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PubMed2006

Amplitude and phase of cerebrospinal fluid pulsations: experimental studies and review of the literature.

OBJECT: A recently developed model of communicating hydrocephalus suggests that ventricular dilation may be related to the redistribution of pulsations in the cranium from the subarachnoid spaces (SASs) into the ventricles. Based on this model, the authors have developed a method for analyzing flow pulsatility in the brain by using the ratio of aqueductal to cervical subarachnoid stroke volume and the phase of cerebrospinal fluid (CSF) flow, which is obtained at multiple locations throughout the cranium, relative to the phase of arterial flow. METHODS: Flow data were collected in a group of 15 healthy volunteers by using a series of images acquired with cardiac-gated, phase-contrast magnetic resonance imaging. The stroke volume ratio was 5.1 +/- 1.8% (mean +/- standard deviation). The phase lag in the aqueduct was -52.5 +/-16.5 degrees and the phase lag in the prepontine cistern was -22.1 +/- 8.2 degrees. The flow phase at the level of C-2 was -5.1 +/- 10.5 degrees, which was consistent with flow synchronous with the arterial pulse. The subarachnoid phase lag ventral to the pons was shown to decrease progressively to zero at the craniocervical junction. Flow in the posterior cervical SAS preceded the anterior space flow. CONCLUSIONS: Under normal conditions, pulsatile ventricular CSF flow is a small fraction of the net pulsatile CSF flow in the cranium. A thorough review of the literature supports the view that modified intracranial compliance can lead to redistribution of pulsations and increased intraventricular pulsations. The phase of CSF flow may also reflect the local and global compliance of the brain.

Adult↗
PubMed2003

Effects of periodic body acceleration on the in vivo vasoactive response to N-omega-nitro-L-arginine and the in vitro nitric oxide production.

Periodic acceleration (pGz), a novel method of ventilatory support, is achieved using a platform that moves cyclically in the headward-footward direction. PGz has been shown to increase vascular shear stress and regional blood flows, as well as decrease pulmonary and systemic vascular resistances. PGz also increases nitric oxide (NO) production. This study was undertaken to determine the effects of pGz on the NO inhibiting effects of N-w-nitro-L-arginine (L-NAME) in vivo, and to determine if increased NO production due to pGz could be reproduced in vitro with isolated arteries. Pigs were assigned to conventional ventilation (CV), or pGz, with no additional breathing assistance. L-NAME was infused in cumulative doses of 1, 3, 10, 30, and 100 mg/kg. Cardiac output decreased in both groups by 50%. There was also a dose-dependent increase in blood pressure, pulmonary artery pressure, and vascular resistances. However, pGz attenuated the vascular response of L-NAME. Isolated porcine aortas exposed to nonpulsatile, pulsatile, and pulsatile flow plus pGz exhibited an increase in nitrites with the addition of pulsatile flow (300%, relative to steady flow), and a further increase with pGz (1000%, relative to steady flow). It has been determined that pGz, a novel method of increasing shear stress on the vascular endothelium. attenuates the vasoactive response to L-NAME. The in vitro experiments demonstrated that increases in NO production in vivo could be reproduced in vitro, which provides the opportunity to investigate the mechanisms of cardiovascular pGz effects.

Acceleration↗
PubMed1993

Volumetric blood flow measurement with color Doppler ultrasonography: the importance of visual clues.

Volumetric flow rates were obtained in an in vivo canine pulsatile flow model using color Doppler ultrasonography (CDUS) and timed collection (TC) over a range which included laminar and turbulent flow. CDUS demonstrated increasing flow disturbance as flow rates increased, with effects on velocity profile, diameter measurements, and flow symmetry. Data comparing CDUS and TC showed marked differences in laminar flow (regression: slope = 1.02; r2 = 0.93; mean error, 11%) and nonlaminar flow (slope = 0.53; r2 = 0.78; mean error, 26%). Assigning the angle of insonation precisely was crucial to measurement accuracy. CDUS quantitates volumetric blood flow with a reasonable degree of accuracy under laminar flow conditions. Visual clues provided by CDUS can help avoid errors associated with deviations from laminar flow.

Animals↗
PubMed1999

Determinants of coronary blood flow after thrombolytic administration. TIMI Study Group. Thrombolysis in Myocardial Infarction.

