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PubMed2002

Recent progress in developing durable and permanent impeller pump.

Since 1980s, the author's impeller pump has successively achieved the device implantability, blood compatibility and flow pulsatility. In order to realize a performance durability, the author has concentrated in past years on solving the bearing problems of the impeller pump. Recent progress has been obtained in developing durable and permanent impeller blood pumps. At first, a durable impeller pump with rolling bearing and purge system has been developed, in which the wear-less rollers made of super-high-molecular weight polythene make the pump to work for years without mechanical wear; and the purge system enables the bearing to work in saline and heparin, and no thrombus therefore could be formed. Secondly, a durable centrifugal pump with rolling bearing and axially reciprocating impeller has been developed, the axial reciprocation of rotating impeller makes the fresh blood in and out of the bearing and to wash the rollers once a circle; in such way, no thrombus could be formed and no fluid infusion is necessary, which may bring inconvenience and discomfort to the receptors. Finally, a permanent maglev impeller pump has been developed, its rotor is suspended and floating in the blood under the action of permanent magnetic force and nonmagnetic forces, without need for position measurement and feed-back control. In conclusion, an implantable, pulsatile, and blood compatible impeller pump with durability may have more extensive applications than ever before and could replace the donor heart for transplantation in the future.

Blood↗
PubMedDate not supplied

Extracorporeal circulation as an additional method for cerebral protection in simultaneous carotid endarterectomy and coronary artery surgical revascularization.

Surgical management of patients with concomitant carotid and coronary artery stenosis remains controversial. Our policy was always to perform at the same time carotid endarterectomy (CE) and coronary artery bypass grafting (CABG), but it was also considered that extracorporeal circulation (ECC), because of full heparinization, hemodilution, pulsatile flow, and hypothermia could provide better cerebral protection during CE. Retrospective data of 124 patients undergoing simultaneous CE and CABGs between January 1994 and December 2001 were reviewed. CE was performed prior to ECC in 65 patients (Group 1-mean age: 70.4 years; sex ratio: 49 male/16 female) and under ECC, prior to CABGs in 59 patients (Group 2-mean age: 69.9 years; sex ratio: 46 male/13 female). Overall hospital mortality was 7.3% (9/124): cardiac-related in 5 patients, or due to septicemia (1 patient), or ARD syndrome (1 patient), or stroke in two others. Univariate analysis demonstrated overweight, unstable angina, and emergency to be significant risk factors. Bilateral carotid stenosis was a significant risk factor of neurologic event when CE was performed prior to ECC (p < 0.05). In Group 1, mortality was 9.2% (6/65), and the incidence of neurologic events was 10.7% (7/65), and was responsible for two of the early deaths in patients with bilateral carotid stenosis. In Group 2, mortality was 5.1% (3/59) but never related to CE, while the neurologic morbidity was 1.7% (1 transient ischemic attack). It is concluded that (1) hospital mortality in patients undergoing simultaneous CE and CABGs was mainly cardiac-related. (2) The combined approach of both localizations appears to be mandatory, when carotid stenosis, even asymptomatic, was hemodynamically significant, or with ulcerative lesions likely to be responsible for embolism. (3) CE, first performed under ECC, appears to be a safe procedure, combining, in terms of cerebral protection, the benefits previously called up. This approach is all the more interesting when carotid stenosis is bilateral; hypothermia < or = 28 degrees C during the carotid clamping time is obviously the optimal method for cerebral protection when ipsilateral or contralateral supply is reduced, or even absent.

Adult↗
PubMed2006

Impact of off-pump coronary artery bypass surgery on postoperative renal dysfunction: current best available evidence.

