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P P Lunkenheimer

Publications and source records attributed to P P Lunkenheimer.

At least 19 recordsLinked to original sources
PubMed2006

A finite element model of the human left ventricular systole.

Local wall stress is the pivotal determinant of the heart muscle's systolic function. Under in vivo conditions, however, such stresses cannot be measured systematically and quantitatively. In contrast, imaging techniques based on magnetic resonance (MR) allow the determination of the deformation pattern of the left ventricle (LV) in vivo with high accuracy. The question arises to what extent deformation measurements are significant and might provide a possibility for future diagnostic purposes. The contractile forces cause deformation of LV myocardial tissue in terms of wall thickening, longitudinal shortening, twisting rotation and radial constriction. The myocardium is thereby understood to act as a densely interlaced mesh. Yet, whole cycle image sequences display a distribution of wall strains as function of space and time heralding a significant amount of inhomogeneity even under healthy conditions. We made similar observations previously by direct measurement of local contractile activity. The major reasons for these inhomogeneities derive from regional deviations of the ventricular walls from an ideal spheroidal shape along with marked disparities in focal fibre orientation. In response to a lack of diagnostic tools able to measure wall stress in clinical routine, this communication is aimed at an analysis and functional interpretation of the deformation pattern of an exemplary human heart at end-systole. To this end, the finite element (FE) method was used to simulate the three-dimensional deformations of the left ventricular myocardium due to contractile fibre forces at end-systole. The anisotropy associated with the fibre structure of the myocardial tissue was included in the form of a fibre orientation vector field which was reconstructed from the measured fibre trajectories in a post mortem human heart. Contraction was modelled by an additive second Piola-Kirchhoff active stress tensor. As a first conclusion, it became evident that longitudinal fibre forces, cross-fibre forces and shear along with systolic fibre rearrangement have to be taken into account for a useful modelling of systolic deformation. Second, a realistic geometry and fibre architecture lead to typical and substantially inhomogeneous deformation patterns as they are recorded in real hearts. We therefore, expect that the measurement of systolic deformation might provide useful diagnostic information.

Computer Simulation↗
PubMed2005

A finite element study relating to the rapid filling phase of the human ventricles.

During the rapid diastolic filling phase at rest, the ventricles of the human heart double approximately in volume. In order to investigate whether the ventricular filling pressures measured under physiological conditions can give rise to such an extensive augmentation in ventricular volumes, a finite element model of the human right and left ventricles has been developed, taking into account the nonlinear mechanical behavior and effective compressibility of the myocardial tissue. The results were compared with the filling phase of the human left ventricle as extrapolated from measurements documented in the literature. We arrived at the conclusion that the ventricular pressures measured during the rapid filling phase cannot be the sole cause of the rise of the observed ventricular volumes. We rather advocate the assumption that further dilating mechanisms might be part of ventricular activity thus heralding a multiple function of the ventricular muscle body. A further result indicates that under normal conditions the influence of the viscoelasticity of the tissue should not be disregarded in ventricular mechanics.

Biomechanical Phenomena↗
PubMed2004

On the significance of fiber branching in the human myocardium.

Myocardial tissue exhibits a high degree of organization in that the cardiac muscle fibers are both systematically aligned and highly branched. In this study, the influence and significance of fiber branching is analyzed mathematically. In order to allow for analytic solutions, a regular geometry and simplified constitutive relations are considered. It is found that branching is necessary to stabilize the ventricular wall.

Humans↗
PubMed2004

The forces generated within the musculature of the left ventricular wall.

