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The shear rate at the wall in a symmetrically branched tube simulating the aortic bifurcation.

The purpose of this study was to determine the shear rate at the wall in a symmetrically branched tube with a branch-to-trunk area ratio and angle of branching that were comparable to the human abdominal aorta. Velocity profiles were measured with a laser Doppler anemometer during steady and pulsatile flow in which the mean Reynolds numbers were 500, 1000, and 1500. During both steady and pulsatile flow, as the Reynolds numbers increased, the shear rates at the inner wall of the branch increased. Only slight increments of the shear rates occurred along the outer wall of the branch, however, as the Reynolds number increased. No reversals of flow were observed at any Reynolds number during steady flow. Transient reversals of flow (causing negative shear rates) occurred along the outer wall of the branch at a Reynolds number of 500; but such transient flow reversals were not observed at the higher Reynolds numbers during pulsatile flow.

Aorta, Abdominal↗

Evaluation of pulmonary systemic blood flow using ECG gated acquisition.

We propose a functional parametric analysis method using ECG-gated 99mTc-labeled red blood cell (RBC) imaging for detection and characterization of periodic variations in local blood activity in the lungs during cardiac cycle. We validated in animal experiments that such count variations correlate with cyclical pulmonary blood flow and may be used for evaluation of systemic-to-pulmonary shunts. Clinical studies were performed in 48 patients. After labeling the RBC pool with 99mTc, ECG-gated gamma camera images of both lung fields were acquired and processed to obtain Fourier transforms of time/activity functions in selected regions. The first harmonic parametric images of amplitude and phase were derived. There was an excellent correlation (r = 0.92) between activity variations and pulsatile flow measured by our method with that obtained by the thermodilution method in dog experiments (n = 10) after implantation of a systemic-to-pulmonary shunt. Patient studies showed the technique to be sensitive in detecting and quantifying abnormal systemic-to-pulmonary blood flow. Lung pulsatile flow can thus be noninvasively measured from functional parametric phase and amplitude images; the technique may be useful for detecting and quantifying abnormal systemic-to-pulmonary blood flow in man.

Animals↗

An investigation into the cause of distal endoleaks: role of displacement force on the distal end of a stent-graft.

PURPOSE: To investigate if the forces developed by pulsatile flow on a stent-graft and dimensional changes of the graft material might contribute to distal endoleak and stent-graft kinking. METHODS: An in vitro experimental model was used to measure the peak displacement force developed by pulsatile flow pressure on the distal end of a stent-graft. Polytetrafluoroethylene (PTFE) graft material (110 mm long, 22 mm in diameter) was evaluated in a flow circuit, with water as the circulating liquid. In addition, the effect of internal pressure on PTFE graft dimensions was measured under nonpulsatile conditions in 3 configurations (1 bifurcated and 2 straight). RESULTS: Pressure in the PTFE graft did not cause a change in graft diameter but did increase the length of the graft. The mean load required to prevent retrograde displacement was 208.5+/-2.5 g. Peak retrograde displacement force developed on the distal end of the stent-graft by the pressure of pulsatile flow was strongly associated with the systolic phase of the cardiac cycle. CONCLUSIONS: The distal end of the stent-graft is subject to a retrograde displacement force by the pressure of pulsatile arterial flow. In addition, pressure inside the PTFE graft causes its length to increase. Both of these factors may be important in the development of late complications of stent-grafting.

Aortic Aneurysm↗

Digital densitometric determination of relative coronary flow distributions.

In clinical cardiology, stenosis in a coronary artery is measured on the basis of visual assessment. The reading of coronary arteriograms leads, however, to large inter- and intra-observer variability. Image analysis and computer assistance result in a more consistent assessment, but this approach is mainly based upon static geometric parameters, such as diameter reduction of a segment of the stenosed artery. A more functional, physiological measurement is thus desirable. This can be realised by measuring the difference between the normal coronary blood flow and the increased flow under hyperaemic conditions, yielding the so-called coronary flow reserve (CFR). In clinical practice, however, this method is difficult and time-consuming. A less demanding approach is reported, in which relative flow distributions are determined densitometrically from digital angiograms acquired under basal and hyperaemic conditions. The proposition is that, if the relative flow distribution in hyperaemic state differs from that during rest, the functional severity of a stenosis downstream from the bifurcation can be indicated. The new approach is validated by comparing the results of a theoretical model for steady flow with a flow phantom experiment for steady and pulsatile flow. The obtained flow ratios correlate very well, both in steady and pulsatile flow, with correlation coefficients exceeding 0.95.

Coronary Circulation↗

Measuring blood flow by nontriggered 2D phase-contrast MR angiography.

