load that bend the valve and subject the valve to tensile and compressive
forces.
 Dynamic cultivation is also a part of a novel approach to valve tissue
engineering, known as ―in-body tissue architecture technology.

9. Distinguish between mechanical and biological valve?(N/D 2016)

Mechanical valve Biological valve

 Mechanical valves are made  Biological valves are made from

completely from man-made human or animal tissue that has
materials. been specially treated so that your
 They have made up of very body does not reject the valves.
light weight and long lasting  After being treated, the valves are
materials. attached to man-made materials to
 The main advantage of give them support.
mechanical valves is that they  They do not last as long as man-
last a very long time in most made valves, although they probably
cases 20 years or more. last longer in older people.
 Ex: Caged ball, Tilting disk,  Ex: Homograft or allograft,
Single leaflet, Bileaflet. Xenograft, Bovine, Porcine.

10. Discuss about the mechanics of aortic and pulmonary valve. (M/J 2016)
- The heart has four separate compartments or chambers. The upper chamber
on each side of the heart, which is called an atrium, receives and collects the
blood coming to the heart.
- The atrium then delivers blood to the powerful lower chamber, called a
ventricle, which pumps blood away from the heart through powerful, rhythmic
contractions.

45
- The right side receives oxygen-poor blood from the various regions of the
body and delivers it to the lungs. In the lungs, oxygen is absorbed in the
blood.
- The left side of the heart receives the oxygen-rich blood from the lungs and
delivers it to the rest of the body.
- The aortic and pulmonic valves are known as the semilunar valves,
whereas the tricuspid and mitral valves are referred to as the atrioventricular
valves.
- All 4 cardiac valves are surrounded by fibrous tissue forming partial or
complete valvular rings, or annuli. These annuli join the fibrous skeleton of
the heart to anchor and support the valvular structures.

- The aortic valve is located between the aorta and the heart's left ventricle.
The pulmonary vein delivers oxygenated blood to the heart's left atrium. Then
it passes through the mitral valve and into the left ventricle. With each of the
heart muscle‘s contractions, oxygenated blood exits the left ventricle through
the aortic valve.
- The main function of aortic valve is that it prevents back flow of blood from
aorta to left ventricle. Aortic regurgitation (back flow) occurs if oxygenated
blood flows in the wrong direction.
46
 - The pulmonic valve is located in the right ventricle of the heart. It allows
blood to leave the heart via the arteries.
- The pulmonic valve opens into the pulmonary artery. It is a one-way valve,
meaning that blood cannot flow back into the heart through it.
- The valve is opened by the increased blood pressure of the ventricular
systole (contraction of the muscular tissue), pushing blood out of the heart
and into the artery. It closes when the pressure drops inside the heart.

9. The aorta of a male patient had an inner radius of 13 mm and was 2.2 mm
thick in the diastolic state. It was 50 cm long and expanded due to the
pumping of the heart. When the heart valve opened in the systolic phase,
70 mL of blood was discharged. Half of this blood was initially stored in the
aorta, expanding its wall to some inner radius. Assume the diastolic
pressure and systolic pressure to be 80 mmHg and 130 mmHg,
respectively, and the heart rate to be 72 beats per minute. Calculate the
systolic radius and the wall thickness. What is the stress in the wall in the
systolic state? How much energy is stored in the elastic wall? What is the
average Reynolds number in the aorta? Is the flow laminar or turbulent?
(M/J 2016)
Solution:
i. Volume of the lumen in diastole = 𝜋* (13 *10−3 ) ^2 = 0.5
= 0.26510−3 𝑚3 .
Increase in volume due to storage of blood = 70/2 = 35 mL
= 0.035 𝑚3
Volume of the lumen in systole= (0.265 +0.035)* 10−3
= 0.3 * 10−3 m3
= 𝜋 *(𝑟5 )^2* 0.5
ii. Systolic radius = 13.8 mm
Cross-sectional area in diastole = 𝜋 *[((13 + 2.2) *10−3 )^2— (13 *10−3 )^2]

