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PubMed2001

Waveform dependence of pulsatile flow in a stenosed channel.

Bloodflow in arteries often shows a rich variety of vortical flows, which are dominated by the complex geometry of blood vessels, the dynamic pulsation of blood flow, and the complicated boundary conditions. With a two-dimensional model of unsteady flow in a stenosed channel, the pulsatile influence on such vortical fluid dynamics has been numerically studied in terms of waveform dependence on physiological pulsation. Results are presented for unsteady flows downstream of the stenosed portion with variation in the wavefiorms of systole and diastole. Overall, a train of propagating vortex waves is observed for all the cases, but it shows great sensitivity to the waveforms. The generation and development of the vortex waves may be linked to the presence of an adverse pressure gradient within a specific interval between two points of inflection of the systolic waveform. The adverse pressure gradient consists of a global pressure gradient that is found to be closely related to the dynamnics of' the pulsation, and a local pressure gradient, which is obsented to be dominated by the nonlinear vortex dynamics.

Arteries↗
PubMed1982

Intracranial pressure and cerebral arterial pulsatile flow measurement in neonatal intraventricular hemorrhage.

We examined the clinical significance of noninvasive intracranial pressure measurements and pulsatility indices in 74 infants with confirmed IC-IVh. The intracranial pressure measurements were obtained using the applanation principle, and the pulsatility indices were calculated from the Doppler flow velocity tracings of the anterior cerebral artery. Fifty-three infants (71.6%) who died had a significantly lower birth weight and gestational age than those who survived. Survival rate decreased significantly with increased intracranial pressure (P less than 0.0002) and increased pulsatility indices (P less than 0.0001). We found no significant relationship between outcome and the size of IC-IVH demonstrated by CT scan. Birth weight, intracranial pressure measurements, and cerebral arterial pulsatile flow changes appear to be major prognostic indicators in neonatal IC-IVH.

Birth Weight↗
PubMed1992

Pressure recovery in aortic stenosis: an in vitro study in a pulsatile flow model.

OBJECTIVES: This study was designed to study pressure recovery in various models of aortic valve stenosis by performing hemodynamic measurements under physiologic conditions in a pulsatile aortic flow circuit. The results were used to validate calculations of pressure recovery based on theoretic considerations derived from fluid dynamics. BACKGROUND: Pressure recovery in aortic stenosis has not been systematically analyzed. METHODS: Stenoses varying in size, shape (circular, Y-shaped, slitlike) and inlet configuration (sharp-edged, nozzle-shaped inlet, artificially stenosed bioprostheses) were used. Aortic pressures were measured at multiple sites distal to the stenotic orifice to determine pressure gradients and recovery. RESULTS: With decreasing orifice area (2, 1.5, 1 and 0.5 cm2) pressure recovery increased (5, 7, 10 and 16 mm Hg, respectively) and the index pressure recovery to maximal peak to peak gradient decreased (56%, 37%, 24% and 14%, respectively). For a given orifice size of 0.5 cm2, this index ranged between 12% for a Y-shaped orifice and 15% for a circular orifice with a nozzle (cardiac output 4 liters/min). Increasing the cardiac output increased pressure recovery, whereas the ratio of pressure recovery to maximal pressure gradient remained constant. CONCLUSIONS: The index pressure recovery to transvalvular pressure gradient, which expresses the hemodynamic relevance of pressure recovery, decreases with increasing severity of aortic stenosis but is independent of transvalvular flow. Thus, pressure recovery is of minor importance in severe aortic stenosis but may account for discrepancies between Doppler and manometric gradients observed in patients with mild to moderate aortic stenosis or a prosthetic valve in the aortic position.

Aortic Valve Stenosis↗
PubMed2006

Movement and dislocation of modular stent-grafts due to pulsatile flow and the pressure difference between the stent-graft and the aneurysm sac.