This study was done to assess the validity of nontriggered 2D phase contrast MR angiography for measuring blood flow in human arteries and veins. Volume in the popliteal and internal carotid arteries was measured by nontriggered and triggered 2DPC in 1.3 normal volunteer (mean age 27, range 18-46). Parameter selection was guided by previous phantom experiments. Results were compared by linear regression analysis. Measurement error was determined by one-way analysis of variance of repeated measurements. In the internal carotid arteries, good agreement was found between the volume flow, Q, as determined by a triggered measurement and a nontriggered measurement: Qntr = 0.988 (+/- 0.006) Qtr, r = 0.98, SEE = 0.16 ml/s. The estimated measurement errors of both techniques were of the same order: 0.27 vs. 0.31 ml/s. Substantial deviations between triggered and nontriggered 2DPC were found in the popliteal artery: Qntr = 0.827 (+/- 0.028) Qtr, r = 0.97, SEE = 0.12 ml/s. The estimated measurement error of nontriggered 2DPC turned out to be twice as large as of triggered 2DPC here: 0.22 vs. 0.13 ml/s. We believe that nontriggered 2DPC is a valid technique for measuring blood flow in stationary vessels with weakly pulsatile flow, but merely provides a rough estimation for strongly pulsatile flow. In its current implementation, nontriggered 2DPC provides the data in 40 s, whereas triggered 2DPC requires 3-4 min, and offers additional time savings with regard to patient preparation and data processing.

Adolescent↗

Determinants of nitric oxide in exhaled gas in the isolated rabbit lung.

Nitric oxide concentrations in the exhaled gas (NOe) increases during various inflammatory conditions in humans and animals. Little is known about the sources and factors that influence NOe. NOe at end expiration was measured by chemiluminescence in an isolated, blood-perfused rabbit lung. The average end-expiratory concentration over 10 breaths was used. The effect of positive end-expiratory pressure (PEEP), flow rate, pH, hypoxia, venous pressure, and flow pulsatility on NOe were determined. At constant blood flow, increasing PEEP from 1 to 5 cm H2O elicited a reproducible increase in NOe from 49 +/- 7 to 53 +/- 8 parts per billion (ppb) (p < 0.05). When blood pH was increased from 7.40 to 7.74 by breathing low CO2 gas, NOe rose from 45 +/- 7 to 55 +/- 7 ppb (p < 0.001). Hypoxia caused a dose-dependent decrease in NOe from 37 +/- 3 during baseline to 23 +/- 2 during ventilation with 0% O2 (p < 0.01). Venous pressure elevation from 0 to 5 and 10 mm Hg decreased NOe from 32 +/- 5, to 26 +/- 5 and 24 +/- 5 ppb, respectively (p < 0.05). Switching from steady to pulsatile flow (same man flow) resulted in a small, albeit significant reduction in NOe; 30 +/- 4 to 28 +/- 4 ppb (p < 0.05). Changes in flow rate between 200 and 20 ml/min were associated with small changes in NOe; however, when flow was stopped, NOe rose substantially to 56 +/- 6 ppb (p < 0.05). The changes in NOe were rapid (1 to 2 min) and reversible. The results suggest that NOe is influenced by ventilatory and hemodynamic variables, pH, and hypoxia. We suggest that caution must be taken when interpreting changes in exhaled NO in humans or experimental animals. Changes in total and regional blood flow, capillary blood volume, ventilation, hypoxia, and pH should not be overlooked.

Animals↗

Effects of pulsatile reperfusion on globally ischemic myocardium.

To evaluate the effects of pulsatile reperfusion on the post ischemic myocardium, two categories of sheep were put on cardiopulmonary bypass (CPB). In Category I, the hearts of 23 sheep were arrested by global ischemia for 30 min, reperfused with pulsatile flow in 10 animals (P group), and non pulsatile flow in 13 animals (NP group), and then defibrillated. The incidence of ventricular fibrillation was much higher in the NP group than the P group, 77% versus 40% (p < 0.05). The lipoperoxide products and creatinine kinase from coronary sinus blood were elevated, but there were no significant differences between the two groups during 2 hour reperfusion. In the P group, less ultrastructural damage was observed, and Na+ and H2O accumulations in the subendomyocardium were significantly less than in the NP group, at 7.11 +/- 0.60 versus 9.98 +/- 1.10 mg/g dry weight (p < 0.05) and 82.58 +/- 0.47% versus 84.3 +/- 0.38% (p < 0.05), respectively. In Category II, the ischemic time of 17 sheep (eight in the P group, nine in the NP group) was prolonged to 45 min, and animals were supported by CPB after defibrillation. Myocardial energy phosphates were measured with high-performance liquid chromatography, and triphenyltetrazolium chloride was used to delineate the infarct size. After 2 hour of reperfusion, there were no significant differences in myocardial AMP and ADP between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗

Retinal circulatory changes after scleral buckling procedures.

