PULSATILE PRESSUREAND FLOW IN ARTERIALSTENOSES

SIMULATEDIN A MATHEMATICAL MODEL

Sven 0ivind Wile and Lars Walbe

ABSTRACT

This paper presents the detailed pulsatile pressure and flow
velocity patterns inside an axis symmetric stenosis model with
75% constriction. The pressure and velocities have been calcu-
lated by solving the Navier-Stokes equations by the finite
element method, the velocity profile in a straight tube caused by
a pulsating driving pressure has been calculated first and then
used as a boundary condition for the stenosis calculations.
The results of the mathematical simulations of the stenosis model
have been obtained in terms of velocib vectors, streamlines and
isobars at16 different instances in time,each 15 degrees apart
during a cardiac cycle. The calculated velocity field shows that
a vortex isdeveloped atthe wall distal to the stenosis as the vel-
ocity decreases from the peak systolic value. At the site of the
vortex, a local pressure minimum is found due to the conversion
of pressure to kinetic energy. When the flow is reversed, the rev-
ersal occurs first along the wall, thus forcing the vortex toward the
the centre of the tube. As the reverse flow velocity increases, a
vortex is also developed at the proximal site of the stenosis.

INTRODUCTION
The steady flow situation in stenosis models has
previously been studied for different Reynolds
numbers and different constrictions of the cross-
section arear. The steady state problem is easier
to solve numerically but does not adequately des-
cribe what is happening with flow and pressure
patterns around constrictions of blood vessels in the
arterial tree.
Measurement of velocity profiles in blood vessels
has been carried out by means of pulsed ultrasound
Doppler flowmeters 2. However, the space resolu-
tion of this instrument is poor, especially along the
wall.
“=O au_.
an an-
Experimental investigations which have been carried
out on physical models have mainly been concerned
with measuring flow velocities by laser Doppler
flowmeter3, visualization of the streamlines, either av_, g=o
by contrast dye4 or hydrogen bubbles’. The large an-
amount of data which has to be collected in order
to map velocity profiles by the laser Doppler flow-
meter, especially for pulsatile flow, has complicated
these measurements. The visualization of streamline
P=Pv)
patterns by contrast dye injection into the moving
fluid has been successful for steady flow. When pul-
satile flow is studied, the problem of dye mixing
in the fluid complicates these investigations. Visua-
lization of the streamlines by hydrogen bubbles has
been more successful as the bubbles are dissolved in
the fluid after a short time.
au
z=o
Viscous, time dependent fluid flow is adequately v=O
described by the Navier-Stokes equations and the
continuity equation. The method which has been Figure 1. The finite element model of the circular
applied to solve these equations is the finite element straight tube. The boundary conditions u = 0, v = 0
method6. In view of the limitations of the experi- correspond to the wall, au/an = 0, v = 0 correspond
mental methods, mathematical models play a useful to the axis of symmetry, au/an = 0, au/an = 0, p = 0
role in the analysis of flow and pressure patterns and correspond to the outlet and au/an = 0, au/&a = 0,
Institute of Informatics and Physiology, University of Oslo,
p = p(t) correspond to the inlet. p(t) is given in
Norway Figure 2a.

0141-5425/81/010017-08 $02.00
0 1981 IPC Business Press J. Biomed. Engng. 1981, Vol. 3, January 17
 Pressure and flow in stenoses: S.0. Wile and 1. Wake

cm6

a04

0.02

a V I
3

Time (I)
I

Time ($1
Figure 2. (a) The pressure gradient, which drives the flow in a straight circular tube as a function of time.
(b) The resulting pulse velocity profile at diff erent sites in the tube as a function of time. The pulse profile
at y = 0 (0) is at the axis of the tube, the profile at y = 0.5 (0) shows the velocities at a distance equal to half
the radius from the centre axis and the profile at y = 0.8 (X) at 0.8 times the radius away from the axis.

