UNIT I

Introduction to Biomechanics:
Biomechanics has participated in virtually every modern advance of medical sciences and
technology. It is a tool for design and invention of devices to improve the quality of life. The
method of biomechanics is the method of engineering, which consists of observation,
experimentation, theorization, validation and application.
It is the branch of science that explains the mechanics of life and living. From molecules
to organisms, everything must obey the laws of mechanics.
What is Biomechanics?
Mechanics - Study of action of forces on particles and mechanical systems.
Bio Prefix for life/living organisms
Biomechanics -
Application of the principles of mechanics to the study of living organisms (i.e)
application of mechanical principles to living organisms.
Basic concepts in Biomechanics:
The study of biomechanics ranges from the inner workings of a cell to the movement and
development of limbs, the vasculature, the mechanical properties of soft tissue and bones. By
applying laws and concepts of physics, biomechanical mechanisms and structures can be
simulated and studied. This includes bioengineering, the research and analysis of the mechanics
of living organisms and application of engineering principles to and from biological systems.
Research and analysis can be carried forth on multiple levels from the molecules wherein
biomaterials such as collagen and elastin are considered, up to tissue and organ level.
Simple examples of biomechanics research include the investigation of forces that act on
limbs, the aerodynamics of bird and insect flight, the hydrodynamics of swimming in fish,
general locomotion in all forms of life from individual cells to whole organisms.
The biomechanics of human beings is core part of Kinesiology.
Plant biomechanics is application of biomechanical principles to plant and plant organs.
Fields which play prominent role in study of biomechanics are, thermodynamics and
continuum mechanics in Applied Mechanics and fluid mechanics and solid mechanics in
mechanical engineering.
Biomechanics as a sports science, Kinesiology where laws of mechanics and physics
are applied to understand human physiology and performance in athletic events through
modeling, computer simulation, stimulation, gesticulation, mastication and measurement.
Common methods used for analysis:
Elements of mechanical engineering ( eg. Strain gauge)
Electrical engineering (eg. Digital filtering)
Physics/Dynamics (eg. Moment of inertia)
Computer science (eg. Numerical methods)
And Clinical neuron physiology (eg. Surface EMG)
Relevant mathematical tools include linear algebra, differential equations, vector and
tensor calculus, numerics and computation techniques such as finite element method. The study
of biomaterials is also of crucial importance to biomechanics. For example the various tissues
within the body organs such as skin, bone and arteries each possess unique material properties.
Passive mechanical response of a particular tissue can be attributed to characteristics of various
proteins, such as elastin, collagen, living cells, ground substances proteoglycans and the
orientations of fibers with in the tissue.
For example if human skin is largely composed of a protein other than collagen many of
its mechanical properties such as its elastic modulus would be different. Also the properties of
living tissue can be affected by applied loads and deformations.
In general, human movement is brought about by the musculo skeletal system
(skeleton, joints, skeletal muscles) under the control of nervous system. All movements and
changes in movements are brought about by action of forces. Two most common types of forces
are pushing and pulling but there are many variations such as, lifting a book from a table,
holding a pen, turning a door handle, kicking a ball and throwing a discus. The muscles pull on
the bones in order to control the movements of the joints and in doing so, controls the whole
body movement.
Key to understand biomechanics is thorough understanding of concepts of force,
Newtons laws of motion, work and energy.
Scope of Biomechanics in Medicine:
Since biomechanics is the science involving the study of biological system from a
mechanical perspective, it is helpful
- to address problems related to human health and performance
- to understand how certain physiological system functions ( eg. Cardiovascular
system)
- To model the system
- To aid in the system of prosthesis


Scope in Medicine field:
- Molecular biology
- Surgery
- Cardiovascular system
- Orthopedics
- Trauma
- Atheroscelerosis
- Endothelial cells
- Pulmonary organs

Molecular Biology:
Makes understand the formation, design, function and production of molocules.
Surgery:
Even though this seems to be unrelated to mechanics, yet healing and rehabilitation are
intimately related to the stress and strain in tissues.
CardioVascular system:
Invention and analysis of prosthesis heart valves, development of heart assist devices,
extra corporeal circulation devices, heart-lung machines and the heamodialysis machines. Also
in heart transplantation and artificial heart replacement.
Trauma:
Helps solving problems of post operative trauma, pulmonary edema, pulmonary
atelectasis, arterial pulse wave analysis, phonoangiography.
Atheroscelerosis:
Analysis of turbulent noise as indications of atheroscelerosis or stenosis in arteries. It is
studied intensely as a heamodynamics disorder because the locations of atheroscelerotic plaques
seems to correlate with certain features of blood flow.
Endothelial cells:
Stress acting in endothelial cells and response of endothelial cells to the stress are studied
for treatment.
Orthopedics:
Most frequent users of the surgery rooms are patients with musculoskeletal problems.
Biomechanics is used in surgery planning, for prosthesis, implantable materials
And artificial limbs. Also in cellular and molecular aspects of healing in relation to stress and
strain and in tissue engineering of cartilage, tendons and bones.
Very importantly, application of biomechanics in trauma and injury & rehabilitation is
becoming more essential to society. Because people injured automobile road accidents and other
incidences are younger and hence the economic impact on the society is bigger.
Biomechanics in sports and exercise:
Biomechanics of sports and exercise is the study of the forces that act on and within
the human body and the effects of these forces on the size, shape, structure and movement of the
body.In sports and exercise, biomechanics is the science underlying technique, every time a
coach / instructor attempts to improve an individuals technique (i.e) to improve the coordination
of the forces produced by various muscle groups. [Mechanics of individual movement]
Benefits of Biomechanics:
Greater understanding of physiological behavior of living tissues, researchers are able
to advance the field of tissue engineering as well as develop improved treatment for a wide array
of pathologies.
Applications of Biomechanics:
- Improving physical function
(Surgery planning in cerebral palsy)
- Musculoskeletal Health
(Replacing injurious falls by older adults preventing bone loss)
- Product design
(Athletic shoes, Prosthetics)
- Forensic Biomechanics
(Accident Investigation)
Uses of Biomechanics:
- Improving sports performance by means of better technique and training and also
better equipment
- Sports injury by identifying safer techniques, reducing the risk of injury by training,
and also by developing protective equipments( eg. Knee brace)
- Occupational Injury prevention [Ergonomics] eg. Low back pain, hand & wrist
trauma
- Injury rehabilitation by identifying when safe to return to activity
Who uses Biomechanics?
Physical education teachers, Coachers, Trainers (personal / Athletic), Physicians,
Athletes, Physical Therapist, Occupational Therapist, Engineers and Researchers.