OBJECTIVES: To test the hypothesis that two populations of myocardial fibres-fibres aligned parallel to the surfaces of the wall and an additional population of fibres that extend obliquely through the wall-when working in concert produce a dualistic, self stabilising arrangement. METHODS: Assessment of tensile forces in the walls of seven porcine hearts by using needle probes. Ventricular diameter was measured with microsonometry and the intracavitary pressure through a fluid filled catheter. Positive inotropism was induced by dopamine, and negative inotropism by thiopental. The preload was raised by volume load and lowered by withdrawal of blood. Afterload was increased by inflation of a balloon in the aortic root. The anatomical orientation of the fibres was established subsequently in histological sections. RESULTS: The forces in the fibres parallel to the surface decreased 20-35% during systolic shrinkage of the ventricle, during negative inotropism, and during ventricular unloading. They increased 10-30% on positive inotropic stimulation and with augmentation in preload and afterload. The forces in the oblique transmural fibres increased 8-65% during systole, on positive inotropic medication, with an increase in afterload and during ventricular shrinkage, and decreased 36% on negative inotropic medication. There was a delay of up to 147 ms in the drop in activity during relaxation in the oblique transmural fibres. CONCLUSION: Although the two populations of myocardial fibres are densely interwoven, it is possible to distinguish their functions with force probes. The delayed drop in force during relaxation in obliquely oriented fibres indicates that they are hindered in their shortening to an extent that parallels any increase in mural thickness. The transmural fibres, therefore, contribute to stiffening of the ventricular wall and hence to confining ventricular compliance.

Animals↗
PubMed2000

Late ventricular structure after partial left ventriculectomy.

Nine months after partial ventriculectomy, a 53-year-old man died of progressive heart failure. His heart was examined to determine the alignment of the muscle fibers around the ventricular scar, which was 11 cm long, 1.3 cm thick and 4 cm wide. The scar reached 2 to 12 mm beyond the surgical suture line. The fibers in the middle and subendocardial layers were malaligned, resulting in convergence, compression and regional necrosis.

Cardiomyopathy, Alcoholic↗
PubMed1997

The anisotropic structure of the human left and right ventricles.

An important determinant of cardiac output derives from the structure of the ventricular wall given by the arrangement of the cardiac muscle fibres. A key feature of this arrangement is both a global and local anisotropy. First, a preparation method necessary for analyzing the main aspects of spatial fibre architecture is outlined. Global anisotropy can be described by a gross band-like structure wrapping both left and right ventricles while local anisotropy results from the arrangement of the individual muscle fibres within the band. In pathologic cases this basic structure may be disturbed leading to cardiac failure. Second, a Finite Element model, formulated on the basis of Magnetic Resonance measurements has been devised which is intended to reflect the global as well as the local anisotropy of the ventricles in order to further the understanding of cardiac performance.

Animals↗
PubMed1997

The heart muscle's putative "secondary structure'. Functional implications of a band-like anisotropy.

Opinions are divided as to whether the rope-like secondary structure, which Torrent-Guasp dissected out of the myocardial body by the blunt unwinding technique (BUT) reveals some kind of functional compartmentation of the heart muscle. The myocardial fibres are aligned parallel to the fibre disruption (cleavage) plane, along which the band has been prepared but they are not necessarily aligned parallel to the long axis of the band. Inconsistencies in the myocardial rope model arise from the obligatory zones of transmural inflection, which are obvious in the base and the apex of both ventricles. They are, however, merely discernible in the midzone of the left ventricular cone. The investigator experienced in BUT knows that the cleavage plane is not unique. We doubt the assumption that the rope structure is the predominant stress transmission pathway, because the fibre strand peel-off technique (SPOT) delivers irregular fibre disruption planes which are definitely different from those which Torrent-Guasp prepares. The rope-like fibre arrangement could be just a redundant structure, a remnant of past developmental steps without, however, any functional implication to the human heart. On the other hand, peeling-off fibre strands from the ventricular wall produces deeply perforating, i.e., oblique transmurally grooved surfaces. Putative functions of force transmission in an oblique transmural direction are (1) ventricular dilation as a function of the variable inclination angle with respect to the epicardial surface, (2) monitoring of ventricular wall stress and ventricular size and (3) segmental stiffening which could serve other dependent segments as a punctum fixum.

Anisotropy↗
PubMed1997

The heart's fibre alignment assessed by comparing two digitizing systems. Methodological investigation into the inclination angle towards wall thickness.