Figure 3. The velocity profiles in a straight circular tube as a response to the pressure gradient in Figure 2a.
The velocity profiles are shown at l/24 s interval.
\,
4
Ia . . . . _ _^__ . . . _
 Pressure and flow in stenoses: S.0. Wille and 1. Wallae

may give useful additional information, particularly

where the geometries are complicated.

METHOD

The time dependent, axis symmetric Navier-Stokes

equations and the continuity equation which des-
cribes viscous, incompressible flow are given by:

+u *+u-=o
3X ar
th
(1)

1.ap au av
1 -__ v +jh+a2v
P ar
- + at+
i F l ar r2 ax2 c
1

+u g+, $0 (2)

V
+&+&=I) (3)
7 ax Time ( s)

where u is velocity in x (longitudinal) direction, v is
velocity in the r (radial) direction,p is pressure, p is
density of the fluid and P the kinematic viscosity.
By applying the finite element method in solving
these equations, the pressure and velocities are app-
roximated by polynomials defined on triangles, the
pressure with linear and the velocities with quadra-
tic polynomials. The non-linear equations are solved
by the Newton-Raphson method, The time deriva-
tives of the velocities are replaced by a finite diffe-
rence time step scheme:
a4
at
By introducing the e-method,
takes the form:
Figure 5. The pressure gradient across the model as
function of time.
ward scheme is more stable and convergence is
obtained in many cases where the trapezoidal rule
leads to a divergent solution. In some cases it can
also be advantageous to obtain a solution by the
Euler backward scheme and then increase the accu-
racy by increasing 0 and use the trapezoidal rule in
the final iterations. In a previous paper, the pulsa-
tile flow in a circular straight tube and the flow in
a suddenly blocked tube has been investigated by
_ this method’.
- f.
In the present work the backward difference scheme
is also tried, which is given by
the time derivative

where the double bar indicates the value two time-

Tile bars denote the values at the previous time. For
0 = ?4 the integration is the trapezoidal rule and for
8 = 0 the Euler backward scheme is obtained7.
The advantage of the trapezoidal integration scheme
is that higher accuracy is obtained than with the
Euler backward scheme. However, the Euler back-
steps backwards. This scheme is claimed’ to give the
same accuracy as the trapezoidal rule and to have
equal stability as the Euler backward scheme. How-
ever, this method has been applied in the present
work without success. It gave divergent solutions
where the Euler backward scheme converged.

Figure 4. The finite element model of the stenosis axis symmetric tube. The boundary condition u = 0,
u = 0 correspond to the wall, au/an = 0, v = 0 correspond to the symmetry axis, au/an = 0, %/an = 0
correspond to the outlet and v = 0, u = u(t) correspond to the inlet. u(t) is given in Figure 3.

I 0:--,-I t____ ,001 x1-1 9 I__ _~ .A

 Pressure and flow in stenoses: S.O. Wille and 1. Wallee

Figure 6. The pressure and flow patterns, l/24 s after the start of a cardiac cycle. Only results on the upper
half of a longitudinal section through the tube are shown. The upper panel shows the velocity vector field,
the one below shows the streamlines of flow and the lower show the pressure isobars. The bottom curve
shows the pressure variation along the axis of symmetry.