= 194.9* 10−3 𝑚2

Cross-sectional area in systole = 194.9*10−3 𝑚2

= 𝜋 * [((13.8 +𝑡𝑠 )* 10−3 )^2— (13.8 *10−3 ) ^2]𝑡𝑠
= 2 mm

47
 Hoop stress, 𝜍𝑠 = 𝑃𝑠 𝑅𝑠 /𝑡𝑠 = 130 mmHg * (133 Pa/mmHg) * 0.0138m/0.002
= 0.113 MPa
iii. Energy stored in the elastic wall = Pmean ∆V
Pmean = (PSystolic + 2PDiastolic )/3 = (130 + 2 * 80)/3 = 96.67 mmHg
= 96.96 *133 Pa = 12.9
∆V= 35 mL = 35 *10−6 𝑚3 ,
Pmean ∆V= 12.9 *103 * 35*10−6 = 0.45J
iv. Volumetric flow rate = 70*10−6 (m3 /beat)/(60 sec/72 beats)
= 84.1*10−6 (m3 /s)
Velocity = volumetric flow rate/average cross-sectional area
= 84.1 *10−6 /( 𝜋 * ((13 + 13.8)/2 *10−3 )^2)
= 0.149 m/s
Density of blood (assume), p = 1.1 gm/cc
= 1,100 kg/m3
Viscosity (assume), 𝜇 = 3 cP = 3*10−3 kg/m.s,
𝑁𝑅𝑒 = 𝜌∆V/ 𝜇 = 1,100 * (2* 0.0134) * 0.149/3*10−3
= 1,465. Hence, the flow is laminar.

10. Write notes on testing of artificial heart valves.

The testing of the artificial heart valves can be done by the following
methods:

 In vitro testing of artificial heart valves

 Durability test
 Durability test system CVE FT-2
 Durability test system CVE-FT3

 Testing of polymer-based heart-valve prosthesis

1) In vitro testing of artificial heart valves
 In vitro testing of artificial heart valves is often performed with simple fluids
like glycerol solutions. Blood, however, is a non-Newtonian fluid with a
complex viscoelastic behavior, and different flow fields in comparable
geometries may result. Therefore, we used different polymer solutions
(Polyacrylamid, Xanthan gum) with blood-like rheological properties as well

48
 as various Newtonian fluids (water, glycerol solutions) in our heart valve test
device.
 Hydrodynamic parameters of Björk-Shiley heart valves with a tissue annulus
diameter (TAD) of 21-29 mm can be investigated under aortic flow
conditions. Systolic pressure difference, closing time and closing volume
depend on TAD and the pressure differences across the valve. In contrast,
rheological behavior has a pronounced influence upon leakage flow and
leakage volume, respectively. Results show furthermore that the apparent
viscosity data as a function of shear rate are not sufficient to characterize the
rheological fluid behavior relevant to hydrodynamic parameters of the heart
valves investigated.

2) Durability test

The assessment of the durability of heart valve prostheses according to the valid
standards ISO 5840 and FDA is one focus in heart valve testing at the department
of Cardiovascular Engineering (CVE).

 Durability test system CVE FT-2

In the totally revised and improved durability test system CVE FT-2 12 heart
valve prostheses can be assessed simultaneously. The prostheses are mounted
into separate test compartments, which are arranged circular on a mounting plate.

Separate test compartments permit an individual adjustment of each test

prostheses. A motor driven swash plate generates a sinusoidal flow through the
test valve by compression and extension of a metallic bellow mounted on the
bottom side of the mounting plate. The valve is closed and fluid from the upper
chamber flows to the lower chamber via an adjustable bypass. Pressures are
measured directly upstream and downstream the test prostheses. The differential
pressure across the closed prosthesis is calculated and can be controlled by
adjustment of the bypass throttle. Stroke volume and test frequency are constant
for all test compartments. The test prostheses can be observed by means of a
triggered stroboscope. By means of a high speed video system a more detailed
documentation of the prostheses‘ motion can be performed.

