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At least 289 records · Page 16Linked to original sources

The effect of angle on wall shear stresses in a LIMA to LAD anastomosis: numerical modelling of pulsatile flow.

The purpose of this study was to examine the effect of anastomotic angle on the flow patterns and wall shear distributions at the distal anastomosis of a left interior mammary artery (LIMA) graft to the left anterior descending artery (LDA). It is now well recognized that abnormal wall shear stress distributions along the anastomotic bed, around the toe, and around the heel can contribute to the focal development of intimal hyperplasia. However, the exact nature of the interaction between the dominant pulsing flow and the anastomotic angle on wall shear stresses has not been fully investigated numerically. In this study a commercial CFD package was used for three-dimensional flow analysis where the pulsatile waveforms and flowrates used as the boundary conditions are representative of an anastomosed left internal mammary artery and a stenosed left anterior descending coronary artery (intermediate, <70 per cent diameter narrowing). The flow patterns and distributions of time-averaged wall shear stress (TAWSS) and the oscillatory shear index (OSI) for three anastomotic angles of 20, 40, and 60 degrees were evaluated and compared with other published data. The findings indicated that transient, highly disturbed flow patterns occurred in localized regions of the proximal and distal native segments and in the anastomotic domain including recirculation zones, moving points of stagnation, and oscillating wall shear stresses mainly on the bed, at the toe, and at the heel. Moreover, higher anastomotic angles resulted in more extreme variations in TAWSS and OSI values, particularly around the toe and along the bed. In addition, the effect of anastomotic angle on OSI values at the heel followed the same pattern whereas the TAWSS values along the graft at the heel showed a significant increase at the lowest anastomotic angle of 20 degrees.

Anastomosis, Surgical↗

Pulsatile flow in tapered tubes: a model of blood flow with large disturbances.

Blood flow-through segments of large arteries of man, between adjacent bifurcations, can be modeled as pulsatile flow in tapered converging tubes, of small angle of convergence, up to 2 deg. Assuming linearity, rigid tube and homogeneous Newtonian fluid, the physiological flow field is governed by the Navier-Stokes equation with dominant nonlinear and unsteady terms. Analytical solution of this problem is presented based on an integral method technique. The solution shows that even for small tapering the flow pattern is markedly different from the flow obtained for a uniform tube. The periodic shear stresses at the wall and pressure gradients increase both in their mean value and amplitude with increased distance downstream. These results are highly significant in the process of atherogenesis.

Animals↗

In vitro pulsatile flow measurements in the vicinity of mechanical heart valves in the mitral flow chamber.

A three-beam laser Doppler anemometer system was used to study the flow fields created by various types of mitral heart valve prostheses under conditions of physiological pulsatile flow. The prosthetic valves studied were the Beall caged-disc valve, Björk-Shiley tilting disc valve, Medtronic-Hall tilting disc valve, and St. Jude bileaflet valve. The results indicate that all four prosthetic valve designs studied create very disturbed flow fields, with elevated turbulent shear stresses and regions of flow separation and/or stagnation. The maximum turbulent shear stresses measured were 1900 dynes/cm2 for the Beall valve, 380 dynes/cm2 for the Björk-Shiley valve, 1800 dynes/cm2 for the Medtronic-Hall valve, and 770 dynes/cm2 for the St. Jude valve. These elevated turbulent shear stresses could cause sublethal and/or lethal damage to red cells and platelets. The regions of flow separation and/or stagnation could lead to thrombus formation and/or tissue overgrowth on the valve structure, as observed on clinically recovered prosthetic valves.

Blood Flow Velocity↗

Comparison of Doppler echocardiographic peak frequency and turbulence parameters in the quantification of aortic stenosis in a pulsatile flow model.

To test the relative accuracy of Doppler echocardiographic peak frequency and turbulence parameters in assessing aortic stenosis, we constructed a pulsatile flow model that simulated human left ventricular and aortic pressures, flow, and anatomy. Continuous wave-measured peak frequencies and pulsed Doppler-measured turbulence were determined in the model ascending aorta for nine stenotic valve areas for each of five different flow rates. The mean squared systolic peak frequency (MSPF) and turbulence spectral envelope area (SEA) were regressed against the mean systolic gradient (r = .94, SEE = 5.6 mm Hg; and r = .96, SEE = 1.2 mm Hg, respectively). SEA was more accurate than MSPF at moderate-to-high degrees of stenosis and exhibited a smaller standard error. MSPF was more accurate than SEA in mild stenoses, where SEA tended to overestimate gradients. When flow data were included in a multiple regression analysis, both MSPF and SEA provided fair predictions of actual effective valve areas (r = .90 and r = .94, respectively). Use of high pulse-repetition-frequency Doppler echocardiography significantly reduced aliasing problems common to pulsed Doppler techniques.

