In 1997 I learned that vortex rings had been observed in the human heart,  and what that might mean for improving diagnoses. Since then, I’ve been fascinated with trying to get a better view of cardiac fluid dynamics, and a better understanding of the possible implications for, well, helping sick people. Who could resist?

 

Précis

By analyzing the fluid mechanics of the heart and great vessels, we can better understand normal and pathologic function, leading to improved diagnostics and treatment. I have been working in experimental fluid mechanics since my PhD. My focus is on shear flows and the resulting vortex dynamics. Initially I studied applications in combustion; ramjets, rockets, and gas turbine engines, using flow visualization techniques that included laser-based diagnostics such as particle image velocimetry (PIV) and laser Doppler anemometry. In 1997 I learned (thank you Robin Shandas) that the physics of three-dimensional unsteady shear and vortex dynamics are also important in the cardiac ventricles and great vessels. The formation mechanism sounded a lot like the unsteady combustion fluid dynamics I’d been studying up to that point. Since then a large fraction of my research has been in this area, primarily in developing diagnostics and analysis techniques such as Echo PIV and 4DMRI.

Currently I’m working with a group at National Jewish Health. NJ is known for its focus on the pulmonary (lungs) issues. They get a lot of patients with pulmonary hypertension (PHT), high blood pressure in the arteries leading from the right side of the heart to the lungs. PHT is important because the right ventricle can’t pump into high pressure forever; eventually it will fail.  So, it’s important to measure the pressure in the pulmonary artery system, but those arteries are a bit hard to get at; you can’t put a blood pressure cuff around them. To diagnose PHT you either have snake a pressure sensing catheter into the pulmonary artery (from the neck or groin) or infer the pressure from other hopefully noninvasive types of measurements. There are a variety of measurements based on echocardiography, but the catheter is still the gold standard.

That’s where the vortex ring in the right ventricle comes in. Vortex rings rotate around toroidal (donut-shaped) cores of fluid with vorticity. Vorticity is a derivative quantity, so it will be sensitive to changes in the fluid dynamics. Our hypothesis is that the progression of a disease like PHT will show up as a change in the vorticity of the fluid in the heart early in the disease. We can determine the vorticity using 4DMRI, aka 4DCMR, which shows us the 3 dimensional, 3 component velocity field of blood flow in the heart, reasonably resolved in time. From that we can compute the vorticity field. This measurement is non-invasive, and it’s non-ionizing, unlike an x-ray. The downside is that these scans take 45 minutes or more, and they are expensive, around $1000. Plus the resolution in time, space and velocity are marginal for this type of analysis, so we have to be careful how we interpret the data.

People

James (Jamey) Browning. He has made all this possible by making our workflow happen, from preprocessing to Q criterion.  This is his PhD thesis work.

Dr Brett Fenster: our primary clinical collaborator. Cardiologist at National Jewish Health. He’s the real driver of this project.

Dr Joyce Schroeder: She got me into this right heart stuff. She was a radiologist at National Jewish, and recently moved to new telemedicine position in Boulder.

There is a whole host of other folks working with us on this data as well. In Summer 2014, CU-ME undergrads Scott Schloss and Elizabeth Whitman did projects with us, along with Alex Honeyman and others. Out at the Anschutz campus, there’s Vitaly Kheyfets,  Michal Shafer, Kendall Hunter and Robin Shandas. As is typical on a project of this size, there are all sorts of other contributors I’m not listing here. If you are missing from this list and don’t want to be, or have an edit, just let me know (and vice versa).

Publications and presentations

Alexander Honeyman, James Browning. “Vorticity for the assessment of pulmonary vascular hemodynamics in pulmonary arterial hypertension.” Journal of Cardiovascular Magnetic Resonance 16, no. Suppl 1 (2014):  doi:10.1186/1532-429X-16-S1-P15.
Vitaly O Kheyfets, Jamey Smyser, Alex Honeyman, James Browning, Jean R Hertzberg, Joyce Schroeder, Brett Fenster, and Robin Shandas. “Irregular Blood Flow Patterns in the Development of Pulmonary Hypertension # 12086.” Poster presented at the American Heart Association Scientific Sessions, Chicago IL., November 15, 2014. http://www.abstractsonline.com/pp8/#!/3547/presentation/41778.  Poster link: AHA 2014
Tan, Yan, Pi-Ou Tseng, Daren Wang, Hui Zhang, Kendall Hunter, Jean Hertzberg, Kurt R. Stenmark, and Wei Tan. “Stiffening-Induced High Pulsatility Flow Activates Endothelial Inflammation via a TLR2/NF-κB Pathway.” PLoS ONE 9, no. 7 (July 16, 2014): e102195. doi:10.1371/journal.pone.0102195.  Paper.
Vitaly Kheyfets, James Smyser, Alex Honeyman, Jamey Browning, Jean Hertzberg, Joyce Schroeder, Brett Fenster, and Robin Shandas. “Changing Vorticity in the Main Pulmonary Artery Is Associated With RV-PA Decoupling in Pulmonary Hypertension.” Oral presentation presented at the Biomedical Engineering Society Annual Meeting, San Antonio, TX, United states, October 22, 2014.
Jean Hertzberg, Jamey Browning, Brett E. Fenster, and Joyce D. Schroeder. “Right Ventricular Diastolic Dysfunction and Vorticity In The Right Human Heart.” Oral presented at the Biomedical Engineering Society Annual Meeting, San Antonio, TX, United states, October 22, 2014.
Fenster, Brett, Jamey Browning, Aurelien F. Stalder, Christopher Glielmi, Lori Silveira, J. K. Buckner, Alex Kluiber, Joyce D. Schroeder, and Jean Hertzberg. “Vorticity for the Assessment of Right Ventricular Diastolic Dysfunction Using 4D Flow CMR.” Journal of Cardiovascular Magnetic Resonance 15, no. Suppl 1 (January 30, 2013): P8. doi:10.1186/1532-429X-15-S1-P8. Abstract.

Leave a Reply

Your email address will not be published. Required fields are marked *