U. Kertzscher

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (122)169.34 Total impact

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    [Show abstract] [Hide abstract] ABSTRACT: Implants inside the cardiovascular system are subjected to blood flow. Platelet deposition usually takes place, eventually leading to thrombus formation. Tests must be performed in order to select a suitable biomaterial, but no generally accepted test method exists for biomaterials in contact with blood. At a first glance, the flow appears to play only a minor role in the complex interaction between platelets and biomaterials. However, experiments and models have indeed demonstrated the importance of flow.Flow is the mechanism by which platelets are transported to the site of deposition, enabling deposition and forming the shape of a growing thrombus. This interaction is investigated here by means of two experimental models. The first model generates the simplest shear flow, the plane Couette flow. It serves to quantify the role of the shear rate. The second model, the stagnation point flowmodel, features a more complex shear flow. This model is used to understand the influence of a changing flow field along the wall over which the platelets travel. The platelet deposition is observed using the two experimental models, and a numerical model is developed to reproduce and simulate the experimental results. In the numerical model, the movement of platelets is computed with a combination of convective and stochastic movements due to diffusion. The combined motion brings some platelets close to the wall. The deposition of the platelet at the wall is modeled by a stochastic model. Probability determines whether the individual platelet deposits or flows onwards. This probability is the product of three different probabilities, which are the properties of the platelet, the wall, and the flow. The results of the models are compared with the experimental results and are used to understand the experiments.
    Preview · Article · Jun 2016 · Biointerphases
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: To account for the impact of turbulence in blood damage modeling, a novel approach based on the generation of instantaneous flow fields from RANS simulations is proposed. Methods: Turbulent flow in a bileaflet mechanical heart valve was simulated using RANS-based (SST k-ω) flow solver using FLUENT 14.5. The calculated Reynolds shear stress (RSS) field is transformed into a set of divergence-free random vector fields representing turbulent velocity fluctuations using procedural noise functions. To consider the random path of the blood cells, instantaneous flow fields were computed for each time step by summation of RSS-based divergence-free random and mean velocity fields. Using those instantaneous flow fields, instantaneous pathlines and corresponding point-wise instantaneous shear stresses were calculated. For a comparison, averaged pathlines based on mean velocity field and respective viscous shear stresses together with RSS values were calculated. Finally, the blood damage index (hemolysis) was integrated along the averaged and instantaneous pathlines using a power law approach and then compared. Results: Using RSS in blood damage modeling without a correction factor overestimates damaging stress and thus the blood damage (hemolysis). Blood damage histograms based on both presented approaches differ. Conclusions: A novel approach to calculate blood damage without using RSS as a damaging parameter is established. The results of our numerical experiment support the hypothesis that the use of RSS as a damaging parameter should be avoided.
    No preview · Article · Mar 2016 · The International journal of artificial organs
  • [Show abstract] [Hide abstract] ABSTRACT: Aim: In current rotary blood pumps, complications related to blood trauma due to shear stresses are still frequently observed clinically. Reducing the rotor tip speed might decrease blood trauma. Therefore, the aim of this project was to design a two-stage rotary blood pump leading to lower shear stresses. Methods: Using the principles of centrifugal pumps, two diagonal rotor stages were designed with an outer diameter of 22 mm. The first stage begins with a flow straightener and terminates with a diffusor, while a volute casing behind the second stage is utilized to guide fluid to the outlet. Both stages are combined into one rotating part which is pivoted by cup-socket ruby bearings. Details of the flow field were analyzed employing computational fluid dynamics (CFD). A functional model of the pump was fabricated and the pressure-flow dependency was experimentally assessed. Results: Measured pressure-flow performance of the developed pump indicated its ability to generate adequate pressure heads and flows with characteristic curves similar to centrifugal pumps. According to the CFD results, a pressure of 70 mmHg was produced at a flow rate of 5 L/min and a rotational speed of 3200 rpm. Circumferential velocities could be reduced to 3.7 m/s as compared to 6.2 m/s in a clinically used axial rotary blood pump. Flow fields were smooth with well-distributed pressure fields and comparatively few recirculation or vortices. Substantially smaller volumes were exposed to high shear stresses >150 Pa. Conclusions: Hence, blood trauma might be reduced with this design. Based on these encouraging results, future in vitro investigations to investigate actual blood damage are intended.