Mechanics of Hard Tissue:
Hard tissue, mineralized tissue and calcified tissue are the bone synonyms for describing
structure and properties of bone/tooth, whereas soft tissues are nothing but mammalian tissue.
Mineralized and calcified in the sense in addition to principle protein Collagen and other proteins
Glycoprotein and Polysaccharides comprising about 50% of the volume, the major constituent of
bone is Calcium Phospate, in the form of crystalline carbonate apatite, similar to naturally
occurring minerals.
Bones:
Skeletal structures are adapted to support musculoskeletal loads. The structural properties
and failure force of skeletal structure is well adapted to functional loads. The primary
responsibility of the skeleton is to provide structural support for the body. In this role, the
skeleton is the basis of posture, opposes muscular contraction resulting in motion, withstands
functional load bearing function and protects internal organs.
Bones are rigid organs that forms part of the endoskeleton of vertebrates. They function
to move, support and protect the various organs of the body, produce red and white blood cells
and store minerals. Bone tissue is a type of dense connective tissue. Because bones come in a
variety of shapes and have a complex internal and external structure they are light weight, yet
strong and hard, in addition to fulfilling this many other functions. One of the types of tissues
that makes up bone in is the mineralized Osseous tissue, also called bone tissue. This gives its
rigidity and a honey comb like three dimensional internal structure. Other types of tissues found
in the bone includes bone marrow, endosteum and periosteum, nerves, blood vessels and
cartilage. Generally, adults have 206 bones and infants have about 300 bones. The Longest bone
found in humans is thigh bone called Femur.
Definition and properties:
Bone is an anisotropic, heterogeneous, inhomogeneous, nonlinear, thermorheologically,
complex viscoelastic material. It exhibits electromechanical effects, presumed to be due to
streaming potentials both in vivo and in vitro when wet. It exhibits piezoelectric properties in dry
state.
Composition of Bone:
The composition of bone depends on a large number of factors such as species, which
bone, location from which the sample is taken, age sex, type of bone tissue. By volume, rough
estimate for overall composition is one third of Apatite crystallites, one third of Collagen and
other organic components and one third of water.
Composition of human bones is given as
1) water 25-30%
2) Minerals 60-70% (resists compression)
Calcium phosphate 85%
Calcium carbonate 10%
Calcium fluoride 2-3%
Magnesium fluoride 2-3%
3) Protein(Collagen) 5-15% (resists tension)
Bone is a composite material composed of 66% hydroxy apatite (HA)crystals and 33%
type I Collagen fibrils (by dry weight). HA crystals are strong and stiff but brittle, collagen
prevents brittle cracking
Characteristics:
The primary tissue of bone , osseous tissue is a relatively hard and light weight composite
material formed mostly of calcium phosphate in the chemical arrangement
Termed calcium hydroxyl apatite( this is the osseous tissue that gives bones this rigidity)
It has relatively high compressive strength but poor tensile strength of 104-121 Mpa, meaning it
resists pushing forces well, but not pulling forces. While bone is essentially brittle, it does have a
significant degree of elasticity, contributed chiefly by collagen. All bones consists of living cells,
embedded in the mineralized organic matrix that makes up the osseous tissue.
Functions of Bones:
Bones have nine main functions. They are given as follows,
*Mechanical protection:
Bones can serve to protect internal organs, such as the skull protecting the brain or ribs
protecting the heart and lungs.
*Shape:
Bones provide a frame to keep the body supported.
*Movement:
Bones, Skeletal muscles, Tendons, Ligaments and Joints function together to generate
and transfer forces so that the individual body parts or the whole body can be manipulated in 3D
space.
*Sound Transduction:
Bones are important in the mechanical aspect of hearing.
*Blood Production:
The marrow, locating within the medullary cavity of long bones and interstices of
cancellous bone, produces blood cells in a process called haemato poiesis.

*Metabolism:
1) Mineral Storage:
Bones act as reserves of minerals important for the body, most notably calcium and
phosphorus.
2) Growth factor Storage:
Mineralized bone matrix stores important growth factors such as insulin. Like growth
factors, transforming growth factor, bone morphogenic proteins and others.
3) Fat Storage:
The yellow bone marrow acts as astorage reserve of fatty acids.
*Acid Base Balance:
Bone offers the blood against excessive pH changes by absorbing or releasing alkaline
salts.
*Detoxification:
Bone tissues can also store heavy metals and other foreign elements removing them from
the blood and reducing their effect on other tissues. These can later be gradually released for
excretion. Also they contain yellow bone marrow.
Types of Bone:
1) Cortical bone
2) Trabecular bone

Compact / Cortical Bone:
The hard outer layer of bone is composed of compact bone tissue, so called due to its
minimal gaps and spaces. This tissue gives bones their smooth, white and solid appearance and
accounts for 80% of the total bone mass of an adult skeleton. It is also referred to as dense bone.
The basic first level structure of cortical bone are Osteons. It is found in the shaft of long bones.
Here blood is surrounded by bone.
Modulus, E ~ 18 GPa
Porosity ranges from 5% to 30%
Trabecullar /Cancellous Bone:
Filling the interior of the organ is the trabecular bone tissue, which is composed of a
network of rod and plate like elements that make the overall organ lighter and allowing room for
blood vessels and marrow. It accounts for the remaining 20% of total bone mass, but has nearly
ten times the surface area of compact bone. It is found in the end of long bones in vertebrae and
in flat bones like the pelvis. Here bone is surrounded by blood.
Modulus, E ~ 1 GPa
Porosity ranges from 30% to 90%
Individual Bone Structure:
Bone is not a uniformly solid material, but rather has some spaces between its hard
elements. It is composed of a cellular component and an extra cellular matrix. The cellular
component is made of Osteoblasts - bone forming cells, Osteoclasts - bone destroying cells and
Osteocytes bone maintaining cells which are inactive Osteoblasts trapped in the extracellular
matrix. The matrix which is responsible for the mechanical strength of the bone tissue is formed
by an organic and a mineral phase of hydroxy-apatite crystals. A liquid component is also
present.
In each cubic mm of bone, there are about 25,000 lacunae and one million canaliculi.
Each lacunae contains an Osteocyte (OC) surrounded in bone fluid (BF). Osteocytes are
connected via gap junctions (GJ) in the canaliculi. Bone is removed at the bone surface by
osteoclasts (OCL), the activity of which activates dormant osteoblasts or bone lining cells
(BLC).
At the smallest unit of structure is tropocollagen molecule and the associated apatite
crystallites (abbreviated as Ap).The former is approx. 1.5 by 280nm, made up of 3 individual
left-handed helical polypeptide (alpha) chains coiled into a right handed triple helix . Ap
crystallites are found to be corbonate-substituted hydroxyapatite generally thought to be non
stoichiometric. Crystallites are 4 by 20 by 60 nm in size. This is Molecular level. Next level is
Ultra Structural. In this collagen and Ap are intimately associated and assembled into a micro
fibrilar composite, several of which are then assembled into fibers from approx. 3 to 5
micrometer thick.
Next level is Microstructural. Here fibers are randomly arranged (Woven Bone) [or]
organized into concentric lamellar groups (Osteons) [or] linear lamellar groups (Plexiform bone).
This is level of structure with respect to bone tissue properties. In addition to the differences in
lamellar organization at this level.
There are also 2 different types of architectural structure. The dense type of bone found
for example in the shafts of long bone is known as Compact [or] Cortical bone.
A more porous [or] spongy type of bone is found, for example at the articulating ends of long
tubular bones. This is called Cancellous bone[or] Trabecular bone. It is important to note that
the material and structural organization of Collagen Ap making up Osteonic [or] Harvesian
bone and Plexiform bone are the same as the material comprising Cancellous bone.
Finally, the whole bone itself is constructed of Osteons and partially destroyed Osteons
(called interstitial lamellae) in case of humans [or] of osteons and or plexiform bone in case of
mammals. This is macrostructural level.
Structure of human Femur bone:
A Femur with a cortex of compact bone and medulla of trabecular bone. It consists of a
shaft( diaphysis) with an expansion(metaphysis) at each end. The metaphysic is surrounded by
an epiphysis which is united by a cartilageous growth plate. At the extremity of each epiphysis a
specialized covering of articular cartilage for the gliding surface of the joints. The coefficient of
dry friction between the articular cartilages of the joints is very low and the coefficient of friction
is 0.0026. Hence the cartilage covering makes an efficient joint. The growth plate is a place
where calcification of the cartilage takes place.
The diaphysis is a hollow tube, its wall are composed of dense cortex which is thick
throughout the extent of diaphysis. But, tappers off to become thin shell of metaphysis. The
central space within the diaphysis contains bone marrow, covering the entire external surface of
a mature long bone, except for the articulation is periosteum. The inner layer of the periosteum
contains highly active cells that produce circumferential enlargement. It is called as Osteogenic
layer. After maturity, this layer consists chiefly of capillary blood vessel network. The outer
layer of the periosteum contains collagen and is loosely attached.
The basic unit is the Haversian system[or] Osteon. In the center of an osteon is a artery
or vein which supply blood. These blood vessels are connected by transverse channels called
Volkmanns channel. About two third of the weight of the bone is the inorganic material and the
materials are hydroxyl-apatite, calcium phosphate and small quantity of ion. The rest of the bone
is organic material mainly collagen. The hydroxyl-apatite crystals are arranged along the length
of collagen crystals. Groups of collagen fibers run parallel to each other to form fibers.
Elastic properties:
The elastic properties of the whole bone results from the hierarchical contribution of each
of these levels.
The dense type of bone fond for Example in the shafts and long bone is known as
compact (or) cortical bone.
A more porous (or) spongy type of bone is found, for example at the articulating of long
bones this is called cancellers bone (or) trabulular bone example ribs.
It is important to hate that the material & structural organization of calljen Ap making
up oceanic (or) harersian bone and plexi form bone are the same as the material comprising
cancellas bone.