49
  Durability test system CVE-FT3

CVE-FT3 is a third durability test system. The main drive mechanism is equal to
CVE-FT2. Also in CVE-FT3 12 heart valve prostheses can be tested
simultaneously in separate compartments. The difference between the two test
systems is, that in the CVE-FT3 the movement of the swash plate is transferred
directly to the heart valve prostheses.

The prostheses are moved through the fluid inside the test compartments,
whereby an sinusoidal opening and closing is generated. The pressure
measurement, the adjustment of the differential pressure across the closed valve
and the documentation of the valve behavior is equal to the CVE-FT2.

3) Testing of polymer-based heart-valve prosthesis

Heart valve prostheses have been used successfully in heart procedures
since 1960 resulting in an overall improvement in the quality of life of the patients.

50
Currently, there are two kinds of valves used: mechanical and bioprosthetic.
Generally, mechanical valves are more durable than bioprosthetic valves. However,
they sometimes involve side effects with irregular blood flow and clotting of blood
around them. Bioprosthetic valves have better hemodynamic (blood flow)
properties, but are more susceptible to wear as a result of material fatigue. Polymer
trileaflet (PT) valves offer natural hemodynamic with the potential for better
durability.

In order to identify the better material from which to manufacture valves, a

certain proprietary polymer is compared to an existing implant-approved polymer
(IAP). Static and dynamic properties of the polymers are being determined in order
to establish the right polymer composite for the heart valve prosthesis.

Tensile and tension fatigue properties for each material are performed
according to ASTM (American Society for Testing and Materials) standards. The
tensile test is displacement controlled, and the specimen is stretched at a constant
rate until failure. The tension fatigue test is load controlled; that is, the specimen is
being cycled between two tensile loads. The loading frequency is 100 Hz.
Cycling continues until failure for each specimen. Since there can be significant
fatigue damage without actual fracture, failure is defined as 50% loss in residual
strength of the material.

11. Describe structure and functions of blood vessels.

The major roles of the blood include:

 . Carries oxygen and nutrients to active tissues.
 Delivers carbon dioxide to the lungs
 Brings metabolic end products to kidneys
 Blood is a buffering reservoir that controls pH of bio-fluids
 Plays a major role in the body's immune system

The main types of blood vessels are:

 Arteries
 Arterioles
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  Capillaries
 Venules
 Veins

The following diagram summarises the sequence of blood flow through the heart,
arteries, arterioles, capillaries, venules, veins, then back to the heart:

The following diagram summarizes the structural differences between different

types of blood vessels.

52
Structure and Functions of Blood Vessels

Structure Functions

The walls (outer structure) of  Transport blood away from

Arteries
arteries contain smooth muscle the heart
fibre that contract and relax under  Transport oxygenated
the instructions of the sympathetic blood only (except in the
nervous system. case of the pulmonary
artery).

Arterioles are tiny branches of  Transport blood from

Arterioles
arteries that lead to capillaries. arteries to capillaries
These are also under the control  Arterioles are the main
of the sympathetic nervous regulators of blood flow
system, and constrict and dilate, and pressure.
to regulate blood flow.

Capillaries are tiny (extremely  Function is to supply

Capillaries
narrow) blood vessels, of the tissues of the body with
approximately 5-20 micrometers the components of blood,
(one micrometer = and (carried by the blood),
0.000001metre) diameter. and also to remove waste
There are networks of capillaries from the surrounding cells
in most of the organs and tissues ... as opposed to simply
of the body. These capillaries are moving the blood around
supplied with blood by arterioles the body (in the case of
and drained by venules. Capillary other blood vessels)
walls are only one cell thick (see  Exchange of oxygen,
diagram), which permits carbon dioxide, water,
exchanges of material between salts, etc., between the
the contents of the capillary and

53
 the surrounding tissue. blood and the surrounding
body tissues.

