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Computational study of the impact of disorders in excitation propagation on left ventricular contraction
Vaverka, Jiří ; Rohan,, Eduard (oponent) ; Horný, Lukáš (oponent) ; Burša, Jiří (vedoucí práce)
This doctoral thesis deals with computational modeling of contraction of human left ventricle using finite element method. The primary goal is to determine the impact of the left bundle branch block on ventricular ejection fraction. Additionally, changes in ventricular motions, strains and stress distribution, resulting from the block, are also investigated. Electrical activation of left ventricle under healthy conditions and during the branch block is modeled by the monodomain equation coupled with an artificial ionic model designed to reduce the computational demands of the monodomain equation. Conduction velocity in myocardium is considered orthotropic. Calculated activation maps show that the left bundle branch block prolongs electrical activation by 50 % which agrees with clinically observed prolongation of the QRS complex on ECG. The activation maps are subsequently used in the simulations of ventricular mechanics to distribute the beginning of contraction throughout the finite-element mesh. Passive mechanical behavior of myocardium is described by an orthotropic hyperelastic model. Active stresses, induced by muscle contraction, are incorporated by means of the time-dependent active strain tensor. Contraction starts from a prestressed reference configuration representing the end-diastolic state of the ventricle. Pressure development during ejection phase is controlled by two-parametric Windkessel model. Results indicate that the left bundle branch block does not substantially reduce the pumping efficiency of the ventricle; ejection fraction in the diseased state decreased by only 2.3 % relative to the healthy conditions which agrees with some of the previously published clinical studies. Changes in displacements and strains, predicted by the model, correspond with clinical and experimental observations. Stress analyses revealed unexpectedly high stresses in the interventricular septum; further analyses with modified boundary conditions have been suggested in order to better assess these result.
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