OBJECTIVES: This study evaluated the determinants of coronary blood flow following thrombolytic administration in a large cohort of patients. BACKGROUND: Tighter residual stenoses following thrombolysis have been associated with slower coronary blood flow, but the independent contribution of other variables to delayed flow has not been fully explored. METHODS: The univariate and multivariate correlates of coronary blood flow at 90 min after thrombolytic administration were examined in a total of 2,195 patients from the Thrombolysis in Myocardial Infarction (TIMI) 4, 10A, 10B and 14 trials. The cineframes needed for dye to first reach distal landmarks (corrected TIMI frame count, CTFC) were counted as an index of coronary blood flow. RESULTS: The following were validated as univariate predictors of delayed 90-min flow in two cohorts of patients: a greater percent diameter stenosis (p < 0.0001 for both cohorts), a decreased minimum lumen diameter (p = 0.0003, p = 0.0008), a greater percent of the culprit artery distal to the stenosis (p = 0.03, p = 0.02) and the presence of any of the following: delayed achievement of patency (i.e., between 60 and 90 min) (p < 0.0001 for both cohorts), a culprit location in the left coronary circulation (left anterior descending or circumflex) (p = 0.02, p < 0.0001), pulsatile flow (i.e., reversal of flow in systole, a marker of heightened microvascular resistance, p = 0.0003, p < 0.0001) and thrombus (p = 0.002, p = 0.03). Despite a minimal 16.4% residual stenosis following stent placement, the mean post-stent CTFC (25.8 +/- 17.2, n = 181) remained significantly slower than normal (21.0 +/- 3.1, n = 78, p = 0.02), and likewise 34% of patients did not achieve a CTFC within normal limits (i.e., <28 frames, the upper limit of the 95th percent confidence interval previously reported for normal flow). Those patients who failed to achieve normal CTFCs following stent placement had a higher mortality than did those patients who achieved normal flow (6/62 or 9.7% vs. 1/118 or 0.8%, p = 0.003). CONCLUSIONS: Lumen geometry is not the sole determinant of coronary blood flow at 90 min following thrombolytic administration. Other variables such as the location of the culprit artery, the duration of patency, a pulsatile flow pattern and thrombus are also related to slower flow. Despite a minimal 16% residual stenosis, one-third of the patients treated with adjunctive stenting still have a persistent flow delay following thrombolysis, which carries a poor prognosis.

Angioplasty, Balloon, Coronary↗
PubMed1991

Direct projective time-of-flight NMR angiography within 4s.

To enhance contrast between flow and static tissue, NMR projective angiographic methods usually require data subtraction, or alternatively the application of special data processing routines such as the "maximum intensity projection" algorithm. We have successfully developed a direct projection method which yields sufficient flow/static contrast in a single acquisition, producing angiograms in under 4 s. Direct projection angiograms of the cervical and abdominal vessels were obtained. The cervical vessels were uniformly depicted in a number of different projection views. The abdominal vessels exhibit intensity variations due to the pulsatile flow pattern. A series of abdominal angiograms were acquired, each triggered at a different starting cardiac phase. When displayed as a movie sequence the pulsatile flow pattern was seen to advance along the arteries. To more uniformly represent the abdominal vessels a 24-s average was adequate. This new technique should allow NMR angiograms to be obtained in a "fluoroscopic" mode.

Abdomen↗
PubMed2006

Characterization of portal vein thrombus with the use of contrast-enhanced sonography.

OBJECTIVES: To select an appropriate treatment regimen, it is essential to accurately characterize the nature of a thrombus. This study prospectively assessed the ability of contrast-enhanced sonography to differentiate between benign and malignant portal vein thrombosis in a population of high-risk patients. METHODS: Fifty-five patients (43 men and 12 women; mean age, 66 years; range, 55-83 years) with thrombi of the portal venous system were examined by power Doppler sonography and contrast-enhanced sonography with the intravenous contrast agent SH U 508A (Levovist; Schering AG, Berlin, Germany). Of the thrombi, 40 were characterized as malignant and 15 as benign. Pulsatile flow in the thrombus on power Doppler sonography and positive enhancement of the thrombus on contrast-enhanced sonography were judged as indications of a malignant thrombus. The sensitivity and specificity of both methods in differentiating the nature of the thrombus were evaluated. RESULTS: The detection of pulsatile flow in a portal vein thrombus as the criterion for diagnosing malignant portal vein thrombus yielded overall sensitivity of 82.5% and specificity of 100%, whereas positive enhancement of the portal vein thrombus itself as a criterion for diagnosing malignancy yielded overall sensitivity and specificity of 100% for each. CONCLUSIONS: Contrast-enhanced sonography can be helpful in discriminating between benign and malignant portal vein thrombi.