Venules are minute vessels that  Drains blood

Venules
drain blood from capillaries and from capillaries into veins,
into veins. Many venules unite to for return to the heart.
form a vein.

The walls (outer structure) of  Transport blood towards

Veins
veins consist of three layers of the heart.
tissues that are thinner and less  Transport deoxygenated
elastic than the corresponding blood only (except in the
layers of arteries. case of the pulmonary
Veins include valves that aid the vein).
return of blood to the heart by
preventing blood from flowing in
the reverse direction.

Comparison between Arteries and Veins

Arteries Veins

 Transport blood Transport blood towards the

away from the heart heart

 Carry Oxygenated Blood Carry De-oxygenated Blood

(except in the case of the (except in the case of the

54
 Pulmonary Artery) Pulmonary Vein)

 Have Have relatively wide lumens

relatively narrow lumens (see diagram above)
(see diagram above) Have
 Have relatively less muscle/elastic
relatively more muscle/elast tissue
ic tissue Transports blood
 Transports blood under lower pressure (than
under higher pressure (than arteries)
veins) Have valves throughout the
 Do not have valves (except main veins of the body. These
for the semi-lunar valves of are to prevent blood flowing in
the pulmonary artery and the wrong direction, as this
the aorta). could (in theory) return waste
materials to the tissues.

12. Explain material properties & modeling of blood vessel system

PROPERTIES OF BLOOD VESSEL:
 Homogenous and isotropic assumptions.
- do not vary within the material.
- Independent of direction in which stress is applied.
 Blood vessel walls
- 70% of walls consist of water (incompressible & inelastic).
- Rest of material: elastic fibers
- Three types of fibers:
 Collagen
 Elastin
 Smooth muscle.

55
 Non-linear behavior.
- Measure effective Young‘s modulus (𝐸𝑒𝑓𝑓 ) by measuring local slope.

56
Endothelium: Single cell layer separating wall and blood
Elastic tissue: Elastin
Fibrous tissue: Collagen
 Viscoelastic behavior
- Purely elastic material:
 No phase lag between strain and stress
 Viscoelastic material
- Strain lags stress.
- Possible to represent major features of viscoelastic behavior via a
Dynamic Young‘s modulus (Edyn) and effective viscosity (h).

MODELING OF BLOOD VESSEL SYSTEM

The essentiality of experimental and speculative investigate on is on blood
vessels of the cardiovascular system. The modeling evaluate numerically the blood
vessels of the cardiovascular system using Inlet section, Reinhold‘s number, rate of
flow and area of cross-section. Here the modeling of blood vessel by using fractals.
Fractals

A fractal is an object or quantity that displays self-similarity, in a somewhat

technical sense, on all scales. The object need not exhibit exactly the same
structure at all scales, but the same "type" of structures must appear on all scales.

Modeling of the blood vessels system through Fractals

In real blood vessels system, vessel walls are elastic and change its
diameters. In this way resistance of blood vessel system is regulated. This process
is known as auto regulation and corrects nutrition of all cells in human body. Blood
flow estimation assumes laminar flow for the entire fractal vascular tree.

The blood vessel of the human cardiovascular system is modeled through

the fractal vascular tree like structure is shown below. The basic idea of fractal is
that breaking down an object into smaller parts and each of which resembles the
whole has been invoked for the blood vessels.

57
 Fig.: Structure of the Fractal vascular tree

Methods

Blood flow in the cardiovascular system has been precisely calculated by the
following methods. These results are very useful to investigate the defects in the
above system. The following methods are the most important parameters in
transport vessel tree.

Rate of flow (Q)

It is defined as the quantity of the fluid flowing per second through a section
of a pipe or a channel. For an incompressible fluid the rate of flow is expressed as
the volume of fluid flowing across the section per second. Mathematically the rate
of flow is defined as

Q = A xV …..(1)

Where Q is the Rate of blood flow (mi/sec), A is the cross-sectional area (cm2),
V is the velocity of the blood.