The noninvasive laser Doppler technique was used to study retinal circulatory characteristics in five patients who underwent uncomplicated scleral buckling procedures. In each patient, the systolic/diastolic variation of the red blood cell speed in the retinal arteries (flow pulsatility ratio) was lower in the eye that had received an intrascleral implant and an encircling band than in the fellow eye. In one patient, an increase in flow pulsatility ratio accompanied an increase in retinal blood flow after removal of the scleral buckling elements. In another patient, the flow pulsatility ratio in the eye that had received a solid implant and an encircling band was less than the ratio in the fellow eye that had received an absorbable implant alone. Our results indicated that reduced retinal blood flow may be common after scleral buckling procedures, and may be a significant factor in otherwise inexplicable postoperative complications.

Adult↗

Effects of acceleration on the accuracy of MR phase velocity measurements.

Acceleration in blood flow can affect the accuracy of phase velocity measurements. Convective acceleration is due to changes in flow geometry and is independent of the time-varying acceleration caused by flow pulsatility. To analyze the effects of convective acceleration on flow velocity measurements, phase velocity measurements were obtained in steady laminar flow in the convergent segment of a 90%, hourglass-shaped stenosis phantom at a Reynolds number of 1,500. Measurements at the stenosis indicated that convective acceleration caused the measured values of average cross-sectional velocity to deviate as much as 37% from the theoretical values. The magnitude of the error could be accounted for by including the convective acceleration term in the phase shift equation. Convective acceleration effects should not be ignored in flow velocity measurements through stenoses, even when time-dependent acceleration due to flow pulsatility can be neglected.

Acceleration↗

A nonlinear analysis of pulsatile blood flow applied to investigate shear stress in arterial prostheses.

Although the main function of an arterial graft is to restore distal blood flow, there is evidence that certain local parameters of blood flow, particularly wall shear stresses, are important in determining the graft's long-term patency. Wall shear stresses were associated with intimal hyperplasia, intimal proliferation, and endothelial cell development, morphology, and attachment. Here we present a detailed method which permits the investigation of the wall shear stress acting on arteries and prostheses in dogs. The theory takes into account the nonlinear terms of the Navier-Stokes equations as well as the nonlinear behaviour and large deformation of the arterial wall. It is based on the numerical resolution of the nonlinear equations by the Crank-Nicolson method which was selected for its unconditional stability. Through the locally measured values of the pressure, pressure gradient, radius and flow rate, the velocity distribution and wall shear stress at a given location along the artery or the prosthesis, can be determined. Complete results on the same dog are presented for the distal aorta and for the middle of a chemically processed prosthesis, implanted as substitute in the thoracic aorta.

Animals↗

Retinal circulatory changes related to retinopathy progression in insulin-dependent diabetes mellitus.

To quantify the vascular deterioration of the diabetic retina, retinal circulatory changes in 45 insulin-dependent diabetic patients, and in 17 normal controls, were measured and divided into four groups according to severity of retinopathy. The noninvasive laser Doppler technique was used to measure the systolic/diastolic variation of red blood cell velocity (V) at sites along temporal retinal arteries. Flow pulsatility [V (systole)/V (diastole)] was 18% lower (P less than 0.00001) in the mild-retinopathy group than in normal controls, but 35% higher (P less than 0.001) in the severe-retinopathy group than in the mild-retinopathy group. Repeated measurements in three eyes during the progression from mild or moderate to severe retinopathy showed progressive increases in both flow pulsatility and mean retinal blood flow. Altered flow pulsatility appears to be a sensitive indicator of vascular alterations during the progression of diabetic retinopathy.

Adult↗

Changes in aortic rotational flow during cardiopulmonary bypass studied by transesophageal echocardiography and magnetic resonance velocity imaging: a potential mechanism for atheroembolism during cardiopulmonary bypass.