    No preview · Article · Mar 2016 · The International journal of artificial organs
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    Full-text · Presentation · Mar 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Left ventricular assist devices (LVADs) have become a standard therapy for patients with severe heart failure. As low blood trauma in LVADs is important for a good clinical outcome, the assessment of the fluid loads inside the pump is critical. More specifically, the flow features on the surfaces where the interaction between blood and artificial material happens is of great importance. Therefore, experimental data for the near-wall flows in an axial rotary blood pump were collected and directly compared to computational fluid dynamic results. For this, the flow fields based on unsteady Reynolds-averaged Navier-Stokes simulations-computational fluid dynamics (URANS-CFD) of an axial rotary blood pump were calculated and compared with experimental flow data at one typical state of operation in an enlarged model of the pump. The focus was set on the assessment of wall shear stresses (WSS) at the housing wall and rotor gap region by means of the wall-particle image velocimetry technique, and the visualization of near-wall flow structures on the inner pump surfaces by a paint erosion method. Additionally, maximum WSS and tip leakage volume flows were measured for 13 different states of operation. Good agreement between CFD and experimental data was found, which includes the location, magnitude, and direction of the maximum and minimum WSS and the presence of recirculation zones on the pump stators. The maximum WSS increased linearly with pressure head. They occurred at the upstream third of the impeller blades and exceeded the critical values with respect to hemolysis. Regions of very high shear stresses and recirculation zones could be identified and were in good agreement with simulations. URANS-CFD, which is often used for pump performance and blood damage prediction, seems to be, therefore, a valid tool for the assessment of flow fields in axial rotary blood pumps. The magnitude of maximum WSS could be confirmed and were in the order of several hundred Pascal.
    No preview · Article · Mar 2016 · Artificial Organs
  • [Show abstract] [Hide abstract] ABSTRACT: Implantable left ventricular assist devices (LVADs) became the therapy of choice in treating end-stage heart failure. Although survival improved substantially and is similar in currently clinically implanted LVADs HeartMate II (HM II) and HeartWare HVAD, complications related to blood trauma are frequently observed. The aim of this study was to compare these two pumps regarding their potential blood trauma employing computational fluid dynamics. High-resolution structured grids were generated for the pumps. Newtonian flow was calculated, solving Reynolds-averaged Navier–Stokes equations with a sliding mesh approach and a k-ω shear stress transport turbulence model for the operating point of 4.5 L/min and 80 mm Hg. The pumps were compared in terms of volumes subjected to certain viscous shear stress thresholds, below which no trauma was assumed (von Willebrand factor cleavage: 9 Pa, platelet activation: 50 Pa, and hemolysis: 150 Pa), and associated residence times. Additionally, a hemolysis index was calculated based on a Eulerian transport approach. Twenty-two percent of larger volumes above 9 Pa were observed in the HVAD; above 50 Pa and 150 Pa the differences between the two pumps were marginal. Residence times were higher in the HVAD for all thresholds. The hemolysis index was almost equal for the HM II and HVAD. Besides the gap regions in both pumps, the inlet regions of the rotor and diffuser blades have a high hemolysis production in the HM II, whereas in the HVAD, the volute tongue is an additional site for hemolysis production. Thus, in this study, the comparison of the HM II and the HVAD using numerical methods indicated an overall similar tendency to blood trauma in both pumps. However, influences of turbulent shear stresses were not considered and effects of the pivot bearing in the HM II were not taken into account. Further in vitro investigations are required.