Reynold’s number

Using the Reynold's equation we can see that a large diameter, with rapid
flow, where the density of the blood is high tends towards turbulence. Rapid
changes in vessel diameter may lead to turbulent flow, for instance when a
narrower vessel widens to a larger one. When normal laminar blood flow becomes
turbulent flow

 The rate of blood flow (i.e.,) the velocity of flow, is high

 It passes by an obstruction in a vessel (as in case of compression by cuff of
Sphygmomanometer).
58
  It makes a sharp turn.
 It passes over a rough surface
Turbulence is also related to the diameter of the vessel and the viscosity
of the blood which can be expressed by ratio of inertia to viscous forces.

𝜌VL
Re = …..(2)
𝜇

Where Reis the Reynold‘s number, L is the length

of the blood vessel, Vis the Average velocity of the blood. This is the most
important dimensionless number; it describes the fluid flow regime. If Reis higher,
there is a greater probability of the turbulence.

Inlet Section

The blood flow in the blood vessel is mainly concerned with Inlet section. The
length of the section is proportional to vessel diameter, Reinhold‘s number and
coefficient le=AdRe…..(3)

Where leis the inlet section, X = 0.056 a value from Navier-Stokes equation, d
diameter of the blood vessel and Re Reynold‘s number.

Note: The Kind of flow depends on value of Re.

1. If Re < 2000 the flow is Laminar

2. If Re > 4000 the flow is turbulent
3. If 2000 < Re < 4000 it is called transition flow.

A synthetic view of human cardiovascular system has been exhibited with a

remarkable variety of components is given in the following table for the normal
Human being.

59
 Data Report of Normal Human Being

Data Report of Ischemic heart disease

13. Explain the development of artificial heart valves.

Introduction

The heart is a vital muscular organ which pumps blood around the body. Valves
are tissue flap components of the heart which react to inertial forces exerted by
surrounding blood by opening and closing. When functioning correctly, valves
ensure unidirectional blood flow during the cardiac cycle, with maximized flow rate
and minimized flow resistance. The four valves of the human heart are the aortic,
mitral, pulmonary and tricuspid valves.
60
 Heart valves can become defective through congenital disease, where
abnormalities in the valve develop before birth, or acquired disease, where problems
develop within valves that once functioned normally. Incorrect function of heart
valves affects hemodynamic (blood flow) performance, primarily via valvular stenosis
in forward flow and valvular incompetence (regurgitation) in reverse flow. Valvular
stenosis is the narrowing of the valve which increases resistance to blood flow,
while valvular incompetence refers to the failure of valve leaflets to close fully
generating reverse blood flow. Both conditions result in decreased efficiency of the
heart, and it is often necessary to repair or replace the native valve to reestablish
correct valve function. Artificial valves have been developed to replace defective
native valves, and fall into two main categories: mechanical and bio prosthetic.

Since the introduction of artificial heart valve replacements there have been
significant improvements in their function and design. Artificial valves, however,
remain inferior in both aspects to native valves, warranting further development.
Computational models can be used to predict and validate function of valve designs
and highlight possible problems, aiding the development of the prostheses.

Mechanical Heart Valves

Mechanical heart valves are based on the occluder principle. Each valve has an
occluder which determines whether the valve is open or closed. The position of the
occluder depends on the blood pressure on either side of it and helps to maintain
unidirectional flow. The three main subtypes of mechanical heart valves are the ball-
and-cage, tilting disc and bileaflet.

Challenges of Mechanical Heart Valves

The main advantage of mechanical over other types of artificial valves is their
durability. Due to the properties of materials used in their manufacture, mechanical
valves can often last the lifetime of the patient. They are therefore favored over
other types of valves in pediatric and adolescent patients, although the inability of
the valve to develop and repair is a major drawback for these patient groups. Issues
which arise with implantation of mechanical valves involve both engineering and
biological problems. Since the system that the artificial valve is implanted into is
composed of living cells, the interaction between the biology of the system and the

61
mechanics of the valve is an important issue. The implanting of a prostheses into the
heart can initiate cascades of biological events, such as formation of blood clots, or
result in a change of function or failure of the heart or valve.