Finally, we have the whole bone itself Constructed of and partially destroyed
called in (lamellae) in case of humans or of osteans and or plexi form bone in the case of
mammals.
This is macro structural level.
The elastic properties of the whole bone results from the hieraschical contribution
of each of these levels.
Composition of Bone:
The composition of bone depends on a large no of factors.
Species, which bone,location from which the sample is taken, age,sex,type of bone tissue
for example : worsen, cancellaes/cartocal. By volume rough estimate for overall composition is
1/3 rd AP, 1/3
rd
and other organic components,
3
1
rd it
2
0
.
Elastic Properties:
Determination of in vivo elastic modules.
Although bone is a visco elastic material, at the quasi-static strain rates in mechanical
listing and even at the ultrasonic frequency used exptly, it is reasonable first appest to model
cortical bone as an anisotroper, linear elastic solid with hookes low as the appropriate
constitutive example.
Tensor rotation for the equation is written as,
kl cijkl ij e = o ----------------------- (1)
kl ij e , o Second rank stress& infinites final second rank strain centers.
Cijikl Forth rank elasticity lenor. Using reduced rotation, re writing equation (1) as,
cijtj i = o c, j =1 to 6 --------------------------- (2)
Ij stifners coefficient (elastic constants)
The inverse of (ij, the sij are known as complain coefficient.
The anisotropy of cortical bone tissue is described in 2 symmetry arrangements. It is
assumed bone to be transferably isotropic with the bone axis of symmetry as the unique axis of
symmetry. (long yoon,Katz)
Any small difference in elastic Properties below the radial of ( ) axes,due to
the apparent gradient in porosify from the perios teal to the endosteal sides of bone, was due to
the defect did not alter the basic symmetry.
For a transverse isotropic material, the stiffhers matrix (cij) is given by,

( )
(
(
(
(
(
(
(
(

=
66 0000
440 000
00 000
000
000
000
44
33 13 13
13 11 12
13 12 11
C
C
C
C C C
C C C
C C C
cij

Where, C66=1/2 (C11 C12) -------------------- (3)
Cut of 12 non zero coefficient only 5 are independent ( van buskirk,Ashman) they used small
differences in elastic properties below the radial & tangential directions to postulate that bone is
an orthotropic material, this requires that 9/12 non zero elastic constants be independent,
That is,
(
(
(
(
(
(
(
(

=
66
55
44
33 23 13
23 22 12
12 11
00000
0 0000
00 000
000
000
3000
) (
C
C
C
C C C
C C C
C C C
Cij ---------------------------------- (4)

Corresponding matrices can be written for the compliance coefficient the Sij based on the inverse
equation to equation (2).
j Sij i o c = i,j=1to 6 ---------------------------------------- (5)
Where the S
ij
th compliance is obtained by dividing the (C
ij
) stiffness matrix, minus the
11
th
row & j
th
column, by the full(Cij) matrix and vice versa to obtain the Cij in terms of the S
ij
.
Thus Although S
33
=1/E3. Where E
3
is younges modulus in the bone axis direction,
,
33 3
C = c Since C
33
and S
33
are not reciprocals of one another even for an isotropic material. Let
alone for transfers isotropy (or) ortho topic symmetry.

The relationship between the compliance matrix the technical cans tants such as youngs
modulus (E
i
), Shear modulus (C
ri
) poisons ratio (Vij) measured in mechanical tests such as
uniaxial (or) pure shear given in equation (6)
[ Sij] =
(
(
(
(
(
(
(
(
(
(
(
(
(
(

0
1
000
00
1
000
000
1
000
1
000
1
131
123
3 2
23
1
13
3
32
2 1
12
3
31
2
21
1
C
C
E E
V
E
V
E
V
E E
V
E
V
E
V
E
------------------------------------- (6)
Again for an orthotropic material, only 9/12 non zero terms are independent due to the
symmetry of the Sij
3
32
2
23
3
31
1
13
2
21
1
12
E
V
E
V
E
V
E
V
E
V
E
V
= = = ---------------------------------- (7)
For transverse isotopic case, Equation (5) reduces to only (5) independent coefficient. Since,
23 13 32 31 21 12 2 1
V V V V V V E E = = = = =
31 23
G G =
) 1 ( 2
12
1
12
V
E
G
+
= ------------------------------------- (8)
In addition to mechanical tests, ultrasonic wave Propagation techniques have been used
to measure the elastic properties of bone. This is possible since combining Hookes law with
Newtons 2
nd
law results in a wave equation that gives fall relation involving the stiffeners matrix.
PV
2
U
m
= C
mrns
N
r
N
s
U
n
P density of medium
Vwave speed
U,N Unit vectors areas particle displacement wave propagation direction. (Direction
cesires)
Major advertising of ultrasonic measurements over mechanical testing is formers can be
done with specimens to small for the latter technique.
Second, the reproducibility of measurements using former is greater than latter.
Third, adjective full let of either five or 9 coefficient can be measured an one specimen a
procedure not possible with letters.
Haversian Bone:
Also called osteonic. The form of bone found in adult humans and mature mammals
consisting mainly of concentric camellar structures surrounding a centsal canal called haverson
canal.
Also the central portion of the blood stays in the center of the vessel.
This type of flow is laminar flare or
stream line flow.
Parabolic Velocity profile during laminar flow.
When laminar flow occurs, the velocity of flow in the center of the vessel is for greater
than towards outer edge.
The portion of the fluid adjacent to the wall has hardly moved.
The portion slightly away from the wall has moved a smaller distance and the portion in
the center has moved a longer distance.
This effect is called as the parabolic profile of the velocity of blood flow.
The cause for thee parabolic profile is the fluid molecules touching there was hardly
move because of adherence to the vessel wall.
The fluid in the middle of the vessel can move rapidly because of the existence of
sliping molecules in the middle of the vessel.
Turbulent Flow of Blood:-
When the rate of blood flow becomes too great (or) when it passes an obstruction in a
vessel (or) when it make a shape turn (or) when it passes a rough surface, the flow may
become turbulent.
The blood flows cross wise in the vessel as well as along the vessel.
Usually forming whorles in the blood called eddy current.
When the eddy current are farmed, the blood flow with much greater resistance than
when the flow is streamlined, because the eddy act tremendously to the overall friction of
the flow in the vessel.

