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A model of pulsatile flow in a uniform deformable vessel.

Simulations of blood flow in natural and artificial conduits usually require large computers for numerical solution of the Navier-Stokes equations. Often, physical insight into the fluid dynamics is lost when the solution is purely numerical. An alternative to solving the most general form of the Navier-Stokes equations is described here, wherein a functional form of the solution is assumed in order to simplify the required computations. The assumed forms for the axial pressure gradient and velocity profile are chosen such that conservation of mass is satisfied for fully established pulsatile flow in a straight, deformable vessel. The resulting equations are cast in finite-difference form and solved explicitly. Results for the limiting cases of rigid wall and zero applied pressure are found to be in good agreement with analytical solutions. Comparison with the experimental results of Klanchar et al. [Circ. Res. 66, 1624-1635 (1990]) also shows good agreement. Application of the model to realistic physiological parameter values provides insight as to the influence of the pulsatile nature of the flow field on wall shear development in the presence of a moving wall boundary. Specifically, the model illustrates the dependence of flow rate and shear rate on the amplitude of the vessel wall motion and the phase difference between the applied pressure difference and the oscillations of the vessel radius. The present model can serve as a useful tool for experimentalists interested in quantifying the magnitude and character of velocity profiles and shearing forces in natural and artificial biologic conduits.

Animals↗

[Generation of a pulsatile flow in the arterial blood line of an artificial circulation apparatus].

A new type of a ventricle pump incorporated in an arterial blood line of the artificial circulation device has been designed. A poor pulsatile flow generated by the artificial circulation system is transformed by the pump into one characterized by marked fluctuations. It may be synchronized with heart cycle phases, if necessary. Basic principles of the method as well as the circuit of the device and its arrangement within the artificial circulation system are considered.

Arteries↗

In vitro pulsatile flow hemodynamics of five mechanical aortic heart valve prostheses.

In vitro measurements of velocity, turbulent shear stress, effective orifice area (EOA), and regurgitant fraction were performed on five new-generation low-profile mechanical aortic heart valve designs under pulsatile flow conditions. These were: Medtronic-Hall tilting disc, St. Jude Medical bileaflet, Björk-Shiley Monostrut tilting disc, Omni-Carbon tilting disc, and Duromedics bileaflet. In general, bileaflet valves have larger EOAs than the tilting disc design, especially in the larger sizes, due to the larger opening angles and lack of obstructive struts. The regurgitant fractions range from 8% for 21-mm valves to 13% for the 29-mm sizes. This increase was largely due to an increase in leakage volume as opposed to closing volume. Furthermore, the leakage volumes increased as the mean aortic pressures increased. The tilting disc valves generally have better regurgitant characteristics compared to the bileaflet valve designs, due to lower leakage volumes and to the smaller opening angle of the occluder providing a more rapid closure of the valve. The velocity and shear stress measurements showed that none of the current valve designs are ideal: all designs create areas of stasis and/or regions of low-velocity reverse flow and regions of elevated turbulent shear stresses capable of causing sublethal and/or lethal damage to the formed elements of blood. It is therefore unlikely that these valve designs will eliminate the problems of hemolysis, thrombosis, and thromboembolic complications.

Aortic Valve↗

Serum S-100beta protein release in coronary artery bypass grafting: laminar versus pulsatile flow.

BACKGROUND: Cerebral injury after Cardiopulmonary bypass (CPB) is still a serious and unpredictable complication. The S-100beta serum marker has been suggested as potentially useful in the detection of cerebral injury during and after CPB. Direct comparisons of whether laminar or pulsatile pump flow in CABG leads to higher S-100beta values and which type might be more neuroprotective have not been made so far. METHODS: All 21 patients of the study were undergoing CABG for the first time and had no history of cerebral disease in whatever form. They were divided into two groups: laminar (n = 10) versus pulsatile (n = 11) pump flow. In all cases, a Stöckert roller pump (Fa. Stöckert, Munich, Germany) with a laminar and pulsatile running mode was used for cardiopulmonary bypass. Serum S-100beta levels were detected using a monoclonal immunoradiometric assay (Sangtec Medical AB, Bromma, Sweden). In total, 5 different samples were drawn per patient, starting before intubation and ending 36 hours after surgery. RESULTS: S-100beta peak values were found at skin closure. Median levels were lower in the pulsatile group. Due to the small study group and wide range, results are non-significant. CONCLUSION: The results indicate that pulsatile flow might have a more neuroprotective effect than laminar flow as S-100beta values were lower.