Renal dysfunction is a serious complication after coronary artery bypass surgery with cardiopulmonary bypass. Cardiopulmonary bypass-related non-pulsatile flow, hypothermia, haemolysis, systemic inflammatory reactions and emboli are mentioned as possible causes for this postoperative renal dysfunction. In an attempt to avoid these deleterious effects of cardiopulmonary bypass, off-pump coronary artery bypass surgery has been rediscovered. Resurgence of interest in off-pump coronary artery bypass surgery is associated with the expectation that avoiding deleterious effects of the cardiopulmonary bypass leads to better outcomes and possibly decreased costs and resource use. We are currently practising in an era of evidence-based medicine that mandates the prospective randomized controlled trial as the most accurate tool for determining a treatment benefit compared with a control population. The present review article attempts to evaluate the current best available evidence from randomized controlled trials on the impact of off-pump coronary artery bypass surgery on postoperative renal dysfunction.

Coronary Artery Bypass, Off-Pump↗
PubMed1993

The PUCA pump: a left ventricular assist device.

Left ventricular assist devices (LVADs) that are being used clinically still have specific drawbacks. Therefore, a new concept for mechanical circulatory support was developed, the pulsatile catheter (PUCA) pump. It consists of an extracorporeally placed, pneumatically driven membrane pump that is connected to a valved catheter. The catheter is introduced into an easily accessible artery and positioned with its distal tip in the left ventricle. Blood is aspirated from the left ventricle and ejected into the ascending aorta. Potential advantages of the catheter pump are its simple design and its fast application with minimal surgery. Preliminary in vitro tests with a first prototype showed that it is possible to create a pulsatile flow of 3 L/min and proved that further developing the PUCA pump will be worthwhile.

Heart-Assist Devices↗
PubMed1995

Evaluation of tilting disc valves after fatigue life testing: preliminary results within a comparison program.

A fatigue life test, by accelerating the beat rate, simulates several years of virtual life of a prosthetic heart valve in a short period of time. The correlation between the in vivo life of a valve and in vitro testing expectations is as yet not well established, but reproducible test conditions yield precious information about wear and failure. The paper reports a qualitative analysis of mechanical valve wear as part of a comparison program designed to investigate the significance of fatigue testing with the ultimate aim of defining standard guidelines for these type of tests. Two tilting disc valves (29 mm) were subjected to 16 years of fatigue life simulated by means of a Rowan Ash fatigue tester (accelerated rate of 1,200 bpm). Fatigue-induced effects on valve disc and ring surfaces were observed under a monitor microscope to identify wear sites and patterns. A high speed cinematographic system was used to investigate the mechanisms responsible for the wear (wear modes). Valve closure was inspected at a 6,000 frame/s rate. Because of disc rotation during the tilting movement, the points of contact between disc and ring are distributed all around the disc edge but focally on the ring. On both sides of the disc, the surfaces present ring-like concentric grooves. After 16 years of fatigue life the valves showed neither severe wear nor alteration of their fluidodynamic behavior in the pulsatile flow test.

Biomechanical Phenomena↗
PubMed1996

State of the art of lipid apheresis.

Currently, 5 different lipid apheresis procedures are available for routine clinical treatment of hypercholesterolemic patients. Unselective plasma exchange is a technically simple extracorporeal circuit, but albumin substitution fluid must be used and there is no high-density lipoprotein (HDL) recovery. Semiselective double filtration with improved size selectivity because of a small-pore secondary filter combines good elimination of low-density lipoprotein (LDL), lipoprotein (a) (Lp[a]), and fibrinogen with adequate HDL recovery; modifications such as thermofiltration, predilution/backflush, or pulsatile flow have been proposed for the improvement of this system. Three highly selective procedures are based on immunologic or electrostatic interactions: immunoadsorption using anti-low-density lipoprotein (LDL) antibodies, chemoadsorption onto dextran sulfate, and heparin-induced LDL precipitation (HELP) apheresis. The features of each system are discussed critically. Lastly, two new developments, Lp(a) immunoadsorption and LDL hemoperfusion using a polyacrylate LDL adsorber compatible with whole blood, are described.

Antibodies↗
PubMed2006

Large Negative Stress Phase Angle (SPA) attenuates nitric oxide production in bovine aortic endothelial cells.