( )( )
ityofblood Vis
l bloodvesse diameterof Velocity
low Turbulentf
cos

The dense type of bone fond for Example in the shafts and long bone is known as
compact (or) cortical bone.
A more porous (or) spongy type of bone is found, for example at the articulating of long
bones this is called cancellers bone (or) trabulular bone example ribs.
It is important to hate that the material & structural organization of calljen Ap making
up oceanic (or) harersian bone and plexi form bone are the same as the material comprising
cancellas bone.
BIO FLUID MECHANICS
Fluids:
Fluid is a substance which deforms continuously when subjected to shear forces. The
tendency of continuous deformation of a substance is called as fluidity and the act of
continuous deformation of a body is called as flow.
A solid has a tendency to regain to its initial state. On the other hand, a fluid deformed
continuously (or) flows when shear ferce is is applied, then fluid suffers rate of shear strain
(or) strain rate.
Shear stress proportional to rate of shear strain.

dy
du
JXm
J - Shear stress (stress which is applied parallel (or) tangential to a
face of a material)
M - Viscosity of fluid
U - Velocity (or) Velocity gradient
The equation that describes the relationship between stress & strain (or) rate is called as
constitutive equation.
c o E =
dy
du
JXm
This equation is known as Newtons law of viscosity.
Newtonian Fluid:-
The fluid which obeys this law is called as Newtonian fluid. In this equation, M is the
slope of the Hookes law of elasticity for solids.
Example:- Water, Molten metals.
Hookes Law Newtons Law
Stress strain shear stress shear strain
Young s modules modulus of elasticity
Shear stress rate of shear strain
Viscosity


dy
du
JX
Viscosity:-
It is an internal property of a fluid material which offers resistance to flow. Viscosity is
denoted by the symbol n and is measured in units of pas
V
ga
9
) ( 2
2
A
=
V Velocity
a radius
g acceleration due to gravity
p difference in density between sphere and liquid.
Properties of Viscosity:-
- Varies with temperature
- Independent of pressure but liquid under extreme pressure of the experience an increase
in viscosity.
Types of viscosity:-
1. Absolute / dynamic viscosity
2. Kinematic Viscosity
Effects of viscosity:-
The effect of viscosity in a fluid flow will give rise to shear stress which oppose the
motion of the neighbouring element in a flow. The velocity gradient depends up on boundary
Condition. The velocity of a fluid in contact with boundary must be same as that of the
boundary.

For example , the viscosity of a fluid flowing through the stationary pipe should be zero
at the wall. This is the condition of No Slip or No Slip Condition

Non Newtonian fluid:-

Viscosity is not constant. Any fluid that does not obey the Newtons law of Viscosity is
called as Non Newtonian fluid. Here, the slope of shear stress Vs strain rate will not be a
constant. Example is liquids in which fine pa
Liquids in which fine particles are suspended, slurries and paste.






Classification of fluids:-
1. Visco elastic fluids
- Shear thinning fluids (Pseudo Plastic fluids)
- Shear thickening fluids
2. Visco plastic fluids
3. Thexotrophic fluids
4. Pheopectic fluids
Visco Elastic Fluids:-
It comprises of 2 components i.e. viscosity and elasticity. A typical example for such a
type is blood viscosity is related to the energy dissipate during flow due to sliding and
deformation of RBC and red blood aggregate, where as the elasticity is related to the energy
stared during flow due to orientation and deformation of RBC.
Shear Thinning Fluids (Pseudo Plastic Fluids)
When viscosity decreases with increase in shear rate, the fluid is said to be shear
thinning fluids also called as pseudo plastic fluids
Example: - Latex paint
Many shear thinning fluids will exhibit a Newtanian behavior at extremely high shear
rate.
Shear Thickening Fluids:
When viscosity increaces with increase in shear rate, the fluid is called as Shear
thickening fluids
Example:- Clay slurries.
Shear Thinning fluid
Viscoplastic Fluids:-
This is a fluid which will not flow when a small stress is applied. The shear stress must
exceed a critical value to for a fluid flow.
Example:- Tooth paste
It behaves like solids, when the applied shear stress is less than yield stress.
Thexotrophic Fluids:-
It is the property of some non-newtanian fluids to show time dependent change in
viscosity.
Example:- Gells and colloids
Rheopectic Fluids
The langerr the fluid undergoes shearing force, the higher is its viscosity.
Example:- Gypsum paste and printer inks thickens (or) Solidifies when shaken.
Bio Fluid Mechanics:
It is the study of certain clean of biological problems from a fluid mechanics point of
view. It does not involve any new development of the general principles of fluid mechanics but it
does involve some new applications of the method of fluid mechanics.
The flow behavior of biological fluids in living organisms plays a crucial role in
determining the state of the tissue through which they flow.
Bio fluid mechanics study of fundamental of biological fluid flow is extremely important
for the understanding of how changes in how behaviors which living tissue may be affect both
the fluid and the tissue.
Fluids in living tissues include blood, waters air and body fluids of animals as well as the
fluids in plants.
The measurement and balance of forces in resting fluids and fluids in motion are away
the basic subjects for research.
Bio fluid mechanics field where importance to the field of bio engineering has increased
over the last two decades pharmaceuticals bio materials and non invasive diagnostic and surgical
procedures create in the fluid mechanics of bio fluids. Bio fluid Mechanics is a complex field
including important areas of study blood flow & cardio vascular diseases.
Complex hemodynamics play a critical role in the development of other osclerise process
of using also other diseases.
It is important to understand the forces and movement of blood cells and whole blood as
under tandins the blood in the cardiovascular circulators sustain of the human body.
V scarity and flow behaviors changes medicatron can influence flow behaviors .
Heamoclo strange influence on creation of ancymes & varicose veins.
Verbal wall structure (geometry, elasticity) determines flow behaviors.
Fluid Dynamics Factors:
Flow rate ratio, pressure & velocity gradients, & flow behaviors, velocity distribution,
shear stress pm the wall and on blood cells.
These mechanical factors are longly responsible for the deposit of blood cells and lipds a
leading course of artho. These depends and found predetermainds at arterial blends & where
blood flow is distributed where a secondary flow is created (or) where flow
Human body is a complex sustain that requires materials such as air,water,minerals and
nutrients for survival and function. Upon in these materials have to be trans ported & distributed
around the body as regarding.
The bio transport and distribution procedures involve interactions with membranes cells
tissues and organs comprising the body.
Subsequent to cellular metabolism in the tissues, waste by products have to be
transported to the extency organs for synthesis & remade.
In addition to these functions, bio transport systems and proceder.
Are regarding for homeostasis and for
( homeostasis physiological regulation example maintenance of
P
H & body
temperature)
Enabling the movement of immune substances to aid in bodys defense and recovery
from infection & injury.
In of ear,fluid transport enables hearing and motion sensing.
- In human body multiple types of fluid dynamic systems that operate at multiple
& widely disparate scales at various levels such as micro,macro,nano,pice &
soon.
Ex.cell,tissue (macro,organs (Macro)
- Transport at micro, nano & pice include, Channeling,binding,Signaling,
endocyosis & soon.
- Tissue constitute organs, organs as systems perform various functions.
Ex. Cardio vascular system consist of the heart blood vesels (astesies,artei,Veins
& capillaries ) lymphatic vesels and the lungs. Its function is to provide adequate
blood flow & resultant the flow as required by the various organs of the blood.
Flow Properties of Blood:
Blood :An out line
Blood is a marvels fluid that neutrinos life, contains many enzymes and hormons &
transport oxygen, & Co2 between lungs & cells of the tissues.
Human blood is a suspension of cells in an aqueons solution of electrolytes and non
electrolytes.
By centilusation, the blood is separated into plasma and cells.
Plasma is about 90% water by weight, 7% Plasma protein,1% inorganic substrains,and
1% other organic substances.
Cellular contents are essentially all erthyocytes (or) RBC with WBC of variance
categories which makes < 1/600 of total cellular volume and plate lets less than 1/800 of the
cellular volume.
Normally RBC occupy above 50% of blood volume.They are small and number about 5
million/mm
s

