A computing system (118) includes a computer readable storage medium (122) with computer executable instructions (124), including: a biophysical simulator (126) configured to simulate coronary or carotid flow and pressure effects induced by a cardiac valve device implantation, using cardiac image data and a device model (212). The computing system further includes a processor (120) configured to execute the biophysical simulator to simulate the coronary or carotid flow and the pressure effects induced by the device implantation with the cardiac image data and the device model. The computing system further includes a display configured to display results of the simulation.