Pulsatile flow in a straight circular tube with a
‘physiological’ pressure gradient
The finite element model of the straight circular
tube with boundary conditions is shown in Figure 1.
The boundary conditions are zero velocities along
the wall and zero normal derivatives of the veloci-
ties at both the inlet and outlet. Along the axis of
symmetry, the normal velocity and the normal deri-
vative of the tangential velocity are zero. The flow
in the tube is driven by the pressure gradient shown
in Figure 2a. The shape of this pressure gradient is
chosen to obtain a velocity waveform with charac-
teristics similar to physiological velocity pulses.
The radius of the tube is 5 x 10m3m and the kine-
matic viscosity is 4 x 10e6 m* s-l. The maximum
mean velocity during the cycle is 4.7 x lO‘*m s-l,
thus giving a maximum Reynolds number of 120.
By taking the angular frequency as 2n, the
Womersley cx becomes 6.27.
In Figure 2b the response of the pressure gradient,
the time-velocity waveforms, are shown for diffe-
rent distances from the axis of symmetry. The
detaih of the veIocity profiles at 16 instances in the
cycle each l/24 s or 15 degrees apart are shown in
Figure 3.
Pulsatile flow through a stenosis
The finite element model of the stenosis with boun-
dary conditions is shown in Figure 4. The boundary
conditions at the walI are zero velocities. At the
outlet the normal derivatives of the velocities are
zero and along the axis of symmetry the normal
velocity and the normal derivative of the tangen-
tial velocity are zero. At the inlet the tangential
velocity is zero whilst the normal velocities are
those of the velocity profiles obtained for pulsatile
flow in a straight tube. These velocity profiles are
used as boundary conditions at the inlet at each

instant in time where the pressure and velocity
patterns in the stenosis model are calculated. With
the velocity profiles in Figure 3 as boundary con-
ditions at the inlet, the pressure gradient across the
stenosis model which is obtained is shown in
Figure 5. Figures 6-l 1 show the velocity vectors,
streamlines and pressure patterns at selected instants
in time.
In the early part of systole (Figure 6) the flow is
accelerated and no separation is seen downstream
of the constriction. The pressure gradient is slightly
greater at the stenosis than in the upstream and
downstream part of the model. Later in the cycle,
at 3124 s, a vortex formation has developed down-
stream of the stenosis and the relative pressure drop
across the stenosis has increased. The size of the
vortex is increased during the following time steps,
4/24 s, 5/24 s, 6/24 s and 7/24 s, (Figure 7,8) and
a local pressure minimum develops at the level of
the vortex. At 8/24 s (Figure 9), the direction of
flow is reversed along the wall upstream of the
stenosis. The influence of the reversed flow down-
Figure 7. The pressure and flow patterns at 4124 s.
Pressure and flow in stenoses: S.0. Wile and 1. Wallee
stream of the stenosis is seen in Figure 10, where
the fluid lamina along the wall are moving upstream
through the stenosis and thus forcing the vortex
towards the axis. The reverse flow is increasing from
9/24 s to 12/24 s. At 13/24 s the velocity vector plot
shows that another vortex has developed u;rstream
of the stenosis. At 14/24 s (Figure 11) this vortex
has increased and it is also apparent in the stream-
line plot. At 15/24 s and 16/24 s all velocities decay
and at 16/24 s there are only two vortices with low
velocities left, one upstream and one downstream
of the stenosis. The calculations were not carried
out for subsequent points in time because the nume-
rical methods produced divergent solutions.
DISCUSSION
Pressure and velocity patterns have been calculated
by the finite element method both in a circular
straight tube and in an axis symmetric constricted
tube. The results for the straight tube are similar to
those obtained analytically by Womersley’. The
two situations cannot be compared exactly because
 Pressure and flow in stenoses: S.O. Wile
Figure 8. The pressure and flow patterns
Womersley used a slightly different pressure gra-
dient. The results show that the reversal of flow in
the diastolic phase of the cycle first occurs at the
vessel wall and that the peak pressure occurs before
the peak velocity, that is: the pressure leads the
velocity.
In the model of the arterial stenosis, a vortex forma-
tion has been shown to appear downstream of the
constriction in the systolic and upstream of the
constriction in the diastolic part of the cycle. As the
flow is reversed in diastole, the vortex is forced
towards the centre of the vessel whilst the reversed
velocities occur in the area close to the wall. At the
level of the vortex a low pressure zone is developed.
In the present simulation, the walls of the stenosis
model are assumed to be stiff. This is not the case
in actual blood vessels, vhich have visco-elastic pro-
perties with varying diameter during the cardiac
cycle. However, the relative change in diameter is in
the order of 10%” and it is therefore believed that
the size of the error introduced by having a fixed
diameter is small.
and L. Wallee
at 6124 s.
The velocity profiles used as boundary conditions
for the stenosis at the inlet are the corresponding
velocity profiles in a long straight tube. However,
the feedback from the stenosis may influence the
velocity profiles at the inlet. The correct velocity
profiles at the inlet are probably slightly different
from those in a straight tube. More correct velocity
profiles are not known, either from experimental or
theoretical work, and the main patterns of the
results are believed not to be affected by small
deviations from our assumptions.
With the present method, it is not possible to obtain
convergent solutions towards the end of the cardiac
cycle. The fact that the downstream vortex grows
out through the outlet of the tube, thus violating
the outlet boundary conditions, may be the reason
for the divergent solution.
In the last part of the cardiac cycle, where it was
not possible to obtain convergent solutions, we
believe that the velocities will decay and that the
effects of small movements in late diastole will have
negligible influence on the next cycle. At least, if
we use the last obtained so!ution (16/24 s) as the
 Pressure and flow in stenoses: 50. Wile ond 1. Wallae