The normal white cell count is considered to be from 5000 to 8000 /mm
3
and plate lets
from 2,50,000 to 3,00,000/mm
3
.
Red cells are disk shaped with a diameter of 7.6mm and thickness 2.8mm.
White cells are more rounded and are of many types.
Plate lets are much smaller and have a diameter of about 2.5mm.
If the blood is allowed to clot, a straw colored fluid called serum appears I the plasma
when the clot spontaneously contracts. Serum is similar to plasma in composition but which one
important colloidal protein, fibrinogen, removed while forming the clot. Most of the platelets are
enmeshed in the clot.
The SP gianty of red cells is about 1.10, plasma is 1.03,when plasma was tested in a
viscometer, it was found to behave like a Newtonion character was revealed.
The blood viscosity varies with the hematocrit, H, the percentage of the total volume of
blood occupied by and with disease start, if any.
The shear rate is defined as the relative velocity of the walls divided by the width of the
gap.
Vanishing shear rate, the blood behaves like an elastic solid.
Existence of a yield stress is meant that no sensible flow can be decided in a fluid under a
shearing stress in a finite interval of time (15mts). It is difficult to determine the yield stressof
blood as 0 is compounded by fact that experiment for very small shear rate is necessarily a
transient one, if executid infinte interval of time.
For blood the analysis is further complicated by the migration of red cells away from the
walls of the walls of the viscometer when is smaller than about 15.
Cokelets analysis took these factors into account.
For a small shear rate say <10s
-1
and for hemtocrit less than 40% is described
approximately by carsons equation.
qo + =
y
t t --------------------- (1)

Shear stress
Shear strain rate
Constant
Constant interpredid as the yield stress in shear.
Is very small of order of 0.05 dyn/cm
2
, and is almost independent of temperature in range of 10-
37 influenced by d macro molecular composition of the suspending fluid.
A suspension of red cells in sline plus albumin has zero yield stress, a suspension of red
cells in plasma containing fibrinogen has a finite yield stress.
At high shear tate, whole blood behave like a newtonian fluid with a constant coefficient
of viscosity, In other words for sufficiently large values of we have
Formula:
As the shear rate increases from o to a high value, there is a transition region in which
stress strain rate relation changes from equation (1) to equation (2)
The range of caliding of equation (1) is smaller for higher hematocrit and the transition
region from equation (1) to equation (2) is larger for higher hematocrit.
This outline shows major features of blood flow in a viscameles of the conette flow type.
The width of the channel in which blood flows in these testing machines is much larger
than the diameter of the RBC. The blood is considered as a homogeneous fluid.
All our blood vessels are not so large
In human body, there are about 10
10
blood vessels where dia is same as that of RBC
ranging from 4-10mm. Ther are capillary blood vessels.
When blood flows in capillary blood vessels, the red cells have to be squeezed and
deformed, and more in single. In this case, blood is considered as non homogeneous fluid of
atleast two phases, one phase being blood cells, the other being the plasma.
Other Aspect of Blood Rheologi:
Actually the rheological properties of blood are more complex. If blood is tested
dynamically, it reveals all features of visco elasticity.
The visco elastic properties / characteristics of blood change with the level of strain hence
it is thixotropic. Blood rheology is significant in clinical applications to diagnosis of diseases,
pathology (or) bio chemical studies.

Types Of Fluid Flow:-
The flow of fluids can be classified into 2 types. They are laminar and turbulent.
Definition:-
Laminar flow is the one in which path taken by the individual particles do not cross one
another and move along well defined directions. This type of flow is called laminar (or) stream
line flow (or) viscous flow.
Example:- flow through a capillary tube, flow of blood in veins and arteries.
Turbulent Flow:-
The turbulent flow is characterized by no well defined movement. Moreover the particles
cross each other in the path making the flow turbulent.
Factors Deciding Flow:
The factors deciding whether the flow in laminar (or) turbulent are.
1. Velocity
2. Viscosity
3. Diameter
4. Density
- At low velocity, the fluid may be laminar but at high velocity, the tendency of the fluid
particles is to mix and then turbulent
- Low density fluids are more likely to flow laminar than high density fluids. This is
because exchange of momentum and hence effectiveness of mixing is less for low density
fluids.
- Flow is laminar if velocity is low, diameter is small, low density and high viscosity
Reynolds Number:-
It is the ratio of inertial force to viscous force. It is given by Re
Reynolds number, Re =

udp

U Velocity
D diameter of tube
P Density
Viscosity
If o Re1, Then Viscous is high because reynolds number is inversely proportional,
then the flow is laminar creeping of flow. This flow is entirely dominated by viscosity.
- When 1Re2000, then fluid flow starts moving slowly making laminar flow, viscosity
and acceleration are also present.
- When2000 < Re10,000, then transition from laminar flow to turbulent flow occurs
- If Re 10,000,then flow will be turbulent ( no viscosity)
Critical Reynilds Number:-
The reynold,s number at which the flow changes from laminar to turbulent is known as
critical Reynolds number.
Critical Velocity:-
The velocity of a fluid comes pending to critical reynolds number is called as critical
Velocity
Laminar Flow Of Blood In A Tube:-
Let us consider the blood flow in a circular cylindrical tube.
Assume
Flow to be laminar, that is not turbulent
Long tube
Study flow i.e conditions of flow change neither with the distance along the tube,
nor with the time.
Polar coordinates are used to solve the problem.
The polar axis coincides with the axis of the cylinder.
The boundary condition is that the blood adheres to the tube wall ( No Slip
Condition)
The boundary condition is axis symmetric, the flow is also axis symmetric and the
only non vanishing component of velocity is u( r) in the axial direction.
U (r) Function of r alone and not of x

LAMINAR FLOW OF BLOOD IN A TUBE:
Let us consider the flow of blood in a circular cylindrical tube. we shall assume the flow
to be laminar that is not turbulent.
We shall also assume that the tube is long and the flow change neither with the time.
Under these assumptions we can analyze the flow with a simple adhoc approach, presented
below.
We shall use polar coordinats for this problem. The polar axis co insides with the axis of
the cylinder. The flow obeys navier strokes equations of motion of an incompressible fluid. The
boundary condition is that blood adheres to the tube wall (no slip condition).
Since the boundary condition is axi symmetric, the flow is also axisymmetric and the
only non vanishing component of velocity is u(r) in the axial direction, u(r) is a function of r
alone and not of x.
Laminar Flow:-
The flow of a fluid is said to be laminar if the flow is characterized by the fluid particles
staying in the laminar. The shape of the lamina depends on the boundaries of passage.
Example:-
1. If how takes place between 2 parallel flat plates, the laminar must be plane sheets parallel
to each other.
2. If the flow takes place through a round pipe, the laminar must be concentric cylindrical
plates.
Isolate a cylindrical body of fluid of radius r and unit length in axial direction. This body is
subjected to a pressure P
1
on the left hand end and P
2
on the right hand end, also shear stress
on the circum ferential surface.

dx
dp
P P
p p
dx
dp

=
=
2 1
1 2

This acts on an area

and c acts an area

By equilibrium balance of force
=

dx
dp

=
dx
dp r
2
(strokes law)
The constitutive equation that relates the shear stress J to the velocity gradient for Newtanian
fluid,we have
dr
du
j =
Therefore, substituting for j in above equation
dr
dp r
dr
du
2
=
Since L
Hs
is a function of r RHS must be also Hence dp/dr cannot be a function of r
But, Since the fluid does not move in radial direction, the pressure in the radial direction must be
balanced and p cannot vary with r Hence the pressure gradient dp/dx must also be a constant.
Integrating above equation, gives
B
dr
dp r
u + =
4
2

Where B integration constant
B can be determined by no slip boundary condition. U=0 when r=a gives
dr
dp a
B
4
2

=
substituting above condition gives the solution.
dr
dp
r a u ) (
4
1
2 2
=

Which shows velocity profile is a parabola.
Flow rate:-
The rate of flow through the tube can be obtained by integrating velocity times area over the tube
cross section.