    No preview · Article · Aug 2015 · Artificial Organs
  • [Show abstract] [Hide abstract] ABSTRACT: When using artificial surfaces that come into contact with the bloodstream, it is important to consider the undesirable consequences of thrombus formation and embolization. Although great progress has been made by creating new surfaces and antithrombotic coatings or evaluating flow conditions, unexpected platelet adhesion and aggregation can lead to the sudden formation of an adverse thrombus. Our experiments in a stagnation point flow chamber with citrate-anticoagulated whole blood and ADP-stimulated platelets mimicked the situations of implanted artificial organs, e.g., mechanical circulatory support devices, or extravascular circulation. With video microscopy, real-time platelet characteristics were observed at shear rate levels between 50 and 500 s−1 on glass, von Willebrand factor, and polyurethane surfaces for at least 5 min after the first contact. Platelet adhesion and aggregation were observed with distinctness in aggregate size, surface coverage, aggregate size, probability of an embolic event, and platelet contraction. The probability of an embolic event increased at lower flow rates. Additionally, platelet contraction was affected by the flow rate. Raising the flow rate intensified the platelet contraction. With this setup, the microembolization caused by surface contact and flow and platelet contraction can be detected in a real-time direct observation. This capability addresses both technical and clinical issues, such as thrombus and embolus formation, and may improve the research on the hemocompatibility of biomaterials.
    No preview · Article · Jul 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Intravital microscopy (IVM) is a well-established imaging technique for real-time monitoring of microscale lung tissue dynamics. Although accepted as a gold standard in respiratory research, its characteristic image features are scarcely understood, especially when trying to determine the actual position of alveolar walls. To allow correct interpretation of these images with respect to the true geometry of the lung parenchyma, we analyzed IVM data of alveoli in a mouse model in comparison with simultaneously acquired optical coherence tomography images. Several IVM characteristics, such as double ring structures or disappearing alveoli in regions of liquid filling, could be identified and related to the position of alveoli relative to each other. Utilizing a ray tracing approach based on an idealized geometry of the mouse lung parenchyma, two major reflection processes could be attributed to the IVM image formation: partial reflection and total internal reflection between adjacent alveoli. Considering the origin of the reflexes, a model was developed to determine the true position of alveolar walls within IVM images. These results allow thorough understanding of IVM data and may serve as a basis for the correction of alveolar sizes for more accurate quantitative analysis within future studies of lung tissue dynamics.
    No preview · Article · Jun 2015 · Journal of Biomedical Optics
  • [Show abstract] [Hide abstract] ABSTRACT: Exit-site infections remain one of the main complications for percutaneous devices, such as catheters for peritoneal dialysis or drivelines for ventricular assist devices. Many efforts have been made to create a biological seal, yet without long-term success. This study investigates a new kind of percutaneous device which is coated with an extricable polymeric membrane. The bionic approach applies the naturally outwards directed growth of skin structures to technology: by pulling the protective membrane it slowly grows out of the body and a developing sulcus is exposed to dry air and an infection is avoided. In a feasibility study this kind of device was shown to reduce the rate of infection. To further investigate these devices, they were implanted in the skin of goats and observed for a period of more than 500 days. The membranes were pulled with a force of up to 2 N and the resulting movement was recorded. When being pulled, the membranes moved 0.4-0.9 mm per week, showing that the application of a continuously acting, defined force on the protective membrane causes the desired slow movement.
    No preview · Article · Mar 2015 · Biomedizinische Technik/Biomedical Engineering
  • [Show abstract] [Hide abstract] ABSTRACT: Drivelines for ventricular assist devices and catheters for peritoneal dialysis are percutaneous implants which are designed for a dwell time of at least one year. The testing of such percutaneous devices in animal experiments should represent this long period, since infection episodes can occur a long time after implantation. Usually, these animal experiments are the final step in the previous development of the implant and represent a high monetary value. However, a single malfunction is already sufficient to end the experiment. As part of a research project preclinical testing of percutaneous implants was performed in goats. Although the percutaneous devices do not cause pain, the animals will bite and pull at them and endanger the experiment. Therefore, protection of the implant is required. Standard wound dressing is not sufficient and appropriate protective garments for goats are not commercially available. Therefore, custom fit protective waistcoats were designed and manufactured. To this end the size of the goats was measured and a pattern for sewing was created. A polyester mesh fabric provides the necessary resistance and good breathability. The waistcoats were reinforced with polyethylene foam to prevent biting through the garment. Side-release buckles were chosen as fasteners. A total of six waistcoats were manufactured. They fit the goats tightly, while preserving the full range of motion. The goats tolerate them well. They are durable, secure and effectively protected the implants for a period of over one year.