Adult↗

Pulsatile flow regulates monocyte adhesion to oxidized lipid-induced endothelial cells.

Oxidized 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine (ox-PAPC), a component of minimally modified low density lipoprotein, induces monocyte adhesion to endothelial cells. It is not known whether the upstroke slopes of pulsatile flow, defined as shear stress slew rates (tau(r)/tauT)), can regulate monocyte binding to ox-PAPC-treated bovine aortic endothelial cells (BAECs). At 60 cycles per minute, ox-PAPC-treated BAECs were exposed to 3 conditions representing known vascular conditions: (1) high shear stress slew rates (tau(r)/tau(T)=293 dyne. cm(-2). s(-1)), with time-averaged shear stress=50 dyne/cm(2); (2) low shear stress slew rate (tau(r)/tau(t)=71 dyne. cm(-2). s(-1)), with identical time-averaged shear stress; and (3) reversing oscillating flow (0+/-2.6 mm Hg). Reverse transcription-polymerase chain reaction and quantification were performed for monocyte chemoattractant protein-1 (MCP-1) mRNA expression. High tau(r)/tau(t) reduced monocyte binding to ox-PAPC-treated BAECs by 64+/-3.2% compared with static conditions, and low tau(r)/tau(t) reduced monocyte binding by 31+/-3.4%, whereas oscillating flow increased monocyte binding by 22+/-1.7% (P<0.005). High partial tau(r)/tau(t) downregulated MCP-1 expression by 33+/-8%, and low partial tau(r)/tau(t) downregulated MCP-1 expression by 15+/-4%, but oscillating flow upregulated MCP-1 by 13+/-5%. These results suggest that shear stress slew rates regulate monocyte binding by modulating the expression of a potent monocyte chemoattractant.

Animals↗

In vitro pulsatile flow velocity and turbulent shear stress measurements in the vicinity of mechanical aortic heart valve prostheses.

A two-dimensional laser Doppler anemometer system was used to study the velocity and turbulent shear stress fields created by various types of mechanical aortic heart valve prostheses under physiological pulsatile flow conditions. The prosthetic valves studied were the Starr-Edwards caged ball valve, Bjork-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 regions of flow separation and/or stagnation and regions of elevated turbulent shear stress. The maximum values of the mean turbulent shear stresses measured during peak systole were 1200 dynes/cm2 for the Starr-Edwards valve, 1600 dynes/cm2 for the Bjork-Shiley valve, 1000 dynes/cm2 for the Medtronic-Hall valve, and 1050 dynes/cm2 for the St. Jude valve. The corresponding values during the deceleration phase were about 800, 600, 450 and 800 dynes/cm2, respectively. These elevated turbulent shear stresses could cause sublethal and/or lethal damage to blood elements, and, together with the regions of flow separation and/or stagnation, could lead to thrombus formation and/or tissue overgrowth on the valve structure, as observed on the clinically recovered prosthetic valves.

Biophysical Phenomena↗

Experimental study of steady and pulsatile flows in cerebral aneurysm model of various sizes at branching site.