PURPOSE: To investigate the stability and movement of modular aortic stent-grafts subjected to oscillating forces from pulsatile blood flow, with particular reference to the thoracic aorta. METHODS: Analytical mathematical modeling was used to understand the forces on modular grafts. In a benchtop experiment, a transparent acrylic box was filled with water to mimic an aneurysm. Two stent-grafts were placed inside the box in a nested, arched configuration where one component was partly inside the other. A pump produced a pulsatile approximately 5-L/min flow of water through the stent-grafts at a mean inlet pressure of approximately 100 mmHg (approximately 13,330 Pa), with systolic and diastolic pressures of approximately 130 and approximately 80 mmHg, respectively (pulse pressure 50 mmHg). The movement of the 2 modular stent-grafts was observed. RESULTS: The curved stent-graft system oscillated transversely when there was zero mean pressure difference between the stent-graft and the aneurysm. As the mean pressure difference was increased, this transverse graft movement was damped and then disappeared. A relatively large pressure difference caused the stent-graft to inflate and become sturdier. In terms of stability, the analytical mathematical model for a 30-mm-diameter Zenith modular stent-graft curved through 90 degrees (with the ends of the graft fixed in place) showed that the modular components will separate at a pressure difference of 0 mmHg for 1 stent segment overlap (20 mm) and at an average 59 mmHg pressure difference for 2 stent overlaps, but the device would not separate at a pressure difference of 90 mmHg for 3 stent overlaps. CONCLUSION: Transverse cyclic movement of the curved stent-graft system with pulsation indicates a pressurized sac. When the pressure difference is large and there is a blood-tight seal between the aneurysm and the stent-graft, then the transverse movement of the stent-graft is minimal, but the risk for modular separation is highest. Curved thoracic endografts are subject to forces that may cause migration or separation, the latter being more likely if the seal between the graft and the sac is blood tight, if the blood pressure is high, and if the diameter of the graft is small and the sac large. Operators should plan for maximum overlap of modular components when treating large or long thoracic aneurysms.

Aortic Aneurysm, Thoracic↗
PubMed2006

Pulsatile flow: a critical modulator of the natural history of atherosclerosis.

Atherosclerosis is a systemic process with multi-focal distribution which progresses or regresses in an entirely independent manner within each patient. The low and oscillatory shear stress along with the geometrical particularities of the coronaries modulate an atherogenic microenvironment in susceptible to atherosclerosis regions and determine the disease's rate of progression. However, the atherogenic effect of flow pulsation remains ambiguous. Since the pulsatile nature of the blood constitutes the major generator of the oscillatory shear stress, one could hypothesize that this physiological process might exert a synergistic effect to low SS by facilitating the lesion progression. The heart rate determines directly the frequency of flow pulsation; therefore, its reduction could potentially decelerate the progression of atherosclerosis by alleviating the local atherogenic hemodynamic environment. This perspective might constitute an insight into the beneficial role of heart rate lowering agents with most significant representative the beta-blockers, which have been proved quite efficient anti-atherosclerotic drugs.

Adrenergic beta-Antagonists↗
PubMed2001

Flow pulsatility is a critical determinant of oxidative stress in endothelial cells.

Atherosclerotic plaques are found in regions exposed to disturbed flow, suggesting the active participation of the hemodynamic environment in atherogenesis. Indeed, unidirectional and oscillatory flow patterns (ie, bidirectional) have been shown to induce contrasting effects on endothelial function. The purpose of the present study was to evaluate the effect of these 2 flow patterns characterizing plaque-free and plaque-prone regions, respectively, on the oxidative stress of endothelial cells. NADH-dependent oxidase activity was shown to be equally induced (2- to 3-fold) in endothelial cells exposed to pulsatile unidirectional or oscillatory flow patterns. Under these flow conditions, an increase in endothelial cell oxidative state compared with static cultures was observed. Pulsatility of flow, but not cyclic stretch, was a critical determinant of flow-induced superoxide anion production. P22phox mRNA level increased in cells exposed to both unidirectional and oscillatory shear stress, suggesting that p22phox gene expression upregulation contributes to flow-induced increase in superoxide anion production in endothelial cells. In conclusion, we demonstrate a flow-induced increase in oxidative stress in endothelial cells. This chronic increase is dependent on the pulsatile nature of flow and is mediated in part by upregulation of an NADH-dependent oxidase expression.

Acetylcysteine↗
PubMedDate not supplied

Pulsatile flow changes in the anterior cerebral arteries in infants with patent ductus arteriosus: measured with Doppler technique.

