Julie Vastmans

Biomechanical evaluation of a personalized external aortic root support applied in the Ross procedure

A commonly heard concern in the Ross procedure, where a diseased aortic valve is replaced by the patients own pulmonary valve, is the possibility of pulmonary autograft dilatation. We performed a biomechanical investigation of the use of a personalized external aortic root support or exostent as a possibility for supporting the autograft. In ten sheep a short length of pulmonary artery was interposed in the descending aorta, serving as a simplified version of the Ross procedure. In seven of these cases, the autograft was supported by an external mesh or so-called exostent. Three sheep served as control, of which one was excluded from the mechanical testing. The sheep were sacrificed six months after the procedure. Samples of the relevant tissues were obtained for subsequent mechanical testing: normal aorta, normal pulmonary artery, aorta with exostent, pulmonary artery with exostent, and pulmonary artery in aortic position for six months. After mechanical testing, the material parameters of the Gasser-Ogden-Holzapfel model were determined for the different tissue types. Stress-strain curves of the different tissue types show significantly different mechanical behavior. At baseline, stress-strain curves of the pulmonary artery are lower than aortic stress-strain curves, but at the strain levels at which the collagen fibers are recruited, the pulmonary artery behaves stiffer than the aorta. After being in aortic position for six months, the pulmonary artery tends towards aorta-like behavior, indicating that growth and remodeling processes have taken place. When adding an exostent around the pulmonary autograft, the mechanical behavior of the composite artery (exostent + artery) differs from the artery alone, the non-linearity being more evident in the former.

Biomechanical characterization of human dura mater

A reliable computational model of the human head is necessary for better understanding of the physical mechanisms of traumatic brain injury (TBI), car-crash investigation, development of protective head gear and advancement of dural replacement materials. The performance and biofidelity of these models depend largely on the material description of the different structures present in the head. One of these structures is the dura mater, the protective layer around the brain. We tested five human dura mater specimens, with samples at different locations, using planar biaxial tests. We describe the resulting stress-strain curves using both the anisotropic Gasser-Ogden-Holzapfel (GOH) model and the isotropic one-term Ogden model. The low-strain section of the curves is also described using a Neo-Hookean formulation. The obtained stress-strain curves reveal highly nonlinear but isotropic behaviour. A significant amount of inter- and intra-specimen variability is noticed, whereby the latter does not seem to be influenced by location. The GOH model achieves the best fit of the individual test data. A simple Neo-Hookean model can only be used with extreme caution, as it does not manage to capture the nonlinear effects present even at low strains.

How important is sample alignment in planar biaxial testing of anisotropic soft biological tissues? A finite element study

Finite element models of biomedical applications increasingly use anisotropic hyperelastic material formulations. Appropriate material parameters are essential for a reliable outcome of these simulations, which is why planar biaxial testing of soft biological tissues is gaining importance. However, much is still to be learned regarding the ideal methodology for performing this type of test and the subsequent parameter fitting procedure. This paper focuses on the effect of an unknown sample orientation or a mistake in the sample orientation in a planar biaxial test using rakes. To this end, finite element simulations were conducted with various degrees of misalignment. Variations to the test method and subsequent fitting procedures are compared and evaluated. For a perfectly aligned sample and for a slightly misaligned sample, the parameters of the Gasser-Ogden-Holzapfel model can be found to a reasonable accuracy using a planar biaxial test with rakes and a parameter fitting procedure that takes into account the boundary conditions. However, after a certain threshold of misalignment, reliable parameters can no longer be found. The level of this threshold seems to be material dependent. For a sample with unknown sample orientation, material parameters could theoretically be obtained by increasing the degrees of freedom along which test data is obtained, e.g. by adding the data of a rail shear test. However, in the situation and the material model studied here, the inhomogeneous boundary conditions of the test set-ups render it impossible to obtain the correct parameters, even when using the parameter fitting method that takes into account boundary conditions. To conclude, it is always important to carefully track the sample orientation during harvesting and preparation and to minimize the misalignment during mounting. For transversely isotropic samples with an unknown orientation, we advise against parameter fitting based on a planar biaxial test, even when combined with a rail shear test.

Reinforcing the pulmonary artery autograft in the aortic position with a textile mesh: a histological evaluation

OBJECTIVES The Ross procedure involves replacing a patients diseased aortic valve with their own pulmonary valve. The most common failure mode is dilatation of the autograft. Various strategies to reinforce the autograft have been proposed. Personalized external aortic root support has been shown to be effective in stabilizing the aortic root in Marfan patients. In this study, the use of a similar external mesh to support a pulmonary artery autograft was evaluated. METHODS The pulmonary artery was translocated as an interposition autograft in the descending thoracic aortas of 10 sheep. The autograft was reinforced with a polyethylene terephthalate mesh (n = 7) or left unreinforced (n = 3). After 6 months, a computed tomography scan was taken, and the descending aorta was excised and histologically examined using the haematoxylin-eosin and Elastica van Gieson stains. RESULTS The autograft/aortic diameter ratio was 1.59 in the unreinforced group but much less in the reinforced group (1.11) (P < 0.05). A fibrotic sheet, variable in thickness and containing fibroblasts, neovessels and foreign body giant cells, was incorporated in the mesh. Histological examination of the reinforced autograft and the adjacent aorta revealed thinning of the vessel wall due to atrophy of the smooth muscle cells. Potential spaces between the vessel wall and the mesh were filled with oedema. CONCLUSIONS Reinforcing an interposition pulmonary autograft in the descending aorta with a macroporous mesh showed promising results in limiting autograft dilatation in this sheep model. Histological evaluation revealed atrophy of the smooth muscle cell and consequently thinning of the vessel wall within the mesh support.

Experimental observations of shear waves in cylindrical phantoms and excised equine carotid artery

To facilitate the development and application of ultrasound shear wave elastography (SWE) in arteries, it is necessary to understand the nature of shear waves (SWs) propagating in pressurized anisotropic tubes embedded in softer surrounding tissues and blood. Phantom models are widely used to study SWE in tubular settings mimicking arterial geometry without yet considering anisotropy. To investigate SWs behavior in thin-walled structures, we performed SWE measurements in tubular phantoms (inner diameter of 6–6.5 mm; 3 mm and 1 mm wall thickness) with 2 types of boundary conditions: embedded in water or in a softer medium. Furthermore, experiments were performed on excised equine carotid arteries (diameter 5.6 mm, thickness 1 mm).