    No preview · Conference Paper · Oct 2014
  • K. Affeld · S. Stefansdottir · J. Schaller · U. Kertzscher
    [Show abstract] [Hide abstract] ABSTRACT: With the ever-increasing clinical application of intra vascular implants like valves, stents, grafts and ventricular assist devices the problem of thrombo-embolism has received new attention. Such a thrombo-embolic adverse event starts with the adhesion of platelets. This is investigated with the stagnation flow chamber. Objective of this paper is to research the stagnation point flow with new methods in order to elucidate questions like: How does a thrombus form, what is the role of shear rate? In the new experiments reported here fresh human blood was used. It was drawn by venipuncture from a healthy donor into 1 mM citrate solution. Flow rates were 20 and 40 ml/h and the blood entered the circular flow chamber through a tube 650 mu m in diameter. Height of the flow space was 480 mu m. The platelets were dyed with Mepacrine. Before the blood entered the flow chamber a platelet-activating agent was added. This agent was mixed with the blood with the help of a micro mixer. The flow chamber was placed in an inverted microscope and platelets deposited on the bottom plate of the flow chamber. This was recorded with fluorescent video microscopy. With the help of image processing the surface coverage (coveraged area / total area) was determined and was plotted as a function of time and shear rate at the bottom plate. The shear rate was derived from computations of the blood flow using computational fluid dynamics (CFD). The platelet deposition of nearly 50 experiments was recorded, and of these a selection of 9 experiments were analyzed and described in this paper.
    No preview · Conference Paper · Oct 2014
  • S. Schneider · G. Gabel · K. Affeld · U. Kertzscher
    [Show abstract] [Hide abstract] ABSTRACT: Continuous non-invasive blood pressure measurement for long-term application remains an unsolved technical challenge. Determining blood pressure by measuring pulse transit times is a promising technique; however, it needs repeated recalibration. The correlation between blood pressure and pulse transit time changes with the elastic properties of the arteries. Experimental data are required to develop a longer calibration interval with a model-based time series analysis. A polymeric vascular model of three artery sections connected by an arterial bifurcation was set up with physiological flow and pressure curves along with physiological pulse transit times. The elastic properties of the three modelled arteries can be changed separately within a physiological range during the experiments. The vascular model provides the pressure signal and pulse wave signal upstream and downstream of the bifurcation; the flow is determined in the inlet. Physiologic pulse transit time changes in the model are mainly realized through changes in the elasticity and not variations in fluid pressure.
    No preview · Conference Paper · Oct 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Pressure drop associated with coarctation of the aorta (CoA) can be successfully treated surgically or by stent placement. However, a decreased life expectancy associated with altered aortic hemodynamics was found in long-term studies. Image-based computational fluid dynamics (CFD) is intended to support particular diagnoses, to help in choosing between treatment options, and to improve performance of treatment procedures. This study aimed to prove the ability of CFD to improve aortic hemodynamics in CoA patients. In 13 patients (6 males, 7 females; mean age 25 ± 14 years), we compared pre- and post-treatment peak systole hemodynamics [pressure drops and wall shear stress (WSS)] vs. virtual treatment as proposed by biomedical engineers. Anatomy and flow data for CFD were based on MRI and angiography. Segmentation, geometry reconstruction and virtual treatment geometry were performed using the software ZIBAmira, whereas peak systole flow conditions were simulated with the software ANSYS(®) Fluent(®). Virtual treatment significantly reduced pressure drop compared to post-treatment values by a mean of 2.8 ± 3.15 mmHg, which significantly reduced mean WSS by 3.8 Pa. Thus, CFD has the potential to improve post-treatment hemodynamics associated with poor long-term prognosis of patients with coarctation of the aorta. MRI-based CFD has a huge potential to allow the slight reduction of post-treatment pressure drop, which causes significant improvement (reduction) of the WSS at the stenosis segment.