Cerebral hemodynamics were measured, using the Doppler ultrasound technique (directed toward anterior cerebral artery through the anterior fontanel), in 6 patent ductus arteriosus (PDA) patients with large left to right shunt and in 32 neonates before and just following functional closure of ductus arteriosus. PDA was confirmed by color echocardiogram and Doppler flow study. All 6 sick babies had prominent retrograde flow in the descending aorta during diastole. The value of pulsatility index (PI) derived from the components of peak systolic and end--diastolic frequency, was calculated. An obvious higher PI with simultaneous decrease in diastolic Doppler frequency in sick babies (PI = 0.89 +/- 0.05) were detected. On the contrary, the PI valves in the presence of opening of the ductus (PI = 0.65 +/- 0.07) in normal newborn infants didn't differ significantly with those just following functional closure (PI = 0.63 +/- 0.05). These data suggested that PDA might result in the physiologic consequence of ischemic cerebral injury if large left to right shunt occurred.

Cerebral Arteries↗
PubMedDate not supplied

Pulsatile flow pattern in cerebral arteries during cardiopulmonary bypass. An evaluation based on transcranial Doppler ultrasound.

Pulsatile wave patterns in basal cerebral arteries were studied by means of transcranial Doppler ultrasound (TCD) in 11 patients undergoing cardiopulmonary bypass (CPB) surgery. Different physiological states and technical parameters were demonstrated influencing wave forms delivered from a pulsatile CPB roller pump. The results gave evidence of the variability of pulsatile perfusion which may explain the inconsistency in the literature concerning its effectiveness in preserving tissue function. TCD proved to be a useful approach to define pulsatility of cerebral blood flow during CPB.

Blood Flow Velocity↗
PubMed2001

Non-linear analysis of the arterial pulsatile flow: assessment of a model allowing a non-invasive ultrasonic functional exploration.

Ultrasonic measurements and modelling of blood flow in large vessels allows non-invasive evaluation of clinically interesting hemodynamic variables. To this aim, a non-linear mathematical model for the pulsatile arterial flow is proposed using the approximation of "local flow" theory. The model requires only measurements of instantaneous radius and centre-line blood velocity, and the knowledge of the tube distensibility to calculate blood velocity profiles, pressure gradient and wall shear stress. Evaluation of the proposed model using experimental data obtained from the literature proved that it can provide reliable results. In addition, as shown by assessing significance of various non-linear terms, results did not significantly change when a linear pressure-radius relationship was used instead of a non-linear relationship. Also, the model was found to be moderately sensitive to arterial tapering. Thus, the proposed model is suitable for a non-invasive clinical arterial exploration since it only requires three measurements which can be easily and precisely obtained in vivo using ultrasonic methods: the instantaneous radius, the centre-line velocity and the mean pulse wave velocity, this last variable characterizing the tube distensibility when assuming a linear pressure-radius relationship.

Arteries↗
PubMedDate not supplied

Approaching comparability and results of pulsatile flow in vitro testing of prosthetic heart valves.

The testing of prosthetic heart valves under pulsatile conditions is still a subject for debate among researchers and competent standardization bodies. The laboratory of Biomedical Engineering, of the Istituto Superiore di Sanità in Rome, has reproduced the current inter-laboratory situation with several test apparatuses, focusing on the definition of significant measurement parameters and procedures to obtain reasonably comparable data. The laboratory is also equipped with a Laser Doppler Anemometer (LDA) and a High-Speed Cinematographic system (HSC). A 29 mm tilting disc valve model, was mounted in the aortic position. Under tightly controlled system conditions the analyses performed on two pulse duplicators (PDs) may be deemed consistent for the valve model tested. Useful results, on the same valve specimen, are reported concerning velocity profiles and turbulent shear stress values (TSS). Furthermore valve motion on the Sheffield PD was monitored during the closing phase, and related cinematic data reported. The applied methodologies can provide relevant data to support surgeon decision making.

Aortic Valve↗
PubMedDate not supplied

Effect of pulsatile flow on gas exchange in the fish gill: theory and experimental data.

A model for gas exchange in the fish gill allowing for time-varying water and blood flow is presented. An analysis based on this mathematical model shows that pulsatile water and blood flow potentially may reduce the efficiency of gas exchange significantly. The degree of inefficiency imposed on gas exchange is, however, determined by the physical dimensions of the gill and the gas capacitance coefficients of water and blood. Using anatomical and physiological data it is shown to be likely that for a large group of fishes, including the salmonids, pulsatility of water and blood flow affects gas exchange efficiency only marginally. A close coupling between cardiac and respiratory rhythms is therefore only of marginal advantage to gas exchange efficiency. Due to their exceptional gill dimensions tunas, and to a lesser extent mackerels, are susceptible to the negative effect of pulsatility on gas exchange, which may be one of the factors favouring ram ventilation in these species.