Cavitation is the rapid formation of vaporous bubbles in a fluid, caused by a

reduction in local pressure below the fluid vapour pressure. When the pressure
recovers the formed bubbles collapse producing thermal and pressure shock waves
which damage solid material near the cavitation site. This damage has been
identified as erosion and pitting (the formation of cavities in the material) on the
housings and leaflets of implanted mechanical valves.

Thrombosis and Embolisms Thrombosis is another adverse effect of mechanical

valves, and refers to the formation of a stationary thrombus, or blood clot, along the
wall of a blood vessel. The detachment of such a clot from the vessel wall, referred to
as an embolism, can lead to an obstruction of a blood vessel elsewhere in the
circulatory system, which can lead to conditions such as myocardial infarction or
ischemicstroke.

Hemorrhage due to thromboembolic risks associated with mechanical valves,

patients areprescribed oral anticoagulation (OAC) therapy. While this minimizes
thrombus formation, the therapy increases the risk of hemorrhage. Although
improvements in mechanical valve design have resulted in a decrease in the amount
of anticoagulant required, OAC therapy is still an integral part of mechanical heart
valve implantation.

An important test of valve design is hemodynamic performance, affected by the

geometry of the valve, such as hinge design, leaflet shape and opening angle, and the
manufacturing material. Materials considered must satisfy several requirements
including biocompatibility, and biological and chemical stability. Biocompatibility
ensures that the biological system in question can endure implantation of the
prosthesis without destruction of tissue. Biological and chemical stability ensure
that the material is resistant to degradation due to biological interactions with the
body and environmental agents encountered during implantation, respectively. If
the material used does not satisfy these requirements, inflammatory diseases, such
as endocarditic, can develop and potentially lead to valve or heart failure. Mechanical

62
properties of the material must also be considered, to ensure durability and correct
function of the valve.

Initial valve designs used metals such as stainless steel. However, due to the
polycrystalline nature of metals, issues such as material fatigue led to the failure of
some replacement valves. Material fatigue is structural damage caused by cyclic
loading of the material, which accumulates and may lead to the formation of cracks
and failure.

The fatigue of metals was partially addressed by using alloys and strong metals
such as titanium, however the introduction of pyrolytic carbon as a material for
artificial valves largely overcame this problem.

Pyrolytic carbon is a biocompatible material with thromboresistant properties,

which makes it suitable for use in mechanical valve production. The material also
presents good durability, wear resistance and strength, all of which are important to
minimize possible mechanical failure of the valve. Pyrolytic carbon was initially
used only for the manufacture of occluder discs, with the struts and housing made
of metal alloys, with the first bileafletvalves comprising an all-pyrolytic carbon
design.

Bioprosthetic and Tissue Engineered Heart Valves

While the development of mechanical valves is an important issue for certain

patient, other types of valves have also been developed. Bioprosthetic valves are a
major group of artificial valves, while tissue engineered heart valve are at the
forefront of current research.

 Bioprosthetic Heart Valves

Bioprosthetic heart valves use tissue from animal or human sources to replace
defective native valves. Natural heart valves work on the principle of maximal central
flow, with blood flowing through the centre of the valve in order to maximize flow rate
and minimize flow resistance. Bioprosthetic artificial valves attempt to mimic this
design and are generally made up of three tissue leaflets, homologous to native
valves. The sourced leaflets are fixed in gluteraldehyde solution, which also decreases

63
biodegradation, and attached to an annular housing which functions much like the
native aortic annulus.

Bioprosthetic valve replacements are grouped into xenografts and

allografts. Xenograftsare replacements using tissue valves sourced from animals,
usually porcine aortic valve leaflets or either bovine or equine pericardium. Porcine
aortic valves are chosen due to anatomical similarities with native valves, while
bovine tissue presents better durability .The use of already formed porcine valves
simplifies the replacement valve production process, since the need to produce
individual cusps is avoided.