Aged↗
PubMed2000

An in vitro cell culture system to study the influence of external pneumatic compression on endothelial function.

PURPOSE: External pneumatic compression (EPC) is an effective means of prophylaxis against deep venous thrombosis. However, its mechanism remains poorly understood. Understanding of the biological consequences of EPC is an important goal for optimizing performance of the EPC-generating device and providing guidance for clinical use. We present a new in vitro cell culture system (Venous Flow Simulator) that simulates blood flow and vessel collapse conditions during EPC, and we examine the influence of these factors on endothelial cell (EC) fibrinolytic activity and vasomotor function. METHODS: An in vitro cell culture system was designed to replicate the hemodynamic shear stress and vessel wall strain associated with induced blood flow during different modes of EPC. Human umbilical vein endothelial cells were cultured in the system and subjected to intermittent flow, vessel collapse, or a combination of the two. The biologic response was assessed through changes in EC morphology and the expression of fibrinolytic factors tissue plasminogen activator, plasminogen activator inhibitor type 1, profibrinolytic receptor (annexin II), and vasomotor factors endothelial nitric oxide synthase and endothelin-1. RESULTS: The cells remained attached and viable after being subjected to intermittent pulsatile flow (F) and tube compression (C). In F and F + C, cells aligned in the direction of flow after 6 hours. Northern blot analysis of messenger RNA shows that there is an upregulation of tissue plasminogen activator expression (1.95 +/- 0.19 in F and 2.45 +/- 0.46 in FC) and endothelial nitric oxide synthase expression (2.08 +/- 0.25 in F and 2.11 +/- 0.21 in FC). Plasminogen activator inhibitor type 1, annexin II, and endothelin 1 show no significant change under any experimental conditions. The results also show that pulsatile flow, more than vessel compression, influences EC morphology and function. CONCLUSION: Effects on ECs of intermittent flow and vessel collapse, either individually or simultaneously, were simulated with an in vitro system of new design. Initial results show that intermittent flow associated with EPC upregulates EC fibrinolytic potential and influences factors altering vasomotor tone. The system will facilitate future studies of EC function during EPC.

Blood Flow Velocity↗
PubMed1996

Flow measurements in an aortocoronary bypass graft casting.

Flow visualization and pressure measurements were carried out in a singel valve saphenous vein casting which was made from a saphenous vein segment obtained from a bypass patient at Cedars Sinai Medical Center. Dye was injected to understand the flow around the valve. The dye showed very complex flow patterns around the valve and in the valve sinus, and the cavity formed by a ligated branch. For steady flow, pressure drops across the valve were 0.72, 2.0 and 6.3 mmHg for the physiological flow rates of 45, 84, and 169 ml/min, respectively. Overall pressure drop across the casting (compared to Poiseuille flow for a straight tube) increased with the flow rate, being 130 to 290 percent higher over this flow rate range. In the case of pulsatile flow, pressure drops across the valve were 0.95 and 3.0 mmHg for the flow rates of 47 and 87 ml/min which were 26 and 43 percent higher than those of steady flow. Overall pressure drop was 220 and 360 percent higher for those flow rates compared to Poiseuille flow. The measured spatial pressure distributions along the casting and flow visualization indicated the global nature of the flow field with the accelerated flow through the valve separating and reattaching downstream along the wall in the pressure recovery region. Atherosclerosis may be prone to occur in the lower shear region along the wall beyond the valve tip in the reattachment region, as we have observed in vivo in rabbit experiments.

Biomechanical Phenomena↗
PubMed2006

Peripheral vascular reactivity in patients with pulsatile vs axial flow left ventricular assist device support.

BACKGROUND: Left ventricular assist devices (LVADs) are either pulsatile or axial flow devices. The latter can be operated at a low-speed setting to allow pulsatility or at a high-speed setting to create continuous flow. The purpose of this study was to compare the effect of continuous flow and pulsatile flow on peripheral vascular reactivity. METHODS: Twenty consecutive patients were divided into two groups based on the type of LVAD they received. Ten patients had a pulsatile flow LVAD, and 10 had an axial flow LVAD. For the purpose of the study protocol, the axial flow devices were operated at a high speed to ensure continuous flow. The patients' peripheral artery vasoreactivity was assessed with an ultrasound vascular transducer that measured flow-mediated dilation (FMD). RESULTS: The FMD of the patients supported with pulsatile flow (15.6 +/- 5%) was higher than the FMD of the patients supported with temporary continuous flow (1.8 +/- 3%). The difference was statistically significant (p < 0.0001). CONCLUSIONS: Pulsatile flow is associated with a better peripheral vascular reactivity than continuous flow. Patients supported by axial flow devices should be kept on the lowest speed setting to allow maximum pulsatility.