Pulsatile and steady flow fields in cerebrovascular aneurysm models of various sizes are presented in terms of laser-Doppler velocimetry measurements and flow visualization. The bifurcation angle was 140 deg and volume flow rate ratio between the branches was 3:1. 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. It is found that among the tested sizes there exists a middle range of aneurysm sizes, above and below which the forced-vortex inside the aneurysmal model is weaker and lacking, respectively, whereas in the middle range of the tested sizes the forced vortex is stronger and the fluctuation level is higher near the dome. The present results also identify the major fluid dynamic factors of the aneurysmal promotion or rupture for the medium and larger aneurysms, respectively. Furthermore, the maximum fluctuation intensity is found to increase with aneurysm size. The locations of the maximum fluctuation intensity are found to occur in the bifurcation area or at the neck instead of intra-aneurysm.

Aneurysm, Ruptured↗

Attenuation of hypoxic pulmonary vasoconstriction by pulsatile flow in dog lungs.

We measured pulmonary arterial pressure in isolated lower lobes of dog lungs perfused in situ at several flows during ventilation with 95% O2-5% CO2 and with 3% O2-5% CO2. Pulsatile perfusion was provided by a piston pump, and steady perfusion was provided by a roller pump. The slope of the pressure-flow curve was 16.1 +/- 1.6 Torr X 1(-1) X min at all flows between 200 and 800 ml/min during 95-5 ventilation and increased to 19.4 +/- 3.7 in hypoxia. When flow was 600 ml/min, with 95-5 ventilation, mean arterial pressure was 16.2 +/- 1.2 Torr in steady flow and was unchanged at 15.0 +/- 1.0 Torr in pulsatile flow. At the same flow during hypoxic ventilation, mean arterial pressure increased to 27.9 +/- 2.4 Torr (P less than 0.01) when flow was steady but only to 19.3 +/- 1.6 Torr (P less than 0.01) when flow was made pulsatile. Thus hypoxia increased perfusion pressure by a nearly parallel shift of the pressure-flow curve to higher pressures, and this change was smaller in pulsatile than in steady flow.

Animals↗

Two-component laser velocimeter measurements downstream of heart valve prostheses in pulsatile flow.

Elevated turbulent shear stresses resulting from disturbed blood flow through prosthetic heart valves can cause damage to red blood cells and platelets. The purpose of this study was to measure the turbulent shear stresses occurring downstream of aortic prosthetic valves during in-vitro pulsatile flow. By matching the indices of refraction of the blood analog fluid and model aorta, correlated, simultaneous two-component laser velocimeter measurements of the axial and radial velocity components were made immediately downstream of two aortic prosthetic valves. Velocity data were ensemble averaged over 200 or more cycles for a 15-ms window opened at peak systolic flow. The systolic duration for cardiac flows of 8.4 L/min was 200 ms. Ensemble-averaged total shear stress levels of 2820 dynes/cm2 and 2070 dynes/cm2 were found downstream of a trileaflet valve and a tilting disk valve, respectively. These shear stress levels decreased with axial distance downstream much faster for the tilting disk valve than for the trileaflet valve.

Blood Flow Velocity↗

Pulsatile flow of non-Newtonian fluid in distensible models of human arteries.

In addition to biochemical factors, hydromechanical influences are responsible for atherogenesis and deposits of blood platelets at bends and bifurcations of human arteries. Hence the flow patterns were simulated in a true-to-scale three-dimensional bifurcation of a human renal artery model and of an arterial femoralis with Newtonian and non-Newtonian blood like fluid. Investigations were made with steady and pulsatile flow. The velocity profiles (at physiological Re-numbers) were measured after the bifurcations with a laser-Doppler-anemometer. In previous works Newtonian fluids were used to investigate the flow in bends and bifurcations of rigid and elastic simplified models. In this paper, emphasis is placed on the difference between rigid and elastic models and also Newtonian and non Newtonian flow behavior. Differences between Newtonian and non Newtonian fluids may especially be expected to occur after branches where the flow has local strong convective elements such as in reverse zones and flow separation points.

Arteries↗

In vitro pulsatile flow visualization on extracardiac conduits for the right ventricular outflow tract reconstruction: qualitative considerations.

