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Recent advances in imaging techniques have allowed physicians to obtain robust measurements of intracardiac flows in the clinical setting. Consequently, the physiological implications of intraventricular fluid dynamics are beginning to be understood. Initial data show that these flows involve complex fluid-structure interactions and mixing phenomena that are modified by disease. Here we critically review the most important aspects of intraventricular fluid mechanics relevant for clinical applications. We discuss current image and numerical methods for assessing intraventricular flows, as well as implemented approaches to analyze their impact on cardiac function. The physiological and clinical insights provided by such techniques are discussed both in health and in disease. The final goal is to encourage research in the application of fluid dynamic foundations to patient-based clinical data. A huge potential is anticipated not only in terms of the basic science of large-scale biological systems, but also in practical terms of improving patient care.
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Supplemental Video 1. Phase-contrast magnetic resonance imaging sequence of 3D intraventricular flow performed in a pig’s heart, showing flow velocity vectors and isosurfaces representing a constant value of the swirling strength, which are used to visualize vortices and are colored using the value of local vorticity. The LV and RV chambers are shaded in red and blue, respectively. Supplemental Video 2. 2D+t flow field sequence (apical long axis view) in the left ventricle of a patient with non-ischemic dilated cardiomyopathy, obtained from color Doppler echocardiography and superimposed on an bright mode ultrasound image sequence depicting the ventricle anatomy. The instantaneous streamlines are shown with black lines and the velocity vector is indicated by the color map. The inset of the upper right corner shows a similar sequence for a normal volunteer. Supplemental Video 3. Time evolution of Finite-time Lyapunov exponent obained in a human volunteer by 2D+t color Doppler echocardiography, indicanting Lagrangian coherent structures in left-ventricular flow.