Myocardial contractile pathways which are not aligned strictly parallel to the heart's epicardial surface, give rise to forces which also act in the ventricular dilating direction. We developed a method which allows us to assess any fibre orientation in the three-dimensional myocardial weave. Decollagenized hearts were prepared by peeling-off fibre strands, following their main fibre orientation down to near the endocardium. In the subepicardium the strands followed a course more or less parallel to the epicardium, whereas from the mid-wall on they tended to dive progressively deeper into the wall. The preparation displays more or less rugged surfaces rather than smooth layers. The grooves and crests on the exposed surfaces were sequentially digitized by two methods: (1) Using a magnet tablet (3 Draw Digitizer System, Polhemus, Cochester VTO 5446, USA) on a dilated pig heart we manually followed the crests using a stylus, handling each groove and crest as an individual contractile pathway. (2) A constricted cow heart was digitized using a contact-free optical system (opto TOP, Dr. Breuckmann, Meersburg, Germany), which is based on the principle of imaging triangulation. Using specially developed software the inclination angles of selected crests and grooves with respect to the epicardial surface were calculated. The two digitizing methods yield comparable results. We found a depth- and side-specific weave component inclined to the epi-endocardial direction. This oblique netting component was more pronounced in the inner 1/3 of the wall than in the subepicardium. The inclination angle probably increases with increasing wall thickness during the ejection period. Manual digitizing is an easy and fast method which delivers consistent results comparable with those obtained by the cumbersome high resolution optical method. The rationales for the assessment of transmural fibre inclination are (1) the putative existence of dilating forces inherent in the myocardial weave and (2) the possible overproportional increase in the oblique transmural weave component during myocardial hypertrophy, which would entail a reduction in efficiency of ventricular performance in terms of haemodynamic work.

Animals↗
PubMed1997

Computation of the alignment of myocardial contractile pathways using a magnetic tablet and an optical method.

The computation of the inclination angle of myocardial contractile pathways, based on the data from (1) optically and (2) manually digitized hearts is described. The measured raw data comprised: (1) A list epi of points on an "epicardial' surface S. (2) For each selected contractile pathway f, a list of points along the contractile pathway. For any point p on a contractile pathway f, the angle of inclination alpha p = alpha p (p,f,S) is defined to be the angle (in degrees) between the tangent tp = tp(f) to the contractile pathway f at the point p and the tangent plane Tvp to the surface S at the surface point up = v(p,S) which is nearest to p. Thus alpha p is a generalization of the imbrication angle of Streeter. The angle of inclination was computed using two separate numerical methods: (1) A discrete method, applying finite differences to the raw data, to compute the tangents tp and the tangent planes Tvp, after which the results were smoothed. (2) A smoothing method in which the data was first smoothed to obtain an approximation Scpi to the epicardial surface and spline approximations to the contractual pathways f. We describe the results for two typical hearts: a manually digitized dilated pig heart and an optically digitized constricted cow heart. For each heart we first present the depths and angles of inclination of typical contractual pathways and then summarize the results in the form of histograms. The results are discussed in detail in the accompanying paper of Lunkenheimer. Redmann et al. [5], where the digitization methods are also described.

Animals↗
PubMed1997

The assessment of intramural stress alignment on the beating heart in situ using micro-ergometry: functional implications.

The main local stress transmission pathways in the left ventricular base, midportion and apex in up to seven layers have been assessed in normal dog and porcine hearts, in hypertrophied dog hearts, and in three pig hearts having undergone a temporary left ventricular outflow stricture. The rotational sensitivity of needle force probes was used to determine the focal surface-parallel direction of the myocardial tension vector. In all places investigated the orientation of the force transmission pathways differs slightly from the morphologically determined fibre alignment. Vector rotation upon an axis normal to the epicardial surface is definitely tempered as compared to fibre rotation. Alterations in the force transmission pathways assessed in hypertrophied dog hearts by micro-ergometry qualitatively confirm structural remodelling in so far as an irregularity in the transmural rotation of the main stress vector was found. The measured disparities between the alignment of the myocardial fibre weave and the direction of stress transmission both in the normal and the diseased heart is widely individual, and hence, scattering of the data is marked. However, it must also be called into consideration that the measured orientation of force vectors is that at the moment of highest developed force, only. Further investigations will elucidate if discrepancies between that force vector and morphology are less pronounced when the vector is averaged over the entire heart cycle.

Animals↗
PubMed1997

Inhomogeneities in wall stress measured by microergometry in the heart muscle in situ.