Valved homograft conduits play an important role in the right ventricular outflow tract (RVOT) reconstruction for the surgical treatment of complex congenital heart disease. An excellent immediate rather than long-term outcome could be obtained. The hemodynamics for late failure, however, remained unclear. In vitro pulsatile flow visualization was not conducted before. A simplified right heart duplicator system was set up and driven under physiologic conditions. Polystyrene of 0.18 mm in diameter was applied as the tracing particle. Flow characteristics of models of normal pulmonary circulation as well as pulmonary artery atresia with the RVOT reconstructed utilizing valved and non-valved extracardiac conduits were observed. Flow patterns in the normal pulmonary circulatory model were mainly of axial flow associated with small scope of flow disturbances. A single vortex in the right ventricle was noted in diastole. In the pulmonary artery atresia model, a couple of vortexes were found in the right ventricle, a secondary flow in the main pulmonary artery, and a stronger secondary flow than in the normal pulmonary circulatory model in the two branches in both systole and diastole. A secondary flow was found in the proximal, an axial flow was observed in the distal portion of the extracardiac conduit with normal bioprosthetic valves and a secondary flow was observed in the entire conduit with stenotic bioprosthetic valves. The secondary flow intensity became stronger with the development of the stenosis. Severe insufficiency occurred in the bileaflet ceramic tilting-disc prosthesis during the entire cardiac circle, i.e., the prosthesis was in a maximum open position. Severe reverse flow could be found in the extracardiac conduit in the deceleration phase. Concavity of the crank shaft was found by examination to be filled with tracing particles and the prosthesis became stuck. Model of RVOT reconstruction with non-valved conduit yielded reverse flow inside the extracardiac conduit as well. Secondary flow may occur in normal or diseased extracardiac conduit for RVOT reconstruction. If micro-thrombus of over 0.18 mm in diameter attached in the concave of the crank shaft of a bileaflet tilting-disc prosthesis under a condition of resistance as occurred in the present study, the prosthesis may become stuck. Model of RVOT reconstruction with non-valved extracardiac conduit yielded reverse flow inside the conduit, of which the flow pattern was of greater energy consumption. Thus, a non-valved conduit should be avoided in clinical practice as far as possible.

Heart Defects, Congenital↗

A pulsatile flow study comparing the Hancock porcine xenograft aortic valve prostheses models 242 and 250.

A modified version of the Hancock porcine xenograft aortic valve bioprosthesis has recently been introduced into clinical use. In this valve, the leaflet containing the septal shelf has been replaced by a leaflet from another valve, thus increasing the effective orifice area of the prosthesis without changing its external dimensions. Modified valves (model 250) have been subjected to pulsatile flow studies and compared to similar studies carried out on the current aortic valve xenografts (model 242) over a range of sizes (19-25 mm). The new model 250 valves caused significantly lower pressure drops or gradients than those of the previous model. They also allowed between 33 percent and 45 percent more flow (depending on size) at a gradient of 20 mmHg than did the model 242 valves. These results indicate that the new valves hould have clear clinical advantages over the current prostheses.

Animals↗

Heat and mass transfer of a thermal indicator in pulsatile flow through the cardio-pulmonary system. I. Modeling.

The construction of a physico-mathematical model which describes the mechanism of indicator dispersion in the circulation and which fits the thermal dilution curves (TDC) is presented. Because of its more evident physical meaning, formulation of the problem in terms of heat and mass transfer is preferred to stochastic theory. Hypotheses necessary to simplify the general system of governing equations are clearly defined and discussed. This deductive method leads to a one-dimensional convective heat transfer model in which pulsatility and form of injection appear naturally. Simulations of TDC in constant and pulsatile flow cases are performed on a digital mini-computer which demonstrates the model's ability to represent different experimental or clinical observations. This will facilitate hemodynamic parameter identification from TD techniques and will increase the accuracy of this identification.

