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Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv;
Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Medical
Center, Tel Aviv; and 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
2
(1)
U U P 2U U
(2)
where U is the velocity vector, P is the fluid pressure, and and are
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1 RA
Fig. 1. A: anatomic scheme of the umbilical cord and placenta showing the
Hyrtl anastomosis (HA). B: physical model of 2 umbilical arteries connected
via an H-type HA. See text for definition of variables.
the fluid density and kinematical viscosity, respectively. The last term
on the right-hand side of Eq. 2 represents the dissipative force of the
porous media at the peripheral end of the umbilical arteries. The
viscous resistance coefficient 1/ is given by Blevins (3) as
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(3)
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Flow generator
Pressure generator
No Anastomosis
Q 1 Q2 Q N
R1 1.3RN
R2 RN
Q1 QN
R1 1.3RN
60%
Q 1 Q2 Q N
R1 1.6RN
R2 RN
Q1 QN
R1 1.6RN
100%
Q 1 Q2 Q N
R1 2RN
R2 RN
Q1 QN
R1 2RN
Q1 0.8QN
Q2 1.2QN
R1 R2 RN
Q1 0.8QN
Pinlet-2 Pinlet-N
R1 R2 RN
Q1 0.8QN
R1 RN
Q1 0.6QN
Q2 1.4QN
R1 R2 RN
Q1 0.6QN
Pinlet-2 Pinlet-N
R1 R2 RN
Q1 0.6QN
R1 RN
40%
RESULTS
Computational simulations of discordant flow in the umbilical arteries were performed by imposing on artery 1 either an
increased placental resistance at the downstream end or a
reduced inlet blood flow due to some upstream pathology,
while artery 2 was subjected to normal blood flow. To simplify
the presentation of the results, we investigated the pressure
distributions along the central axis of each umbilical artery as
being representative of the 3-D distribution of arterial pressure.
The results of blood flow in the umbilical arteries when artery
1 feeds placental territories with increased resistance are depicted in Fig. 2 for numerical simulations with and without the
Hyrtl anastomosis compared with the normal case of identical
arteries feeding a symmetric placenta. The results for the
model with the anastomosis are presented for boundary conditions of either FG or PG.
In the absence of the anastomosis, increased placental resistance by 30, 60, and 100% at the peripheral end of artery 1
(while Q1 250 ml/min) resulted in significant increases in the
pressures up to 20, 41, and 70%, respectively (Fig. 2, A and C).
Note that the static pressure at the junction that simulates the
insertion of the umbilical artery in the placenta was elevated,
whereas the slope of the pressure along the artery was practically identical. This pattern is due to the increased placental
resistance that increases the pressure drop along the porous
media that represents the placenta but does not change the
pressure drop along the artery segment. On the other hand,
when the anastomosis was included in the model using the FG
boundary conditions, the increase in pressures was only 10, 19,
and 28%, respectively, whereas use of the PG boundary conditions yielded pressure distributions along the vessel that were
almost identical to the normal symmetric case (Fig. 2C). As
blood flows through the anastomosis from artery 1 into artery
2, which is feeding placental territories with normal resistance
(R2 RN), the pressure drop along the central axis of artery 2
is also increasing due to increased blood flow through the
AJP-Regul Integr Comp Physiol VOL
porous cylinder (Fig. 2B). For the simulation with FG boundary conditions, the pressures in artery 2 demonstrated an
increase of 9, 16, and 24% compared with normal symmetric
placenta, as the resistance of the placental territories of artery
1 increased by 1.3, 1.6, and 2.0, respectively.
Fig. 2. Distribution of static pressure along the central axes of the umbilical
arteries and porous cylinders in models with and without the HA for different
resistances of the placental territories fed by artery 1. A: pressure in artery 1
and cylinder 1 for boundary conditions of a flow generator (FG). B: pressure
in artery 2 and cylinder 2 for boundary conditions of FG. C: pressure in artery
1 and cylinder 1 for boundary conditions of a pressure generator (PG). D:
pressure in artery 2 and cylinder 2 for boundary conditions of PG. F, R1 1.3
RN without HA; E, R1 1.3 RN with HA; , R1 1.6 RN without HA; ,
R1 1.6 RN with HA; , R1 2 RN without HA; , R1 2 RN with HA.
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Fig. 3. Blood flow rates in the umbilical arteries and in the Hyrtl anastomosis
(QHA) for increasing resistance R1 of the placental territories fed by artery 1. A:
arterial inlet and outlet flow rates for boundary conditions of FG. B: arterial inlet
and outlet flow rates for boundary conditions of PG. C: flow rate through the HA.
, inlet to artery 1; , outlet of artery 1; F, inlet to artery 2; E, outlet of artery 2.
Fig. 4. Distribution of static pressure along the central axes of the umbilical
arteries and porous cylinders in models with and without the HA for different
reduced inlet flow rates into artery 1. A: pressure in artery 1 and cylinder 1 for
boundary conditions of FG. B: pressure in artery 2 and cylinder 2 for boundary
conditions of FG. C: pressure in artery 1 and cylinder 1 for boundary
conditions of PG. D: pressure in artery 2 and cylinder 2 for boundary
conditions of PG. F, Q1 0.8 QN without HA; E, Q1 0.8 QN with HA; ,
Q1 0.6 QN without HA; , Q1 0.6 QN with HA.
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Fig. 5. Blood flow rates in the umbilical arteries and in the Hyrtl anastomosis
(QHA) for reduced inlet flow rates into artery 1. A: arterial inlet and outlet flow
rates for boundary conditions of FG. B: arterial inlet and outlet flow rates for
boundary conditions of PG. C: flow rate through the HA. , inlet to artery 1;
, outlet of artery 1; F; inlet to artery 2; E, outlet of artery 2.
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