Allografts are replacements using valves sourced from human cadavers. In

this case, the valve is geometrically similar to the native valve, but the leaflets stiffen
and annulus shrinks slightly due to cryopreservation. Allograft valves often fail due to
structural damage which occurs as a result of the functioning of the valve. There are
also issues with availability of cadaveric valves, especially of the correct size and
geometry.

In order to implant bioprosthetic valves, support is required for the leaflets,

achieved by both stented and non-stented methods. Stented valves are generally
xenografts, and both porcine and pericardial tissue is used. A metal or polymer stent
is used to support the leaflets at the commissures (joins). Stented valves have been
reported to be relatively stenotic compared to native valves, due to construction of
the leaflets, the stent restricting full opening of the leaflets and the stiffness of the
fixed tissue. Non-stented valve implants, the necessary support is provided by
attaching the valve to the aorta.

Developments are also being made on valves which can be implanted via
percutaneous methods, whereby a collapsed valved stent is delivered to the
implantation site by catheter and balloon-expanded to open out the valve. The
development of these valves depends largely on the availability of suitable
biomaterials for use in collapsable stents. Collapsable valves that can be
compressed into a catheter, yet still be able to unfold into the precise geometry
required for them to function correctly, are also necessary.

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 Tissue Engineered Heart Valves

A limitation of mechanical and bioprosthetic valves is the lack of living tissue,

deeming the valves incapable of repair, growth or remodeling. Heart valve tissue
engineering (HVTE) is an area of regenerative medicine concerned with the use of
autologous cells and bioengineered materials to develop replacement valves which
have the structure and function of native valves.

Native valves have a ―layered architectural‖ structure constituting of the

extracellular matrix (ECM) and specialized cells.

The ECM is the ‗frame‘ on which cells form tissue, and gives the tissue the
necessary structural and mechanical properties. The cells involved include valvular
endothelial cells (VECs) and valvular interstitial cells (VICs). VECs line the valve
surface to provide the necessary thromboresistance and regulate immune and
inflammatory reactions, while VICs act to remodel the ECM and repair functional
damage, thus determining valve durability.

Tissue engineering attempts to form functional tissue capable of remodeling and

growth based on this structure. One approach is to use scaffolds seeded with cells in a
bioreactor to allow tissue formation. Bio absorbable scaffolds are used as temporary
matrices for cells to attach to in order to proliferate and organize, developing the ECM.
As ECM development occurs, the scaffold is fully degraded. Scaffolds are therefore
required to have characteristics resembling the native ECM. The structures are
grown in vitro in bioreactors, which provide mechanical and metabolic support in an
environment resembling in vivo conditions. The tissue is then implanted to allow in
vivo growth and remodeling.

14. Explain laminar flow, Coquette flow and turbulent flow

Laminar flow is the normal condition for blood flow throughout most of the
circulatory system. It is characterized by concentric layers of blood moving in
parallel down the length of a blood vessel. The highest velocity (Vmax) is found in
the center of the vessel. The lowest velocity (V=0) is found along the vessel wall.
The flow profile is parabolic once laminar flow is fully developed. This occurs in
long, straight blood vessels, under steady flow conditions.
65
 One practical implication of parabolic, laminar flow is that when flow velocity
is measured using a Doppler flowmeter, the velocity value represents the average
velocity of a cross-section of the vessel, not the maximal velocity found in the
center of the flow stream.

The orderly movement of adjacent layers of blood flow through a vessel

helps to reduce energy losses in the flowing blood by minimizing viscous
interactions between the adjacent layers of blood and the wall of the blood vessel.
Disruption of laminar flow leads to turbulence and increased energy losses.