Aorta↗

Steady and pulsatile flow studies on a 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 in the aortic position indicate that overall it has improved leaflet motion characteristics and pressure drop characteristics compared to the Carpentier-Edwards porcine and Ionescu-Shiley pericardial tissue valves in current clinical use. The ABIOMED valve is, however, more stenotic compared to the St. Jude and Medtronic-Hall low profile mechanical valves, at normal cardiac outputs. Steady and pulsatile flow velocity measurements with a laser-Doppler anemometer system indicate that the flow field downstream of the ABIOMED valve is jet-like and leads to elevated shear stresses. These shear stresses are, however, lower than those observed with the Ionescu-Shiley and Carpentier-Edwards tissue valves. The ABIOMED valves tested 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↗

Influence of membrane oxygenators on the pulsatile flow in extracorporeal circuits: an experimental analysis.

An experimental analysis was carried out to evaluate the effects induced by two typical extracorporeal circuits on the pressure and flow generated by a roller pump with a pulsatile module. The hydraulic behaviour of the patient was simulated by means of a mechanical mock-up system consisting of a few lumped parameters reproducing the physiologic vascular impedance. Pressure and flow tracings were acquired at different locations along the circuit using an automatic data acquisition system. Nine lest conditions with different pulse frequency and systolic time values were examined using a mean volumetric flow rate of approximately 4 l/min. A complete analysis of the results obtained in terms of pressure drops and inflow-outflow differences across the components of the arterial line, as well as the calculation of the hydraulic pulsatile power along the circuit, allowed us to assess the influence of the various components upon the pulsatility. The results indicated that the membrane oxygenators tested slightly affect the pulsatility of the flow and the pressure; on the contrary the arterial pipe line is responsible for large damping and head losses. To optimize the use of pulsatile flow for cardiopulmonary bypass it is necessary to reduce the length of the arterial pipe lines thus integrating the circuit as much as possible.

Cardiopulmonary Bypass↗

Heat and mass transfer of a thermal indicator in pulsatile flow through the cardio-pulmonary system. II. Identification of cardiac output.

Hamilton's celebrated formula for cardiac output measurement is simple but its validity is dependent on several methodologic requirements which are not generally fulfilled, particularly in thermal dilution. A quite different method, based on a physico-mathematical model of the indicator dispersion in the circulation, is proposed. It allows direct derivation of cardiac output once the model's parameters have been identified. Combined deconvolution and least squares procedures are used with truncated data for this identification. Numerical tests and application to clinical observations are presented. Both limitations and possibilities of further developments in estimation of pulsatile flow conditions from TD technique are discussed.

Blood Circulation↗

On the discrimination between band-limited coherent and random apparent stresses in transitional pulsatile flow.

A frequency domain approach that incorporates a matched filter was examined for discriminating between ordered velocity fluctuations with band-limited frequency content and random velocity variations in pulsatile disturbed flows. Fluctuations at pseudo-discrete frequencies may yield a significant contribution to the apparent stress tensor computed from the unsteady Navier Stokes equations, and an estimate of the stresses arising from these ordered structures can be obtained once the velocity variations have been decomposed. This type of decomposition permits the estimation of the apparent stresses in turbulent flows, consisting of coherent and random parts, in blood flow applications such as diseased constricted arteries or downstream of artificial heart valves.

Blood Flow Velocity↗

Pulsatile flow improves renal function in high-risk cardiac operations.

The effects of pulsatile perfusion on microcirculation and renal function in high-risk patients were evaluated in this study. Pulsatile roller pumps with a pulsatile control module and membrane oxygenator were used in a clinical setting. 40 patients undergoing elective cardiac surgery with a high risk of either having chronically obstructive pulmonary disease or chronic renal failure were randomly included in the study to be perfused using pulsatile or continuous flows. Blood samples were collected at induction of anesthesia, at the time of aortic clamping and declamping and 1 and 24 h following cessation of the bypass. Urea and creatinine concentrations in blood were measured and systemic vascular resistance was calculated. Urine output, crystalloid and colloid infusions were recorded. We observed that pulsatile roller pump perfusion and the extracorporeal circuit used in the clinical study improved microcirculation and renal function in high-risk patients undergoing cardiopulmonary bypass.

Adult↗