    No preview · Article · Sep 2014 · Annals of Biomedical Engineering
  • [Show abstract] [Hide abstract] ABSTRACT: Coils and flow diverters or stents are devices successfully used to treat cerebral aneurysms. Treatment aims to reduce intra-aneurysmal flow, thereby separating the aneurysmal sac from the blood circulation. The focus and this manuscript combining literature review and our original research is an analysis of changes in aneurysmal hemodynamics caused by endovascular treatment devices. Knowledge of post-treatment hemodynamics is a path to successful long-term treatment. Summarizing findings on hemodynamic impact of treatment devices, we conclude: coiling and stenting do not affect post-treatment intra-aneurysmal pressure, but significantly alter aneurysmal hemodynamics through flow reduction and a change in flow structure. The impact of treatment devices on aneurysmal flow depends, however, on a set of parameters including device geometry, course of placement, parent vessel and aneurysm geometry.
    No preview · Article · Jun 2014 · Expert Review of Medical Devices
  • [Show abstract] [Hide abstract] ABSTRACT: Hunterian ligation affecting hemodynamics in vessels was proposed to avoid rebleeding in a case of a fenestrated basilar artery aneurysm after incomplete coil occlusion. We studied the hemodynamics in vitro to predict the hemodynamic changes near the aneurysm remnant caused by Hunterian ligation. A transparent model was fabricated based on three-dimensional rotational angiography imaging. Arteries were segmented and reconstructed. Pulsatile flow in the artery segments near the partially occluded (coiled) aneurysm was investigated by means of particle image velocimetry. The hemodynamic situation was investigated before and after Hunterian ligation of either the left or the right vertebral artery (LVA/RVA). Since post-ligation flow rate in the basilar artery was unknown, reduced and retained flow rates were simulated for both ligation options. Flow in the RVA and in the corresponding fenestra vessel is characterized by a vortex at the vertebrobasilar junction, whereas the LVA exhibits undisturbed laminar flow. Both options (RVA or LVA ligation) cause a significant flow reduction near the aneurysm remnant with a retained flow rate. The impact of RVA ligation is, however, significantly higher. This in vitro case study shows that flow reduction near the aneurysm remnant can be achieved by Hunterian ligation and that this effect depends largely on the selection of the ligated vessel. Thus the ability of the proposed in vitro pipe-line to improve hemodynamic impact of the proposed therapy was successfully proved.
    No preview · Article · May 2014 · The International journal of artificial organs
  • [Show abstract] [Hide abstract] ABSTRACT: PurposeTo reduce the need for diagnostic catheterization and optimize treatment in a variety of congenital heart diseases, magnetic resonance imaging (MRI)-based computational fluid dynamics (CFD) is proposed. However, data about the accuracy of CFD in a clinical context are still sparse. To fill this gap, this study compares MRI-based CFD to catheterization in the coarctation of aorta (CoA) setting.Materials and Methods Thirteen patients with CoA were investigated by routine MRI prior to catheterization. 3D whole-heart MRI was used to reconstruct geometries and 4D flow-sensitive phase-contrast MRI was used to acquire flows. Peak systolic flows were simulated using the program FLUENT.ResultsPeak systolic pressure drops in CoA measured by catheterization and CFD correlated significantly for both pre- and posttreatment measurements (pre: r = 0.98, p = 0.00; post: r = 0.87, p = 0.00). The pretreatment bias was −0.5 ± 3.33 mmHg (95% confidence interval −2.55 to 1.47 mmHg). CFD predicted a reduction of the peak systolic pressure drop after treatment that ranged from 17.6 ± 5.56 mmHg to 6.7 ± 5.58 mmHg. The posttreatment bias was 3.0 ± 2.91 mmHg (95% CI −1.74 to 5.43 mmHg).Conclusion Peak systolic pressure drops can be reliably calculated using MRI-based CFD in a clinical setting. Therefore, CFD might be an attractive noninvasive alternative to diagnostic catheterization.J. Magn. Reson. Imaging 2014. © 2014 Wiley Periodicals, Inc.