Mean Velocity:-
Division of the rate of flow by the cross sectional area of the tube gives the
mean velocity of flow,

2
a
u
m
t
u
=
(

=
(

=
+
=

=
(

|
.
|

\
|

=
=
+
}
}
}
}
4 2 2
4 2 4
2
1
) (
4
2
) (
4
1
2
2
4 4
0
4 2
2
1
0
3 2
2 2
0
*
0
*
a a
dx
dp
r r
a
dx
dp
n
r
dr r
dr r r a
dx
dp x
dr r a
dr
dp
r
urdr
a
n
n
a
a
a

t u
t u
L
p a
dx
dp a
dx
dp a
A
=

t
u

t
u

t
8
8
4
4 2
4
*
4
u rate of flow
2
a t cross sectional area of tube
dx
dp a
u
m
8
2

=
Resistance of Flow:-
Resistance to blood flow can be calculated from the measurement of blood flow and
pressure difference in the vessel. If the pressure difference between 2 points in a vessel 1mmH
g

and

flow is 1ml/second, the resistance is said to be peripheral resistance unit.
Iu
VP
V=IR R=
I
V


4
8
a
p
R
t

u
=
A
=
Parabolic Velocity Profile During Laminar Flow:-
When laminar flow occurs the velocity of flow in the centre of the vessel is for
greater than that towards the outer edges. The portion of the fluid adjacent to the wall has hardly
moved. The portion slightly away from the wall moves a smaller distance and the portion at the
centre of the wall moved a long distance. This effect is called parabolic effect for velocity of
blood flow.
Cause for The Parabolic Profile:-
The fluid molecules torching the wall hardly move because of adherence to the
vessel wall. The next layer of molecules flips over these.
Applications Of Bio Fluid Mechanics
- Bio fluid Mechanics helps us to understand
- Blood flow within the cardiovascular system
- Air flow within the airway and lungs.
- Removal of waste products via the kidney and urinary system.
- Principle of movement of extensive water within the cartilage in the articulating joints
such as the knee, which helps in standing, walking and running.
- Design of artificial hearts, ventricular assist devices, heart valves, artificial arteries,
mechanical ventilators, heart lung machines, artificial kidneys, Iv pumps and so on.

UNIT II
Heart valves:
Heart valves are very important, as they prevent the back flow of blood, which ensures
the proper direction of blood flow through the circulatory system.
a. Without these valves the hear would have to work. Much harder to push
blood into adjacent champers.
The heart is composed of 4 valves
1. Tricuspid
2. Pulmonary
3. Mitral
4. Aortic
Heart Valve Problems:
These are numerous complication and disease of the heart valves that prevent the
proper flow of blood.
Heart valve diseases fall into 2categories
o Stenosis
o Incompetence

The stenotic heart valve prevents the valve from opening fully due to stiffened valve
tissue. Hence there is more work required to push blood through the valve.
The incompetent valves cause inefficient blood circulation by permitting back flow of
The heart is a vital part of the human anatomy because it functions as a pump to
circulate blood throughout the body.
Heart valves allow the heart to pump blood to specific locations efficiently.
These valves are phone to disease and malfunction, and can be replaced by prosthetic
Heart valves
Heart valves are designed to fit the peculiar requirements of blood flow through the
specific chamber of the heart, with emphasis on producing more central flow and
reducing blood clots.
Introduction to Prosthetic Heart Valves:
Background
Implantation of prosthetic cardiac valves to treat hemodynamically significant valvular disease
has become an increasingly common procedure. It is estimated that more than 60,000 patients
per year are undergoing heart valve replacement in the United States. Replacement of diseased
valves reduces the morbidity and mortality associated with native valvular disease but comes at
the expense of risking complications unique to the implanted prosthetic device. These
complications include primary valve failure, prosthetic valve endocarditis (PVE), prosthetic
valve thrombosis (PVT), thromboembolism, and mechanical hemolytic anemia. In addition,
anticoagulant-related hemorrhage may occur.
Emergency physicians must be able to rapidly identify patients at risk and begin appropriate
diagnostic testing, stabilization, and treatment. Even when promptly recognized and treated,
acute prosthetic valve failure is associated with a high mortality rate.
More than 80 models of artificial valves have been introduced since 1950. In clinical emergency
practice, however, it is necessary to be familiar with a few basic types. Prosthetic valves are
either created from synthetic material (mechanical prosthesis) or fashioned from biological tissue
(bioprosthesis).
Blood interfacing implants:
Blood comes in contact with foreign materials for a short term in extra corporeal devices
such as dialysers, blood oxygenators, ventricular assist devices and catheters. Long term vascular
implants include heart valve prostheses, vascular grafts and cardiac pacemakers.
Primary requirement for biomaterials for long term implants are biocompatibility, non
toxicity and durability. Also, material should be non irritating to the tissue, resistant to platelet
and thrombus deposition, non degradable in the physiological environment, and neither absorb
blood constituents for release foreign substances into the blood stream.
In addition, design considerations include that the implant should mimic the function of
the organ that it replaces without interfering with surrounding anatomical structures and must be
of suitable size and weight. Biomaterials chosen must be easily available, inexpensive, easily
machinable, sterilizable and have a strong life. Biomaterial chosen for valve is such that it is
durable and should not fail under fatigue stress after implantation in a patient.
Artificial Heart Valve:
An artificial heart valve is a device implanted in the heart of a patient with heart valvular disease.
When one of the four heart valves malfunctions, the medical choice may be to replace the natural
valve with an artificial valve. This requires open-heart surgery.
Valves are integral to the normal physiological functioning of the human heart. Natural heart
valves are evolved to forms that perform the functional requirement of inducing unidirectional
blood flow through the valve structure from one chamber of the heart to another. Natural heart
valves become dysfunctional for a variety of pathological causes. Some pathologies may require
complete surgical replacement of the natural heart valve with a heart valve prostheses.
Types of heart valve prostheses:
There are two main types of artificial heart valves: the mechanical and the biological valves.
Mechanical Valves:
A mechanical artificial heart valve with a pivoting disc. Mechanical heart valves (MHV) are
prosthetics designed to replicate the function of the natural valves of the human heart. The
human heart contains four valves: tricuspid valve, pulmonic valve, mitral valve and aortic valve.
Their main purpose is to maintain unimpeded forward flow through the heart and from the heart
into the major blood vessels connected to the heart, the pulmonary artery and the aorta. As a
result of a number of disease processes, both acquired and congenital, any one of the four heart
valves may malfunction and result in either stenosis (impeded forward flow) and/or backward
flow (regurgitation). Either process burdens the heart and may lead to serious problems including
heart failure. A mechanical heart valve is intended to replace a diseased heart valve with its
prosthetic equivalent.
Three main designs of mechanical valves exist: the caged ball valve, the tilting disc
(single leaflet) valve, and the bileaflet valve.