Animals↗
PubMed1996

Pulsatile flow of non-Newtonian fluids through arterial stenoses.

The problem of blood flow through stenoses is solved using the incompressible generalized Newtonian model. The Herschel-Bulkley, Bingham and power-law fluids are incorporated. The geometry corresponds to a rigid circular tube with a partial occlusion. Calculations are performed by a Galerkin finite-element method. For the pulsatile case, a predictor-corrector time marching scheme is used with an adaptive time step. Results are obtained for steady and pulsatile physiological flows. Computations show that the memory effects taken into account in the model affect deeply the flow compared with Newtonian reference case. The disturbances are stronger by their vorticity intensity and persist after the geometrical obstacle. This is especially true for severe stenoses.

Arteries↗
PubMed1987

Laser Doppler anemometer measurements of pulsatile flow in a model carotid bifurcation.

Hemodynamics at the human carotid bifurcation is important to the understanding of atherosclerotic plaque initiation and progression as well as to the diagnosis of clinically important disease. Laser Doppler anemometry was performed in a large scale model of an average human carotid. Pulsatile waveforms and physiologic flow divisions were incorporated. Disturbance levels and shear stresses were computed from ensemble averages of the velocity waveform measurements. Flow in the common carotid was laminar and symmetric. Flow patterns in the sinus, however, were complex and varied considerably during the cycle. Strong helical patterns and outer wall flow separation waxed and waned during each systole. The changing flow patterns resulted in an oscillatory shear stress at the outer wall ranging from -13 to 9 dyn cm-2 during systole with a time-averaged mean of only -0.5 dyn cm-2. This contrasts markedly with an inner wall shear stress range of 17-50, (mean 26) dyn cm-2. The region of transient separation was confined to the carotid sinus outer wall with no reverse velocities detected in the distal internal carotid. Notable disturbance velocities were also time-dependent, occurring only during the deceleration phase of systole and the beginning of diastole. The present pulsatile flow studies have aided in identifying hemodynamic conditions which correlate with early intimal thickening and predict the physiologic level of flow disturbances in the bulb of undiseased internal carotid arteries.

Blood Flow Velocity↗
PubMed1990

Prosthetic heart valves: waveform comparisons and average value disposition for pulsatile flow in vitro.

With the development of the in vitro testing of heart valves, the standardization of the test methods becomes increasingly important and they should also be improved continuously. This paper discusses the problems of waveform comparison and average value dispositions. In the pulsatile model driven by pneumatics, the pressures before and after the valve, and the flow through it, are measured as three one-dimensional variates. The mean values are calculated according to the FDA and the ISO. A comparison and analysis of experimental waveforms indicate that, for basically the same ranges of pressures and flow rate, the flow curves of different types of valve are clearly different. The mean values and the waveforms in the time domain should be taken into consideration synthetically so that the pusatile characteristics of the valve can be more completely reflected. Using numerical filtering methods to treat the waveforms allows for better comparisons between the measured results taken from the different devices. By means of the constellation graphical method for treating mean values as multivariates, it is feasible to classify the valves and to judge their qualities under conditions of pulsatile flow.

Computer Graphics↗
PubMed1999

Catheter obstruction effect on pulsatile flow rate--pressure drop during coronary angioplasty.

The coupling of computational hemodynamics to measured translesional mean pressure gradients with an angioplasty catheter in human coronary stenoses was evaluated. A narrowed flow cross section with the catheter present effectively introduced a tighter stenosis than the enlarged residual stenoses after balloon angioplasty; thus elevating the pressure gradient and reducing blood flow during the measurements. For resting conditions with the catheter present, flow was believed to be about 40 percent of normal basal flow in the absence of the catheter, and for hyperemia, about 20 percent of elevated flow in the patient group. The computations indicated that the velocity field was viscous dominated and quasi-steady with negligible phase lag in the delta p(t)-u(t) relation during the cardiac cycle at the lower hydraulic Reynolds numbers and frequency parameter. Hemodynamic interactions with smaller catheter-based pressure sensors evolving in clinical use require subsequent study since artifactually elevated translesional pressure gradients can occur during measurements with current angioplasty catheters.

Algorithms↗