Generally in the body, blood flow is laminar. However, under conditions of

high flow, particularly in the ascending aorta, laminar flow can be disrupted and
become turbulent. When this occurs, blood does not flow linearly and smoothly in
adjacent layers, but instead the flow can be described as being chaotic. Turbulent
flow also occurs in large arteries at branch points, in diseased and narrowed
(stenotic) arteries (see figure below), and across stenotic heart valves.

Turbulence does not begin to occur until the velocity of flow becomes high
enough that the flow lamina break apart. Therefore, as blood flow velocity

66
increases in a blood vessel or across a heart valve, there is not a
gradualincrease in turbulence. Instead, turbulence occurs when a criticalReynolds
number (Re) is exceeded. Reynolds number is a way to predict under ideal
conditions when turbulence will occur. The equation for Reynolds number is:

Where v = mean velocity, D = vessel diameter, ρ = blood density, andη = blood

viscosity.As can be seen in this equation, Re increases as velocity increases, and
decreases as viscosity increases. Therefore, high velocities and low blood viscosity
(as occurs with anemia due to reduced hematocrit) are more likely to cause
turbulence. An increase in diameter without a change in velocity also increases Re
and the likelihood of turbulence; however, the velocity in vessels ordinarily
decreases disproportionately as diameter increases. The reason for this is that flow
(F) equals the product of mean velocity (V) times cross-sectional area (A), and area
is proportionate to radius squared; therefore, the velocity at constant flow is
inversely related to radius (or diameter) squared. For example, if radius (or
diameter) is doubled, the velocity decreases to one-fourth its normal value, and Re
decreases by one-half. Under ideal conditions (e.g., long, straight, smooth blood
vessels), the critical Re is relatively high. However, in branching vessels, or in
vessels with atherosclerotic plaques protruding into the lumen, the critical Re is
much lower so that there can be turbulence even at normal physiological flow
velocities.

Turbulence generates sound waves (e.g., ejection murmurs, carotid bruits) that
can be heard with a stethoscope. Because higher velocities enhance turbulence,
murmurs intensify as flow increases. Elevated cardiac outputs, even across
anatomically normal aortic valves, can cause physiological murmurs because of
turbulence. This sometimes occurs in pregnant women who have elevated cardiac
output and who may also have anemia, which decreases blood viscosity. Both
factors increase the Reynolds number, which increases the likelihood of turbulence.

Coquette flow is the laminar flow of a viscous fluid in the space between two
parallel plates, one of which is moving relative to the other. The flow is driven by

67
virtue of viscous drag force acting on the fluid and the applied pressure gradient
parallel to the plates.

Coquette flow is frequently used in undergraduate physics and engineering

courses to illustrate shear-driven fluid motion. The simplest conceptual
configuration finds two infinite, parallel plates separated by a distance h. One plate,
say the top one, translates with a constant velocity u0 in its own plane. Neglecting
pressure gradients, the Navier–Stokes equations simplify to

where y is a spatial coordinate normal to the plates and u(y) is the velocity
distribution. This equation reflects the assumption that the flow is uni-directional.

That is, only one of the three velocity components is non-trivial.

If y originates at the lower plate, the boundary conditions are u(0) = 0 and u(h) = u0.
The exact solution

can be found by integrating twice and solving for the constants using the
boundary conditions.

68
15. Explain in detail about intrinsic fluid properties.

69
70
71
72
73
74
75
16. Describe in detail about viscometers: capillary, coaxial cylinder , cone and
plate.

76
77
78
79
80
Fig.: schematic of coaxial (couette) cylinder viscometer

81
82
83
Fig.: schematic of cone and plate viscometer

84
85
86
17. Explain in detail about fluid mechanics in straight tube.

87
18. Describe in detail about flow stability and related characteristics. Or
explain in detail about steady laminar flow and turbulent flow.

88
89
90
91
92
Fig.: plots of laminar (poiseulle) and turbulent velocity profiles for n=6, 8, and
10
93
94
19. Describe about flow development.

95
96
20. Explain about cardiac muscle characterizatrion.

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98