The human aorta is a curved conduit with a complex three-dimensional geometry. The curvature influences axial velocity distribution and introduces transverse velocity components. Rotational flow in the aorta can be demonstrated during normal pulsatile flow using transesophageal echocardiography. Cardiopulmonary bypass may affect the pattern of rotational flow in the aorta and thus influence the generation of atheroemboli. We investigated rotational flow in the descending aorta using color flow mapping and pulse-wave Doppler on transesophageal echocardiography before and during cardiopulmonary bypass. We correlated our findings with magnetic resonance velocity imaging in a model of a human aortic arch connected to a cardiopulmonary bypass circuit. Before cardiopulmonary bypass, rotational flow in the descending aorta was seen in 37 of 40 patients (93%). In the majority of these patients, rotational flow was in the clockwise direction during systole, looking in the direction of flow (30 of 37 patients, 81%, P < 0.01 vs counterclockwise rotation). During cardiopulmonary bypass, there were almost equal numbers of patients with clockwise (18 patients) and counterclockwise rotation (19 patients). Forty-seven percent of patients with clockwise rotation before cardiopulmonary bypass developed reversal in the direction of rotation to counterclockwise during cardiopulmonary bypass. Twenty-nine percent of patients with counterclockwise rotation developed reversal of the direction of rotation during cardiopulmonary bypass. The transverse velocity component increased during cardiopulmonary bypass regardless of the direction of rotation. We also demonstrated clockwise rotation in the descending aorta of a human aortic arch model connected to a cardiopulmonary bypass circuit using magnetic resonance velocity mapping. Before cardiopulmonary bypass, rotation was predominantly clockwise, while during cardiopulmonary bypass, there was no preferred direction of rotation. The geometry of the aorta, which is fairly constant in all patients, imposes handedness to aortic flow before cardiopulmonary bypass. However, during cardiopulmonary bypass, other extrinsic factors such as aortic cannula orientation may influence the direction of rotation. The change in direction of rotational flow and increase in its transverse velocity component during cardiopulmonary bypass may have implications for atheroembolism and arterial branch perfusion during extended periods of non-pulsatile flow.

Aorta↗

Effect of prolonged pulsatile shear stress in vitro on endothelial cell seeded PTFE and compliant polyurethane vascular grafts.

OBJECTIVES: Compliance mismatch between graft and native artery, and failure of the graft to develop an endothelial lining are the two main factors in graft failure. The objective of this study was to assess a new compliant graft for effective cell attachment and cell retention at physiological levels of pulsatile shear stress over a 6-hour period of physiological pulsatile flow. DESIGN: Laboratory haemodynamic study. MATERIALS AND METHODS: Human umbilical vein endothelial cells labelled with 111In-oxine were seeded on compliant polyurethane (CPU) and polytetrafluoroethylene (PTFE) vascular grafts. These were then exposed to varying shear stresses of up to 13.8 +/- 0.6 dyn/cm2 using a pulsatile flow model. Dynamic scintigraphy images were acquired using a gamma camera linked to an on-line computer during 6 h of perfusion and data presented as mean +/- standard error of mean. RESULTS: Mean seeding efficiencies were significantly different at 4,316 +/- 505 and 825 +/- 504 CPM/cm2 on the CPU and PTFE grafts, respectively (p = 0.018). The flow experiment showed a higher percentage of cells retained on the CPU graft after exposure to shear stress caused by pulsatile flow compared to PTFE with respect to time. After 6 h pulsatile perfusion there was a significantly higher proportion of initial cells attached to CPU graft compared to PTFE graft (73 +/- 8% vs 42 +/- 8%, p = 0.018). The areas under the time activity curves over the 6-hour period were 280 +/- 26.4 for CPU and 176.0 +/- 30.0 for PTFE, confirming a significant greater total cell loss from PTFE compared with CPU grafts (51 +/- 7.0% vs 23 +/- 8.3%, p = 0.018, Wilcoxon matched-pairs signed-ranks test). CONCLUSIONS: This flow model provides an effective method of assessing cell retention on graft materials under physiological conditions over a 6-hour period; CPU combines both excellent compliance and endothelial cell attachment rates after 6 h exposure to shear stress.

Compliance↗

Pulse oximetry in the diagnosis of non-critical peripheral vascular insufficiency.

Pulse oximetry was used to detect return of pulsatile flow in 27 subjects during reactive hyperaemia following 3 min of total limb ischaemia induced by above knee tourniquet occlusion. Fourteen patients with exercise induced leg pain had 18 symptomatic limbs tested. Thirteen controls had 25 limbs tested. Return of pulsatile flow during reactive hyperaemia occurred within 20 s of tourniquet release in the 25 control limbs which was then regarded as normal. The mean time for return of pulsatile flow in 18 symptomatic limbs was 53 +/- 37 s (P < 0.05 versus controls). Three limbs had a normal value, two of which did not have peripheral vascular disease. Pulse oximetry correctly identified all 25 asymptomatic limbs and 15 of 16 patients with claudication secondary to peripheral vascular disease (PVD). This modification of the reactive hyperaemia test using the pulse oximeter is simple and quick to perform. It has potential as a non-invasive screening test for PVD, suitable for outpatient assessment.

Adult↗