Hemodynamics plays an important role in cardiovascular physiology and pathology. Pulsatile flow (Q), pressure (P), and diameter (D) waveforms exert wall shear stress (WSS), normal stress, and circumferential strain (CS) on blood vessels. Most in vitro studies to date have focused on either WSS or CS but not their interaction. Recently, we have shown that concomitant WSS and CS affect EC biochemical response modulated by the temporal phase angle between WSS and CS (stress phase angle, SPA). Large negative SPA has been shown to occur in regions of the circulation where atherosclerosis and intimal hyperplasia are prevalent. Here, we report that nitric oxide (NO) biochemical secretion was significantly decreased in response to a large negative SPA of -180 deg with respect to an SPA of 0 degrees in bovine aortic endothelial cells (BAEC) at 5 h. A new hemodynamic simulator for the study of the physiologic SPA was used to provide the hemodynamic conditions of pro-atherogenic (SPA = -180 deg) and normopathic (SPA = 0 deg) states. The role of complex hemodynamics in vascular remodeling, homeostasis, and pathogenesis can be advanced by further assessment of the hypothesis that a large negative SPA is pro-atherogenic.

Animals↗
PubMed1992

Wall shear stress estimates in coronary artery constrictions.

Wall shear stress estimates from laminar boundary layer theory were found to agree fairly well with the magnitude of shear stress levels along coronary artery constrictions obtained from solutions of the Navier Stokes equations for both steady and pulsatile flow. The relatively simple method can be used for in vivo estimates of wall shear stress in constrictions by using a vessel shape function determined from a coronary angiogram, along with a knowledge of the flow rate.

Blood Flow Velocity↗
PubMed1994

Shear stress at a compliant model of the human carotid bifurcation.

To investigate the role of a compliant wall to the near wall hemodynamic flowfield, two models of the carotid bifurcation were constructed. Both were of identical internal geometries, however, one was made of compliant material which produced approximately the same degree of wall motion as that occurring in vivo while the other one was rigid. The inner geometries were formed from the same mold so that the configurations are directly comparable. Each model was placed in a pulsatile flow system that produced a physiologic flow waveform. Velocity was measured with a single component Laser system and wall shear rate was estimated from near wall data. Wall motion in the compliant model was measured by a wall motion transducer and the maximum diameter change varied between 4-7 percent in the model with the greatest change at the axis intersection. The mean shear stress in the compliant model was observed to be smaller by about 30 percent at most locations. The variation in peak shear stress was greater and occasionally reached as much as 100 percent with the compliant model consistently having smaller positive and negative peaks. The separation point was seen to move further upstream in the compliant cast. The modified flowfield in the presence of a compliant wall can then be important in the hemodynamic theory of atherogenesis.

Arteriosclerosis↗
PubMed1981

Correlation of human arterial morphology with hemodynamic measurements in arterial casts.

A realistic pulsatile flow was passed through a cast of the aortic bifurcation of a 63-yr-old male with mild atherosclerosis, and a laser Doppler anemometer was used to measure fluid velocities in the cast at 15 selected sites near the lateral and medial walls. Intimal, medial and adventitial thicknesses were measured and sudanophilia was scored at corresponding sites in the vessel from which the cast had been made. A negative correlation was found between intimal thickness (IT) and wall shear rate. The strongest negative correlation (p less than 0.005) was between IT and "pulse shear rate" (PSR), defined by analogy with pulse pressure. Sudanophilia also correlated negatively with PSR (p less than 0.01). Medial thickness correlated positively with shear rate, and most strongly with the mean (i.e., time-average) rate (p less than 0.005). From an analysis of the fluid mechanical data, it appears possible to separate the effects of bifurcation geometry and the shape of the arterial cross section on interfacial shear.

Aorta↗
PubMed1983

In-vitro fluid dynamic characteristics of the abiomed trileaflet heart valve prosthesis.