Figure 9. The pressure and jlow patterns at 8/24 s.

:-====-

Figure 10. The pressure and flow patterns at IO/24 s.

Pressure and Now in stenoses: S.O. Wile and 1. Walloe

Figure 11. The pressure and flo w patterns at 14124 s.

solution at the end of diastole, the effects of the 2 Peronneau, P., Hinglais, J., Xhaard, M., DeIouche, P.
two vorticies disappeared after two time steps. and Phillipo, J. The effects of curvature and stenosis on
pulsatile flow in vivo and in vitro. in Cardiovascular
Azuma and Fukushima’ investigated the velocity Application of Ultrasound, (Ed. Renemann, R.S.),
patterns downstream of a stenosis in a glass model. North Holland Publishing Co, Amsterdam, 1974, 203-
Their constriction ratio of 0.6, was slightly more 215.
serious than the one used in this study. The flow 3 Durst, F., Melling, A. and Whitelaw, J.H. Principles and
was driven by a sinusoidal piston pump and the practice of laser-doppler anemometry, Academic Press,
sinusoidal oscillation was superimposed on a steady London, 1976.
flow component. Their results are difficult to com- 4 Roach, M.R. Poststenotic Dilatation in Arteries in
pare with those obtained in the present work as Cardiovascular fluid dynamics, (Ed. Bergel.), 1972
their Reynolds number of 1210, is several times 111-139
5 Azuma, T. and Fukushima, T. Flow patterns in stenotic
higher than used here. Azuma and Fukushima
blood vessel models, Biorheology, 1976, 13, 337-35.5.
showed that the ffow was turbulent downstream of 6 Zienkiewicz, O.C. The Finite Element Methods in
the stenosis. Engineering Science, McGraw Hill, London, 1971.
7 Lambert, J.D. Computational Methods in Ordinary
ACKNOWLEDGEMENT Differential Equations, John Wiley 8c Sons, London,
1973.
The authors are grateful to Olav Dahl for valuable 8 Wille, SO. A finite element formulation of the time
discussions of the numerica methods. dependent Navier-Stokes equations. Comput. Meth. Appl.
Mech. Engxg, in press
9 Womersley, J.R. Methods for calculation of velocity,
REFERENCES
rate and flow and viscous drag in arteries when the pres-
1 Wille, SO. Pressure and flow in arterial stenoses simu- sure gradient is known, J. Physiol., 1955, 127, 553-563.
lated in mathematical models. Appl. Math. Modelling, 10 McDonald, D.A. Blood Flow in Arteries, The Camelot
in press. Press Ltd., 1974.

24 J. Biomed. Ennnn 1981 Vol. 3 lnntlnrv