Fig. Caged Ball Valve Mitral
The first artificial heart valve was the caged-ball, which utilizes a metal cage to house a
silicone elastomer ball. When blood pressure in the chamber of the heart exceeds that of the
pressure on the outside of the chamber the ball is pushed against the cage and allows blood to
flow. At the completion of the heart's contraction, the pressure inside the chamber drops and is
lower than beyond the valve, so the ball moves back against the base of the valve forming a seal.
Caged ball valves have a high tendency to forming blood clots, so the patient must have a high
degree of anti-coagulation. Soon after came tilting-disc valves. Tilting disk valves have a single
circular occluder controlled by a metal strut. They are made of a metal ring covered by a ePTFE
fabric, into which the suture threads are stitched in order to hold the valve in place. The metal
ring holds, by means of two metal supports, a disc which opens and closes as the heart pumps
blood through the valve. The disc is usually made of an extremely hard carbon material
(pyrolytic carbon), in order to allow the valve to function for years without wearing out. The
Medtronic-Hall model is the most common tilting-disc design in the US. In some models of
mechanical valves, the disc is divided into two parts, which open and close as a door.
Bileaflet valves, which consist of two semicircular leaflets that rotate about struts attached to the
valve housing. Bileaflets are vulnerable to backflow and so they cannot be considered as ideal.
Bileaflet valves do, however, provide much more natural blood flow than caged-ball or tilting-
disc implants. One of the main advantages of these valves is that they are well tolerated by the
body. Only a small amount of blood thinner is needed to be taken by the patient each day in
order to prevent clotting of the blood when flowing through the valve.
These bileaflet valves have the advantage that they have a greater effective opening area. Also,
they are the least thrombogenic of the artificial valves.
Mechanical heart valves are today very reliable and allow the patient to live a normal life. Most
mechanical valves last for at least 20 to 30 years.
Advantages
The main advantages of mechanical valves are their high durability. Mechanical heart valves
are placed in young patients because they typically last for the lifetime of the patient.
Disadvantages
The main problem with all mechanical valves is the increased risk of blood clotting. When
blood clots of any kind occur in the heart, there is a high probability of a heart attack or stroke.
As a result, to prevent blood clots, mechanical valve recipients must take anti-coagulant drugs
(sodium warfarin) chronically, which effectively makes them borderline hemophiliacs. The anti-
coagulant used causes birth defects in the first trimester of fetal development, rendering
mechanical valves unsuitable for women of child-bearing age. Mechanical valves are suitable for
people who do not want additional valve replacement surgery in the future.

Fig. Tilting disc valve Mitral models

Fig. Bileaflet Valves


Biological valves
PROSTHETIC TISSUE VALVES
Prosthetic tissue valves can be broken into two groups: human tissue valves, and animal tissue
valves. Both types are often referred to as bioprosthetic valves, which hold many advantages
over mechanical valves. The design of bioprosthetic valves are closer to the design of the natural
valve. Bioprosthetic valves do not require long-term anticoagulats, have better hemodynamics,
do not cause damage to blood cells, and do not suffer from many of the structural problems
experienced by the mechanical heart valves.
Human Tissue Valves
Human tissue valves fall into two categories: Homografts, which are valves that are
transplanted from another human being, and Autografts, which are valves that are transplanted
from one position to another within the same person.
First biological valves implanted were homografts (i,e) valves explanted from cadavers within
48 hours of death. Preservation of valves included various techniques of sterilization, freeze
drying and immersing in antibiotic solution. A homograft is a valve that is transplanted from a
deceased person to a recipient. A recipient has minimal problems with valve rejection and they
do not require immune suppressive therapy. A homograft that has been donated must be
cryopreserved in liquid nitrogen until it is needed. In cases where the valve implants fit the
dimensions of the patient correctly, homografts tend to have good hemodynamics and good
durability. However, it is not clear whether homografts have better hemodynamics or durability
than animal tissue valves. Also it is limitedly available.
Autografts are valves taken from the same patient that they are implanted into. The most
common autograft procedure is the Ross procedure, which is used in patients with diseased aortic
valves. The dysfunctional aortic valve is removed and the patient's pulmonic valve is then
transplanted to the aortic position. A homograft pulmonic valve is usually used to replace the
patients pulmonic valve. The Ross procedure allows the patient the advantage of receiving a
living valve in the aortic position. The long term survival and freedom from complications for
patients with aortic valve disease are better with the Ross Procedure than any other type of valve
replacement. After 20 years, only 15% of patients require additional valve procedures. In cases
where a human pulmonary artery homograft is used to replace the patients pulmonary valve,
freedom from failure has been 94% after 5 years time, and 83% at 20 years. The tissues of the
patients pulmonary valve have not shown a tendency to calcify, degenerate, perforate, or
develop leakage.
The Ross procedure requires a high level of technical skill on the part of the surgeon. The
pulmonic valve and the pulmonary homograft must be sculpted to fit the aortic root. Many
patients have small amounts of aortic regurgitation, which in some cases is severe enough to
merit a second operation for valve replacement. Other possible complications could include
stenosis, right-sided endocarditis, as well as the usual complications of valve replacement.
Animal Tissue Valves
Biological valves are valves of animals, like pigs, which undergo several chemical procedures
in order to make them suitable for implantation in the human heart. The porcine (or pig) heart is
most similar to the human heart, and therefore represents the best anatomical fit for replacement.
Implantation of a porcine valve is a type of Xenotransplantation, or Xenograft, which means a
transplant from one species (in this case a pig) to another. There are some risks associated with a
Xenograft such as the human body's tendency to reject foreign material. Medication can be used
to retard this effect, but is not always successful.
Another type of biological valve utilizes biological tissue to make leaflets that are sewn into a
metal frame. This tissue is typically harvested from the Pericardial Sac of either Bovine (cows)
or Equine (horses). The pericardial sac is particularly well suited for a valve leaflet due to its
extremely durable physical properties. This type of biological valve is extremely effective means
of valve replacement. The tissue is sterilized so that the biological markers are removed,
eliminating a response from the host's immune system. The leaflets are flexible and durable and
do not require the patient to take blood thinners for the rest of their life.
Bioprosthetic (xenograft) valves are made from porcine valves or bovine pericardium..
Animal tissue valves are often referred to as heterograft or xenograft valves. These valves are
most often heart tissues recovered from animals at the time of commercial meat processing. The
leaflet valve tissue of the animals is inspected, and the highest quality leaflet tissues are then
preserved. They are then stiffened by a tanning solution, most often glutaraldehyde. The most
commonly used animal tissues are: porcine, which is valve tissue from a 7 to 12 months old pig,
and bovine pericardial tissue, which is from a cow.
In Porcine valves, the valve tissue is sewn to a metal wire stent, often made from a cobalt-
nickel alloy. These stents helps to provide support to preserve the valve in its natural shape and
to achieve normal opening and closing. The wire is bent to form three U-shaped prongs. A
Dacron cloth sewing skirt is attached to the base of the wire stent, and then the stents themselves
are also covered with cloth. Porcine valves have good durability and usually last for ten to fifteen
years.
Bovine pericardial valves are similar to porcine valves in design. The major difference is the
location of the small metal cylinder which joins the ends of the wire stents together. In the case
of pericardial valves, the metal cylinder is located in the middle of one of the stent post loops.
Pericardial valves have excellent hemodynamics and have durability equal to that of standard
porcine valves after 10 years.
Both the porcine and bovine pericardial valves are stented valves. The metal stent in these
valves takes up room which could be available for blood flow. Stentless valves are made by
removing the entire aortic root and adjacent aorta as a block, usually from a pig. The coronary
arteries are tied off, and the entire section is trimmed and then implanted into the patient. The St.
Jude Toronto Stentless Porcine Valve (SPV) is one such valve. It appears to have excellent
hemodynamics, and a significant decrease in the thickness of the heart has been observed after
the valve is implanted. However, the valve is extremely difficult to implant, and it is still too new
to have any valid data accounting for durability. Other biomaterials for bioprosthese are facsia
lata tissue which is prone to deterioration and human durameter tissue which lacks commercial
availability.
The most common cause of bioprosthesis failure is stiffening of the tissue due to the buildup
calcium. Calcification can cause a restriction of blood flow through the valve (stenosis) or cause
tears in the valve leaflets. Since younger patients have a greater calcium metabolism,
bioprostheses tend to last best in senior citizens. Once a bioprosthesis is implanted, the valve
itself does not require any type of anti-coagulant drugs. Its degeneration is simply a gradual
process, as it grows with the body. Its average lifetime is about 10 years before replacement is
necessary. Generally attributed to the tissue fixation process.