The need for better and longer lasting trileaflet valves has led to the design and development of the Abiomed polymeric trileaflet valve prosthesis. In-vitro fluid dynamic studies on sizes 25 and 21 mm valves in the aortic position indicate an overall improvement in performance compared to the Carpentier-Edwards and Ionescu-Shiley tissue valves in current clinical use. The pressure drop studies yielded effective orifice areas of 1.99 and 1.54 cm2, and performance indices of 0.41 and 0.45 for the Nos. 25 and 21 valves, respectively. Leaflet photography studies indicated that the two valve sizes had maximum opening areas of 225 and 145 mm2, respectively, at a normal resting cardiac output. Steady and pulsatile flow velocity measurements with a laser-Doppler anemometer (LDA) system indicate that the flow field downstream of the Abiomed valve is jetlike and turbulent. Maximum mean square axial velocity fluctuations of 55 and 83 cm/s, and turbulent shear stresses of 220 and 450 N/m2 were measured in the immediate vicinity of the nos. 25 and 21 valves, respectively. The Abiomed valves studied had been originally configured for use in valved conduits, and it is therefore our opinion that further improvements can be made to the valve and stent design, which would enhance its fluid dynamic performance.

Aortic Valve↗
PubMed1985

An experimental study of coronary artery fluid mechanics.

Preserved baboon and canine hearts were perfused using an in-vitro pulsatile flow system. Flow rate and pulsation frequency were controlled, and velocity profile measurements were made at several sites on the left epicardial coronary arteries of each heart. Velocity profiles were measured using a multi-channel, pulsed ultrasonic Doppler velocimeter, and the data were processed with a laboratory microcomputer system. Flow in the left main coronary artery appeared to be similar to descriptions of developing curved tube flow, but an unexplained oscillation of the velocity profiles was observed in this artery. Near the bifurcation of the main coronary artery into the anterior descending and the circumflex, the pattern of velocity profile skewing appeared to be determined by the angle through which the daughter vessels turned from the main and the overall curvature of the "plane" of bifurcation. Several diameters downstream from the bifurcation the flow appeared to be quasi-steady.

Animals↗
PubMed1977

An in-vitro assessment of the hydraulic characteristics of the mark II Abrams-Lucas mitral valve prosthesis.

As a result of the durability problems associated with the first Abrams-Lucas mitral valve, a redesigned model has recently been introduced into limited clinical trials. The new valve was subjected to in-vitro pulsatile flow studies, and measurements were made of mean diastolic pressure gradient and volume of reflux on closure. Similar measurements were made on other mitral valve prostheses of comparable size. High-speed cinematography was used to analyse the motion of the occluder during the simulated cardiac cycle, and the flow patterns produced by the valve in the model ventricular cavity were observed and photographed. The pressure gradient of the Abrams-Lucas valve was significantly lower than that of the 29 mm Björk-Shiley valve and all other prostheses tested, but its reflux level was higher at 12 ml per stroke. The valve opened and closed smoothly and the flow visualisation study revealed that the valve produced a large vortex or swirl in the model ventricular cavity.

Heart Valve Prosthesis↗
PubMed1986

Magnetic resonance angiography.

Pulse sequences that permit selective detection of moving spins in a magnetic resonance image have been developed. Experiments were performed by the authors to produce projected angiographic data without the use of contrast agents, with the intensity of each image pixel determined by the macroscopic velocity of the detected spins. With this method, suppression of nonmoving spins is essentially complete, yielding a high dynamic range in signal intensity for detected vessels. Selective detection of moving spins is not dependent on pulsatile flow. Consequently, not only arterial structures, but also venous structures can easily be visualized. High-resolution angiographic images can be obtained by combining the flow experiment with surface coil techniques.

Angiography↗
PubMed1992

Peripheral MR angiography with variable velocity encoding. Work in progress.

An electrocardiographically triggered two-dimensional phase-contrast (PC) magnetic resonance angiographic pulse sequence was developed in which velocity encoding (VENC) was varied throughout an acquisition in response to changes in blood velocity during the cardiac cycle. This was done to better capture signal in the peripheral vasculature, where pulsatile flow degrades images. After reconstruction, a matched filter addition technique was applied to the cardiac phase images to obtain a single high-quality static image. Images were obtained of six healthy volunteers--with and without varying VENC--and contrast-to-noise ratio (C/N) calculations were performed for the added images. Varying VENC significantly improved vascular signal from small and large vessels (P less than .02), but it was most helpful for small vessels, for which the C/N increased by as much as 260% (average increase, 149%). These preliminary findings suggest that variable VENC can enhance the signal from the small and large peripheral blood vessels in cardiac-gated PC acquisitions.