Adult↗
PubMedDate not supplied

[Pulse rate of the venous wave in the eco-Doppler study of the lower extremities as a sign of elevated pressure in the right atrium].

AIM: The aim of this study is to determine the nature of venous flow in the lower extremities, as well as to correlate the velocity of the flow with average vein pressure in the right atrium. MATERIAL AND METHODS: Over a period of one year 236 pulsated Doppler echographs were made of patients, bearers of a venous catheter located in the right atrium. The patients were in a supine lying position and breathing gently. The lines of the Doppler wave were used to analyse the frequency of the wave, the components of its velocity, the relationships of velocity and the existence of pulsatile flow. These parameters were compared with the pressure in the right atrium. RESULTS: The study showed a cardiac and respiratory periodicity of the venous wave. A statistically significant correlation (p<0.0001) was found between average venous pressure in the right atrium and the following variables: the systolic atrium wave (a), the diastolic atrium wave (d), the relation of pulsatility (RP=Velocity min/Velocity max) and the index of pulsatility (IP=[Velocity max-Velocity min]/Velocity average). CONCLUSION: There is an inverse and significant relationship between pulsatile flow and atrium pressure. Nonetheless, although a relation exists between the different components of the venous wave, an elevation in central vein pressure cannot be predicted.

English Abstract↗
PubMed1998

Assessment of the total artificial heart (TAH) pulsatility: the coalition between pulsatility and ejection time in TAH in vitro study.

There are many types of pulsatile pumps with various pulsatile flow waveforms. These authors perceived that pulsatility was an important characteristic for a pulsatile pump. The effect of a total artificial heart (TAH) was estimated using a pulse power index (PPI) in a mock loop. This method helps in the development of a standard criterion for measurement of a pulsatile waveform. The pulsatility of the TAH was found to be useful as a physiological control method. At first the relationship between ejection time and dp/dt was examined and then the relation between PPI, ejection time and preload. The dp/dt was unchanged by ejection time and PPI was unchanged by preload. However, PPI was changed by the ejection time. There was an inverse correlation between ejection time and PPI (r = 0.80). The PPI at ejection time 150 msec was significantly higher than the other ejection time's PPI. These results suggest that the TAH should be driven with an ejection time of 150 msec, because this ejection time has a high pulsatility and can obtain a higher flow. This happens without increasing the dp/dt and this ejection time can be preplanned, because a fixed ejection time improves the durability of the actuator.

Biomechanical Phenomena↗
PubMedDate not supplied

Mini hemoreliable axial flow LVAD with magnetic bearings: part 2: design description.

This paper gives the preliminary configuration of the flow geometry used to eliminate bearing thrombus by forced pressure wash-out of the bearing gaps. This left ventricular assist device (LVAD) is physiologically controllable without extraneous sensors based on the measurement of pump differential pressure using the magnetic bearings. Knowing the LVAD differential pressure allows safe cyclic variation of impeller rpm with feedback around differential pressure, which obtains desired pressure pulsatility. Flow pulsatility is known to be of major benefit for minimizing thrombus in both the pump and arteries. It also results in improved perfusion of many organs. The ability of a conventional virtual zero power feedback loop to axially control the bearing in a long-term drift free manor is also explained.

Equipment Design↗
PubMed1993

Cyclic variation of the power of ultrasonic Doppler signals backscattered by polystyrene microspheres and porcine erythrocyte suspensions.