Aortic Valve Stenosis↗

Pulsatile flow during cardiopulmonary bypass. Evaluation of a new pulsatile pump.

Pulsatile cardiopulmonary bypass (CPB) has been suggested to be superior to nonpulsatile CPB. This report concerns a newly developed pulsatile pump for clinical use. It is designed as a positive displacement pump, with blood allowed to collect in a valved cavity from which it is ejected by the reciprocating action of a piston. Using a uniform procedure of anaesthesia and surgery, 14 pigs were subjected to CPB at 37 degrees C for 3 hours. The pulsatile pump was used in seven pigs and a conventional roller pump in the other seven. The wave-form of the pulse during pulsatile CPB was similar to that recorded in the pigs before bypass. The values for rate of pressure change with respect to time (dp/dt) obtained in the aorta were close to the pre-CPB values. No difference was found between the two groups with respect to platelet count or haemolysis. The investigated pulsatile device appeared to be reliable and easy to handle, and the pulsation it produced closely resembled the physiologic pulse-wave form.

Animals↗

Numerical simulation of pulsatile flow in a carotid bifurcation model.

The finite element method is used to solve the time-dependent Navier-Stokes equations for pulsatile flow through a model of the human carotid bifurcation. Theoretical fluid dynamic investigations can be useful in gaining insight into flow phenomena in arteries; our mathematical results show the zones of reversed flow during the pulse period and the paths of single blood particles in the flow field. The separated flow zones and the visualization of the particle paths indicate the haemodynamic particularity of the carotid sinus.

Blood Flow Velocity↗

Comparison of Doppler ultrasound velocity measurements with pressure differences across bioprosthetic valves in a pulsatile flow model.

Continuous wave Doppler ultrasound was used in vitro to assess the pressure differences across four different cardiac bioprosthetic valves in a pulsatile flow test apparatus. Valves were tested under four different flow conditions. Pressure differences were calculated from the maximum flow velocity measured by Doppler ultrasound and correlated well with the pressure differences measured directly in the flow model (r = 0.98). Thus Doppler ultrasound can accurately measure pressure differences across bioprosthetic valves in vitro.

Bioprosthesis↗

MR angiography with pulsatile flow.

To achieve acceptable scan times, current multiple thin slice and 3D MR angiography (MRA) methods usually are based on continuous data acquisition, without ECG-synchronization. The purpose of this work is to study consequences of pulsatile blood flow for the 2D inflow method. Arterial blood flow and blood signal intensity versus cardiac phase were studied by a 2D phase based method with retrospective cardiac synchronization. Such studies were performed in different parts of the body and with different excitation flip angles. As expected, a clear relation between intensity enhancement and time dependent flow can be demonstrated. The raw data of these multiphase studies was used to simulate alternative inflow MRA data acquisition strategies to improve image quality, without the excessive increase in scan time implied by standard cardiac triggering. The alternatives investigated were data collection during part of the cardiac cycle and cardiac-ordered phase encoding. Simulation results indicate that the best results are obtained by a combination of both strategies. This method was implemented on Philips Gyroscan systems to compare it with standard nontriggered 2D inflow in practical MRA studies. For highly pulsatile flow, much better MR angiograms were obtained in this way.

Blood Vessels↗

Pulsatile flow through a bifurcation with a cerebrovascular aneurysm.

Laser-Doppler velocimetry measurements and flow visualization were complementarily made in pulsatile and steady flow in a cerebrovascular aneurysm model with bifurcation angles of 60, 90, and 140 deg, and volume-flow rate ratios between the branches of 1 to 1 and 3 to 1. The mean, peak, and minimal Reynolds numbers based on the bulk average velocity and diameter of the parent vessel were 600, 800, and 280, respectively. For uneven branch flow, it is found that the flow activity inside the aneurysm and the stresses acting on the aneurysmal wall increase with increasing bifurcation angle. More importantly, the present angle suggests the presence of a critical bifurcation angle below which the aneurysm is prone to thrombosis, whereas above which the aneurysm is susceptible to progression or rupture. For evenly distributed branch flow, the intra-aneurysmal flow is sluggish and therefore prone to thrombosis for all studied bifurcation angles.

Aneurysm, Ruptured↗

[Design and preliminary experiment of an intelligentized physiologic pulsatile flow cardiac support system].