Angiography↗
PubMed1995

Hepatocellular carcinoma: use of color Doppler US to evaluate response to treatment with percutaneous ethanol injection.

PURPOSE: To determine the usefulness of color Doppler ultrasound (US) in the evaluation of the response of hepatocellular carcinoma (HCC) to percutaneous ethanol injection (PEI). MATERIALS AND METHODS: Forty-one patients with 48 lesions 2-5 cm in diameter underwent color Doppler US before and after PEI. Computed tomography (CT), magnetic resonance (MR) imaging, and percutaneous biopsy were also performed to help establish the outcome of therapy. RESULTS: Before treatment, color signals with an arterial Doppler spectrum were seen in 44 of 48 lesions with a frequency shift of 0.51-4.11 kHz (mean, 1.65 kHz). After PEI, 37 of these lesions showed no color signal and were found to be necrotic at CT, MR imaging, and biopsy. In six of seven lesions containing residual tumor, pulsatile flow was still identified, although the frequency shift was significantly decreased (P = .01). CONCLUSION: Color Doppler US proved useful in the assessment of the therapeutic effect of PEI on HCC.

Aged↗
PubMed1993

Improved in vitro rheological system for studying the effect of fluid shear stress on cultured cells.

A rheological in vitro system has been developed to study and quantify cellular adhesion under precisely defined external shear forces. The system is similar to a cone-and-plate viscosimeter. A rotating transparent cone produces both steady and pulsatile flow profiles on cultured cells. Direct visualization of cells by phase-contrast or fluorescence optics and connection of the optical system to a computer-controlled x/y-linear stage allows automatic recording of any point of the cell cultures. With the use of up to 12 individual rheological units, this setup allows the quantitative analysis of cell substrate adhesion by determination of cell detachment kinetics. Two examples of application of this rheological system have been studied. First, we show that the extracellular matrix protein laminin strongly increases endothelial cell adhesion under fluid shear stress. In a second approach, we obtained further support for the concept that shear stress-induced formation of actin filament stress fibers is important for endothelial cells to resist the fluid shear stress; inhibition of stress fiber formation by doxorubicin resulted in significant detachment of endothelial cells exposed to medium levels of fluid shear stress (5 dyn/cm2). No detachment was seen under resting conditions.

Animals↗
PubMed2006

Quantification of right ventricular afterload in patients with and without pulmonary hypertension.

Right ventricular (RV) afterload is commonly defined as pulmonary vascular resistance, but this does not reflect the afterload to pulsatile flow. The purpose of this study was to quantify RV afterload more completely in patients with and without pulmonary hypertension (PH) using a three-element windkessel model. The model consists of peripheral resistance (R), pulmonary arterial compliance (C), and characteristic impedance (Z). Using pulmonary artery pressure from right-heart catheterization and pulmonary artery flow from MRI velocity quantification, we estimated the windkessel parameters in patients with chronic thromboembolic PH (CTEPH; n = 10) and idiopathic pulmonary arterial hypertension (IPAH; n = 9). Patients suspected of PH but in whom PH was not found served as controls (NONPH; n = 10). R and Z were significantly lower and C significantly higher in the NONPH group than in both the CTEPH and IPAH groups (P < 0.001). R and Z were significantly lower in the CTEPH group than in the IPAH group (P < 0.05). The parameters R and C of all patients obeyed the relationship C = 0.75/R (R(2) = 0.77), equivalent to a similar RC time in all patients. Mean pulmonary artery pressure P and C fitted well to C = 69.7/P (i.e., similar pressure dependence in all patients). Our results show that differences in RV afterload among groups with different forms of PH can be quantified with a windkessel model. Furthermore, the data suggest that the RC time and the elastic properties of the large pulmonary arteries remain unchanged in PH.

Adult↗

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