Factors affecting the power of the ultrasonic Doppler signal within the flow cycle have been evaluated experimentally using a pulsatile flow loop model. Polystyrene microspheres and porcine red cells suspended in saline solution for hematocrits between 2 and 40% were used as scattering fluid in the flow model. Experiments were performed at mean flow velocities of 11, 64, and 76 cm/s. In laminar flow experiments performed at a mean velocity of 11 cm/s, no variation of the Doppler power was found for both polystyrene microspheres and red cell suspensions (40% hematocrit). When turbulence was induced in the flow model, the power increased during systole, a maximum was observed early after peak systole, and a decrease was obtained in diastole during deceleration of flow. At higher mean flow velocities (64 and 76 cm/s), a significant cyclic variation of the Doppler power was also measured for all values of hematocrits (between 2 and 40%). The power of the signal scattered by microspheres and red cell suspensions at 4% hematocrit dropped in systole, reached a minimum at peak systole, and then increased during early diastole. For red cells suspended in saline at 40% hematocrit, a slightly different pattern of variation was obtained. The cyclic variations observed at high flow velocities and in the presence of turbulence are believed to be associated with cyclic changes in the correlation among particles. In the present study, the effect of red cell aggregation on the cyclic variation has not been addressed.

Animals↗
PubMed1990

Pulsatile pressure and flow in the skeletal muscle microcirculation.

Although blood flow in the microcirculation of the rat skeletal muscle has negligible inertia forces with very low Reynolds number and Womersley parameter, time-dependent pressure and flow variations can be observed. Such phenomena include, for example, arterial flow overshoot following a step arterial pressure, a gradual arterial pressure reduction for a step flow, or hysteresis between pressure and flow when a pulsatile pressure is applied. Arterial and venous flows do not follow the same time course during such transients. A theoretical analysis is presented for these phenomena using a microvessel with distensible viscoelastic walls and purely viscous flow subject to time variant arterial pressures. The results indicate that the vessel distensibility plays an important role in such time-dependent microvascular flow and the effects are of central physiological importance during normal muscle perfusion. In-vivo whole organ pressure-flow data in the dilated rat gracilis muscle agree in the time course with the theoretical predictions. Hemodynamic impedances of the skeletal muscle microcirculation are investigated for small arterial and venous pressure amplitudes superimposed on an initial steady flow and pressure drop along the vessel.

Animals↗
PubMedDate not supplied

Comparison of Björk-Shiley ABP and St. Jude Medical Prostheses in a newly developed pulse duplicator.

Pre-clinical and clinical testing of artificial heart-valves has not been standardized. Therefore different centers have been using individual procedures. As a consequence, the results from different laboratories on different valves can be compared only after certain assumptions. In order to compare different valves under identical conditions, a pulse duplicator was developed and the Björk-Shiley and St. Jude Medical valves were studied in the aortic position under pulsatile flow, at stroke volumes ranging from 40 to 90 ml and frequencies from 40 to 130 cpm. Linear relationships were observed between the gradients as measured across the artificial valves and both, stroke volume and frequency. Loss of pressure divided by stroke volume, expressed as a function of frequency, was found to be a simple parameter to describe the fluid mechanical properties of an artificial valve under pulsatile flow and to compare different types of devices. The comparison of BS ABP and SJM aortic prostheses of equal diameter revealed the fluid mechanical properties of the SJM valve to be superior to those of the BS prosthesis under identical testing conditions.

Heart Valve Prosthesis↗
PubMed2006

Gastrointestinal motility during cardiopulmonary bypass: a sonomicrometric study.

Cardiopulmonary bypass (CPB) is known to impair the integrity of the gastrointestinal tract. However, little is known about the movement behavior of the gastrointestinal tract during CPB. This study was aimed to assess the gastrointestinal motility with sonomicrometry, a distance measurement using ultrasound, in a porcine model of CPB. Twelve pigs weighing 70-112 kg were having a standard hypothermic CPB for 120 min either with the nonpulsatile flow (n = 6) or the pulsatile flow (n = 6). Before CPB, piezoelectric echo crystals were placed either along the longitudinal or the circular axis of the pylorus. Patterns of gut movement and the total sonomicrometric activity (TSA) were recorded at several time intervals during experiments as qualitative and quantitative parameters of gut motility. Results showed that the intact regular rhythmic pattern of gut movement was detected before CPB. This pattern changed little when CPB started, but it disappeared at 60 min when the body temperature lowered down to 32 degrees Celsius. During the same period, the TSA reduced significantly along the longitudinal as well as the circular directions of the pylorus. There was no significant difference between the nonpulsatile and pulsatile groups. Gut blood flow reduced significantly in both groups, but it was not associated with the reduced sonomicrometric activity. In conclusion, gastrointestinal motility during CPB can be measured qualitatively and quantitatively by sonomicrometry in a large animal model. Suppression of gut motility during CPB does not seem to be associated with the mode of perfusion but with the reduced body temperature during the hypothermic phase of CPB.

Animals↗