A patent cardiac support system which is used as a bridge treatment for acute myocardial infarction has been designed and tested in vitro and in two dogs in vivo. This is an easy-to-use intelligentized pulsatile flow cardiopulmonary bypass device to replace the function of heart. The device consists of two identical pumps and perfusion chambers, a sensing and control system, a gas exchanger between the vein and pump, two one way valves between pump and veins or arteries. Arterial pressure and EKG feedback mechanisms are used for maintaining blood pressure and coordinating the pumping activity with heart contraction. A prototype of the device was built to perform hydraulic in vitro tests with aims of verifying the new device's pumping behavior. Functional evaluation of the device was carried out by using it in a model circuit made with standard CPB components plus a mock hydraulic pipeline. This system demonstrated easy manipulation, good controllability, and provided a 65+/-2ml x beat(-1) flow volume. There was a linear correlation between peak pressure value and pulsatile frequency. In the two in vivo experiments, the primary objective was to determine whether the device could work well in dog, whether physiologic pulsatility could be achieved and whether the blood supply to heart should be sufficient during asystole status by drugs. The results suggest that all the goals have been achieved.

Animals↗

Numerical and experimental studies on pulsatile flow in aneurysms arising laterally from a curved parent vessel at various angles.

Both numerical and experimental studies have been performed to characterize the fluid flow inside the lateral aneurysms arising from the curved parent vessels at various angles gamma. The implicit solver was based on the time-dependent Navier-Stokes equations of incompressible laminar flow. Solutions were generated by a cell-center finite-volume method that used second order upwind and second order center flux difference splitting for the convection and diffusion term, respectively. The second order Crank-Nicolson method was used in the time integration term while the SIMPLEC algorithm was adopted to handle the pressure-velocity coupling. Complementarily, the particle tracking velocimetry (PTV) was used to measure the velocity fields. The conditions selected were to simulate an internal carotid artery with a diameter of 5 mm by similarity rules. The values of gamma explored were 0 degrees, 45 degrees, 90 degrees, and 135 degrees. Pulsatile flow with Wormersley number 3.9 and Reynolds numbers varying from 350 to 850 was considered. The computed results are firstly verified by the PTV measured ones. Discussion of the results is in terms of pulsatile main and secondary velocity vector fields, inflow rates into the aneurysm, and the distributions of wall shear stress and static pressure. It is found that among the angles examined gamma=45( composite function) is the riskiest angle from a fluid dynamics point of view and the aneurysmal dome is at risk.

Blood Flow Velocity↗

Flow pulsatility in the portal venous system: a study of Doppler sonography in healthy adults.

OBJECTIVE: The purpose of our study was to describe Doppler sonography patterns of venous flow in the portal system of healthy subjects and to compare pulsatility of flow with subjects' body mass, degree of inspiration, and body position. SUBJECTS AND METHODS: Doppler signals from the main, right, and left portal veins; superior mesenteric vein; splenic vein; and inferior vena cava of 23 healthy adults were prospectively studied. Pulsatility of flow was quantified using an index of venous pulsatility (VPI = [maximum frequency shift-minimum frequency shift]/maximum frequency shift). Antegrade flow peak velocities were also related to ECG tracings the time between two R waves being divided into four equal parts for analysis. The caliber variations of the main portal vein and inferior vena cava were measured with M-mode sonography. Doppler tracings were obtained with subjects in supine and sitting positions and during mid and deep inspiration. The subjects' heights and weights were obtained and the body mass index calculated (weight/[height2]). RESULTS: In the portal vein, the VPI was 0.48 +/- 0.31 (mean +/- SD). Marked pulsatility of venous flow (VPI > 0.5) was found in 12 of 23 subjects. We found an inverse correlation between the VPI and the subjects' body mass index (r = -.76; p < .001). Portal vein pulsatility decreased significantly during sitting (p < .05) and deep inspiration (p < .01). The portal VPI was correlated with caliber variation of the inferior vena cava (r = .59; p < .05). In the portal venous system, antegrade flow peak velocities occurred most often during the third quarter of the cardiac cycle, particularly in the splenic vein. CONCLUSION: Doppler sonography shows pulsatile portal venous flow in healthy adults, especially in thin subjects. This pulsatility has an inverse correlation to body mass. The finding of a pulsatile portal vein needs to be interpreted in clinical context and does not necessarily imply dysfunction of the right side of the heart.

Adult↗

Calculation of pulsatile flow and particle paths in an aneurysm-model.

The velocity field and the wall shear stress have been calculated numerically by the finite element method to the time-dependent Navier-Stokes equations for pulsatile flow in a model of an aneurysm. The results show a complex flow field with two eddies growing and disappearing during the cardiac cycle. Downstream at the outlet vessel high wall shear stress occurs, which may lead to a downstream-growing of the aneurysm. With the knowledge of a sufficiently accurate flow field, the calculation of several particle paths has been carried out. Starting points and starting time are varied. The paths demonstrate the time-dependent development, shift and disappearance of vortices during the pulsatile cycle and provide hints on zones of stasis. These are significant factors in thrombogenesis.