    No preview · Article · Apr 2014 · Journal of Magnetic Resonance Imaging
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    S Weber · P Scharfschwerdt · T Schauer · T Seel · U Kertzscher · K Affeld
    [Show abstract] [Hide abstract] ABSTRACT: Cardiovascular diseases are the main cause of death in Germany. A long-term blood pressure measurement is crucial to identify hypertension which can lead to cardiovascular disease. Conventional techniques use the automatic arm cuff method which is painful and provides only intermittent results. A new method for continuous measurement is developed using a DOPPLER ultrasound sensor on a superficial artery and a small balloon. A voice coil actuator is used to change the balloon pressure using a control loop. Holding the control variable - the ultrasound signal - constant and low by con-trolling the balloon pressure permits a continuous measurement. The system was tested using a blood pressure simulator with variable pressure curves and abrupt pressure changes. The controller-induced balloon pressure tracks the pressure in the model artery very closely.
    Full-text · Article · Sep 2013 · Biomedizinische Technik/Biomedical Engineering
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    Preview · Article · Sep 2013 · Biomedizinische Technik/Biomedical Engineering
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    [Show abstract] [Hide abstract] ABSTRACT: Aortic coarctation (CoA) accounting for 3-11% of congenital heart disease can be successfully treated. Long-term results, however, have revealed decreased life expectancy associated with abnormal hemodynamics. Accordingly, an assessment of hemodynamics is the key factor in treatment decisions and successful long-term results. In this study, 3D angiography whole heart (3DWH) and 4D phase-contrast magnetic resonance imaging (MRI) data were acquired. Geometries of the thoracic aorta with CoAs were reconstructed using ZIB-Amira software. X-ray angiograms were used to evaluate the post-treatment geometry. Computational fluid dynamics models in three patients were created to simulate pre- and post-treatment situations using the FLUENT program. The aim of the study was to investigate the impact of the inlet velocity profile (plug vs. MRI-based) with a focus on the peak systole pressure gradient and wall shear stress (WSS). Results show that helical flow at the aorta inlet can significantly affect the assessment of pressure drop and WSS. Simplified plug inlet velocity profiles significantly (p < 0.05) overestimate the pressure drop in pre- and post-treatment geometries and significantly (p < 0.05) underestimate surface-averaged WSS. We conclude that the use of the physiologically correct but time-expensive 4D MRI-based in vivo velocity profile in CFD studies may be an important step towards a patient-specific analysis of CoA hemodynamics.
    Full-text · Article · Aug 2013 · Annals of Biomedical Engineering
  • L Goubergrits · J Schaller · U Kertzscher · Ch Petz · H-Ch Hege · A Spuler
    [Show abstract] [Hide abstract] ABSTRACT: Background and study aims: Image-based computational fluid dynamics (CFD) provides a means for analysis of biofluid mechanical parameters of cerebral aneurysms. This may enable patient-specific rupture risk analysis and facilitate treatment decisions. Application of different imaging methods may, however, alter the geometrical basis of these studies. The present study compares geometry and hemodynamics of an aneurysm phantom model acquired by means of magnetic resonance imaging (MRI), computed tomography (CT), and rotational angiography (3DRA). Materials and methods: The phantom model of a basilaris artery aneurysm was fabricated based on data generated by CT angiography. This model underwent imaging by means of CT, MRI, and 3DRA. We compared the geometrical reconstructions using the original dataset with those obtained from CT, MRI, and 3DRA. Similarly, CFD analyses were performed using the four reconstructions (3DRA, MRI, CT, and original dataset). Results: MRI and the 3DRA-based reconstructions yield mean reconstruction errors of 0.097 mm and 0.1 mm, which are by a factor of 2.5 better than the CT reconstruction. The maximal error for the aneurysm radius (7.11 mm) measurement was found in the 3DRA reconstruction and was 3.8% (0.28 mm). A comparison of calculated time-averaged wall shear stress (WSS) shows good correlations for the entire surface and, separately, for the surface of the aneurysmal sack. The maximal error of 8% of the mean WSS calculation of the whole surface was found for the CT reconstruction. The calculations of the aneurysmal sack mean WSS from the MRI reconstruction were estimated to have a maximal error of 7%. Conclusion: All three imaging techniques (CT, MRI, 3DRA) adequately reproduce aneurysm geometry and allow meaningful CFD analyses.
    No preview · Article · May 2013 · Journal of Neurological Surgery. Part A: Central European Neurosurgery