Fig. Mitral bioprosthesis (porcine)

Fig. Aortic bioprosthesis (porcine)
Pericardial valves include the Perimount series valves. More recently, stentless porcine
valves have been used. They offer improved hemodynamics with a decreased transvalvular
pressure gradient when compared with older stented models.


Homografts or preserved human aortic valves are used in a minority of patients.
Current mechanical heart valves all require lifelong treatment with anticoagulants (blood
thinners), e.g. warfarin, which requires monthly blood tests to monitor. This process of thinning
the blood is called anticoagulation. Tissue heart valves, in contrast, do not require the use of
anticoagulant drugs due to the improved blood flow dynamics resulting in less red cell damage
and hence less clot formation. Their main weakness however, is their limited lifespan.
Traditional tissue valves, made of pig heart valves, will last on average 15 years before they
require replacement
Pathophysiology
Valve failure
Primary valve failure may occur abruptly from the tearing or breakage of components or from a
thrombus suddenly impinging on leaflet mobility. More commonly, valve failure presents
gradually from calcifications or thrombus formation. Bioprostheses are less thrombogenic than
mechanical valves, but this advantage is balanced by their diminished durability when compared
with mechanical valves. Although 30-35% of bioprostheses will fail within 10-15 years, it can be
anticipated that most mechanical valves will remain functional for 20-30 years.
Stenosis or incompetence of prosthetic valves occurs and may be due to a tear or perforation of
the valve cusp, valvular thrombosis, pannus formation, valve calcification, or stiffening of the
leaflets.
Primary failure of mechanical valves may be caused by suture line dehiscence, thrombus
formation, or breakage or separation of the valve components. Acute valvular regurgitation or
embolization of the valve fragments may result.
When the mitral valve acutely fails, rapid left atrial volume overload causes increased left atrial
pressure. Pulmonary venous congestion and, ultimately, pulmonary edema occur. Cardiac output
is decreased because a portion of the left ventricular output is being regurgitated into the left
atrium. The compensatory mechanism of increased sympathetic tone increases the heart rate and
the systemic vascular resistance (SVR). This may worsen the situation by decreasing diastolic
filling time and impeding left ventricular outflow, thereby increasing the regurgitation.
Acute failure of a prosthetic aortic valve causes a rapidly progressive left ventricular volume
overload. Increased left ventricular diastolic pressure results in pulmonary congestion and
edema. The cardiac output is reduced substantially. The compensatory mechanism of an
increased heart rate and a positive inotropic state, mediated by increased sympathetic tone, partly
helps to maintain output. However, this is hampered by an increase in SVR, which impedes
forward flow. Increased systolic wall tension causes a rise in myocardial oxygen consumption.
Myocardial ischemia in acute aortic regurgitation may occur, even in the absence of coronary
artery disease.
Biological prosthetic valves often slowly degenerate over time, become calcified, or suffer from
thrombus formation. These events result in the slowly progressive failure of the valve. The
presentation is usually that of gradually worsening congestive heart failure, with increasing
dyspnea. Alternatively, patients may present with unstable angina or systemic embolization, or
they may be entirely asymptomatic.

Prosthetic valve endocarditis
PVE occurring within 60 days of implantation (early PVE) usually is due to perioperative
contamination or hematogenous spread. PVE occurring after 60 days (late PVE) usually is
caused by hematogenous spread.
Mortality/Morbidity
Acute failure of a prosthetic aortic valve usually leads to sudden or near-sudden death. Prompt
recognition and treatment of acute prosthetic mitral valve failure can be lifesaving.

Age
In children, bioprostheses rapidly calcify and, therefore, undergo rapid degeneration and valve
dysfunction. Incidence of bioprosthetic failure is much higher in patients younger than 40 years.
The incidence of having any prosthetic valve complication decreases with age.
Functional requirements of heart valve prostheses
The functioning of natural heart valves is characterized by many advantages:
- Minimal regurgitation - This means that the amount of blood lost upstream as the valve
closes is small. For example, closure regurgitation through the mitral valve would result
in some blood loss from the left ventricle to the left atrium as the mitral valve closes.
Some degree of valvular regurgitation is inevitable and natural (Fixme: Give indicative
value). However, several heart valve pathologies (e.g. rheumatic endocarditis) may lead
to clinically significant valvular regurgitation. A desirable characteristic of heart valve
prostheses is that regurgitation is minimal over the full range of physiological heart
function (i.e. complete functional envelope of cardiac output vs. heart rate).
- Minimal transvalvular pressure gradient - Whenever a fluid flows through a restriction,
such as a valve, a pressure gradient arises over the restriction. This pressure gradient is a
result of the increased resistance to flow through the restriction. Natural heart valves have
a low transvalvular pressure gradient as they present little obstruction to the flow through
themselves, normally less than 16 mmHg. A desirable characteristic of heart valve
prostheses is that their transvalvular pressure gradient is as small as possible.
- Non-thrombogenic - As natural heart valves are lined with an endothelium continuous
with the endothelium lining the heart chambers they are not normally thrombogenic. This
is important as should thrombus form on the heart valve leaflets and become seeded with
bacteria, so called "bacterial vegetations" will form. Such vegetations are difficult for the
body to deal with as the normal physiological defense mechanisms are not present within
the valve leaflets because they are avascular and largely composed of connective tissue
(Fixme: Create article discussing the pathgonesis of leaflet bacterial vegetations.). Should
bacterial vegetations form on the valve leafets they may continually seed bacteria into the
arterial tree which may lead to bacteremia or septicaemia. Portions of the vegetation may
also break off forming septic emboli. Septic emboli can lodge anywhere in the arterial
tree (e.g. brain, bowel, lungs) causing local infectious foci. Even dislodged fragments
from non-infectious vegetations (Fixme: Is this the correct terminology?) can be
hazardous as they can lodge in, and block, downstream arteries (e.g. coronary arteries
leading to myocardial infarction, cerebral arteries leading to stroke). A desirable
characteristic of heart valve prostheses is that they are non or minimally thrombogenic.
- Self-repairing - Although of limited extent compared to well vascularised tissue (e.g.
muscle), the valve leaflets do retain some capacity for repair due to the presence of
regenerative cells (e.g. fibroblasts) in the connective tissue from which the leaflets are
composed. As the human heart beats approximately 3.4x10
9
times during a typical human
lifespan this limited but nevertheless present repair capacity is critically important. No
heart valve prostheses can currently self-repair but replacement tissues grown using stem
cell technology may eventually offer such capabilities. (State that they wear).
- Rapid dynamic response - STD
Design challenges of heart valve prostheses

A replaceable model of Cardiac Biological Valve Prosthesis.
- Thrombogenesis / haemocompatibility
o Mechanisms:
Forward and backward flow shear
Static leakage shear
Presence of foreign material (i.e. intrinsic coagulation cascade)
Cellular maceration
- Valve-tissue interaction
- Wear
- Blockage
- Getting stuck
- Dynamic responsiveness
- Failure safety
- Valve orifice to anatomical orifice ratio
- Trans-valvular pressure gradient
- Minimal leakages