Aneurysm↗

Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress.

Fluid velocities were measured by laser Doppler velocimetry under conditions of pulsatile flow in a scale model of the human carotid bifurcation. Flow velocity and wall shear stress at five axial and four circumferential positions were compared with intimal plaque thickness at corresponding locations in carotid bifurcations obtained from cadavers. Velocities and wall shear stresses during diastole were similar to those found previously under steady flow conditions, but these quantities oscillated in both magnitude and direction during the systolic phase. At the inner wall of the internal carotid sinus, in the region of the flow divider, wall shear stress was highest (systole = 41 dynes/cm2, diastole = 10 dynes/cm2, mean = 17 dynes/cm2) and remained unidirectional during systole. Intimal thickening in this location was minimal. At the outer wall of the carotid sinus where intimal plaques were thickest, mean shear stress was low (-0.5 dynes/cm2) but the instantaneous shear stress oscillated between -7 and +4 dynes/cm2. Along the side walls of the sinus, intimal plaque thickness was greater than in the region of the flow divider and circumferential oscillations of shear stress were prominent. With all 20 axial and circumferential measurement locations considered, strong correlations were found between intimal thickness and the reciprocal of maximum shear stress (r = 0.90, p less than 0.0005) or the reciprocal of mean shear stress (r = 0.82, p less than 0.001). An index which takes into account oscillations of wall shear also correlated strongly with intimal thickness (r = 0.82, p less than 0.001). When only the inner wall and outer wall positions were taken into account, correlations of lesion thickness with the inverse of maximum wall shear and mean wall shear were 0.94 (p less than 0.001) and 0.95 (p less than 0.001), respectively, and with the oscillatory shear index, 0.93 (p less than 0.001). These studies confirm earlier findings under steady flow conditions that plaques tend to form in areas of low, rather than high, shear stress, but indicate in addition that marked oscillations in the direction of wall shear may enhance atherogenesis.

Adult↗

An automated and portable low-flow pulsatile perfusion system for organ preservation.

While machine preservation reduces the incidence of delayed graft function in renal transplant recipients, it is only used in 10% of kidney transplantations. The performance of our portable, low-flow-pulsatile organ perfusion system was examined in a canine kidney autotransplantation model. Grafts were stored for 72 h by simple cold preservation in University of Wisconsin (UW) solution, or by high or low-flow machine preservation After preservation, the grafts were autotransplanted and the animals were followed for 15 days. Graft function was better in machine-preserved kidneys. Tissue biochemistry indicated that machine preservation resulted in higher levels of adenine nucleotides and better histological integrity than the cold storage. While histology and biochemistry of machine-preserved groups were similar, electromicroscopy of high-flow grafts showed mild accumulation of intravenous debris and endothelial swelling. This study shows that a simplified machine perfusion technique is effective for organ preservation.

Animals↗

Pulsatile flow velocity and shear stress measurements on the St. Jude bileaflet valve prosthesis.

The velocity and turbulent shear stress fields in the immediate vicinity of the St. Jude bileaflet valve were measured under pulsatile flow conditions with a two-dimensional laser Doppler anemometer system. The valve was studied in both aortic and mitral positions. In both positions, the valve created relatively centralized flow fields. However, a major portion of the flow occurred through the two side orifices. Regions of flow separation were observed adjacent to the valve sewing ring in the area of the valve pivot (hinge) mechanism. Elevated turbulent shear stresses were measured in both positions. Peak values of 760 dynes/cm2 and 2 000 dynes/cm2 were observed in the mitral and aortic flow chambers, respectively. Such turbulent shears could cause sublethal and/or lethal damage to blood elements. The regions of flow separation adjacent to the pivot mechanism could lead to tissue overgrowth and/or thrombus formation, which in turn could impede proper motion of the valve leaflets.

Aortic Valve↗

Pulsatile flow past St. Jude Medical bileaflet valve. An in vitro study.

An in vitro hemodynamic study of the St. Jude Medical bileaflet aortic prosthesis was performed in a mock circulatory system simulating physiological pulsatile flow. The study included measurements of pressure drop across the valves, percent regurgitation, velocity, and turbulence in a model human aorta. The measurements indicated that pressure drop (mean systolic pressure drop of 6.2 mm Hg), percent regurgitation (10.15%), and turbulent normal stresses immediately downstream from the valve (825 dynes/cm2) were better than those with other prosthetic valves and bioprostheses. The flow development in the aorta was not significantly affected by the orientation of the bileaflet valve in the root of the aorta. However, velocity measurements immediately downstream from the valves showed flow reversal and separation in the vicinity of the hinge points of the leaflets where thrombus formation has been previously reported.

Aorta↗