Microergometry is a method which we have developed as a tool to measure local mesh-tension within the myocardial weave at any measuring site of both ventricles and the septum on the beating heart in situ. In a mapping procedure on pig and dog hearts, both in control conditions and in the hypertrophied state after aortic banding, local mesh-tension was measured in several areas and in up to eight depths proceeding from the epicardium to the endocardium: Probe-to-fibre coupling is definitely more stable in the canine myocardium than in the porcine heart muscle, probably due to a more effective connective tissue fettering of the canine myocardial weave. The observed longitudinal gradient, with the highest tension in the base, of control dog hearts was levelled out in the hypertrophied hearts. Furthermore, in control dog hearts mesh-tension in the subepi- and subendocardial layers was higher than in the midlayers. This pronounced midlayerhypotension was smoothed in the hypertrophied hearts. Further studies will be dedicated to the question of whether the impact of ventricular size and shape on intersegmental stress transmission is determined by the Frank-Starling mechanism alone or whether protracted remodelling processes on the level of the local fibre weave cause slow coupling alterations.

Animals↗
PubMed1994

High-frequency oscillation in an adult porcine model.

OBJECTIVE: Controversy exists as to whether high-frequency oscillatory ventilation can be used on babies and small laboratory animals only, or whether high-frequency oscillatory ventilation can also be efficient in the adult patient and large (> 65 kg body weight) laboratory animals. Moreover, controversy exists as to whether limitations in high-frequency oscillation efficiency are caused by the size and shape of the bronchial system, by the lack of low impedant intersegmental gas flow in lung parenchyma, or by inappropriate high-frequency ventilators and ancillary hardware. Therefore, our objective in this study using the adult pig as a model of the adult patient was to test whether the adult airway system is suited to the use of high-frequency oscillatory ventilation or whether there are geometrical, structural, or functional limitations to efficient ventilation by high-frequency oscillation. DESIGN: Prospective, controlled, randomized comparison over 8 to 16 hrs of ventilatory management. SETTING: Experimental thoracovascular surgery laboratory in a university hospital. SUBJECTS: Fifteen adult, female, house swine (weight 90 to 140 kg). INTERVENTIONS: We evaluated the ventilatory effect of a wide range of oscillation frequencies (10-15 to 35-45 Hz), tidal volumes (0.5 to 2.2 mL/kg), and bias flow volumes (10 to 70 L/min) at a mean airway pressure of 12 +/- 1 cm H2O in anesthetized and relaxed pigs who did not have lung injury. MEASUREMENTS AND MAIN RESULTS: Arterial blood gases are mainly dependent on tidal volume, frequency, and mean airway pressure. A threshold bias flow volume of 35 +/- 5 L/min is required to prevent CO2 rebreathing. In the group of lightweight animals (65 to 99 kg), the most efficient frequency band for CO2 elimination was approximately 25 Hz. The most efficient frequency band for arterial oxygenation was found to vary between individuals more than the most efficient frequency band for CO2 elimination. In the group of heavy animals (100 to 140 kg), no most efficient mean frequency could be assessed, probably because the excitation system was limited. We confirmed that tidal volume on its own had an effect on CO2 elimination ("tidal-volume effect"), although CO2 elimination was mainly determined by the product of tidal volume and oscillation frequency (oscillated minute volume), at least up to a critical frequency. Beyond that frequency, CO2 elimination could not be enhanced. The most efficient mean airway pressure in unimpaired lungs was assessed at 12 +/- 1 cm H2O. CONCLUSIONS: Adult pigs with a body weight in the range of the weight of clinical adult patients can be ventilated by high-frequency oscillation at tidal volumes smaller than, equal to, or slightly more than anatomical deadspace. The most efficient frequency for gas exchange varied between individuals. Tidal volume had an enhancing effect on CO2 elimination. The frequency dependency of PaO2 may have been related to a frequency-dependent structural remodeling of the airway system, which occurred even though the mean airway pressure was kept constant. These results demonstrate that failure of adequate ventilation by high-frequency oscillation is caused by a) CO2 rebreathing, b) the avoidance of an appropriate alveolar recruitment strategy, and c) an underpowered, high-frequency ventilatory system (oscillator) that is unable to deliver appropriate pressure oscillations. These limitations led to insufficient CO2 elimination and/or inadequate arterial oxygenation.

Animals↗