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Experimental study of pulsatile and steady flow through a smooth tube and an atherosclerotic coronary artery casting of man.

In vitro investigation of pulsatile and steady flows through a smooth, straight circular tube and a diseased human coronary artery cast was conducted with sugar-water solutions simulating the viscosity of blood. Time averaged pressure drops for pulsatile flows measured in the circular tube over a Reynolds number ranging from 50 to 1,000 were found to be identical to those for steady flows in the same tube, both of which were in excellent agreement with the Poiseuille flow prediction. For the polyurethane case (# 124) made from a human main coronary with significant but 'non obstructive' diffuse atherosclerotic disease, pressure drops for steady flows were found to be greater than Poiseuille flow predictions by a factor of 3-8 in the physiological Reynolds number range from about 100 to 400. Pulsatile flows in the same artery cast resulted in additional 30% increases in time averaged pressure drops, and thus flow resistance, compared to the steady flow data. Steady and pulsatile flow data measured in a straight, axisymmetric model of cast # 124 showed considerably smaller increases in flow resistance than those observed in # 124 casting.

Arteriosclerosis↗

Turbulence characteristics downstream of bileaflet aortic valve prostheses.

This study was focused on a series of in vitro tests on the turbulent flow characteristics of three bileaflet aortic valves: St. Jude Medical (SJM), CarboMedics (CM), and Edwards Tekna (modified Duromedics, DM). The flow fields of the valves were measured in a pulsatile flow model with a laser-Doppler anemometer (LDA) at the aortic sinus area downstream of the valves. The heart rate was set at 70 beats per minute, the cardiac output was maintained at 5 liters per minute, and the aortic pressure wave forms were kept within the physiological range. Cycle-resolved analysis was applied to obtain turbulence data, including mean velocity, Reynolds stresses, autocorrelation coefficients, energy spectral density functions, and turbulence scales. The Reynolds shear stresses of all three valves induced only minor damage to red blood cells, but directly damaged the platelets, increasing the possibility of thrombosis. The smallest turbulence length scale, which offers a more reliable estimate of the effects of turbulence on blood cell damage, was three times the size of red blood cells and five times the size of platelets. This suggests that there is more direct interaction with the blood cells, thus causing more damage.

Aortic Valve↗

[Experimental studies of pulsatile retrograde cerebral perfusion].

This study was investigated for the effects of pulsatile flow on retrograde cerebral perfusion under profound hypothermic circulatory arrest. Fifteen adult mongrel dogs were placed cardiopulmonary bypass and induced profound hypothermia of 20 degrees C at nasopharyngeal temperature. Five dogs were performed non-pulsatile retrograde cerebral perfusion (NP-RCP) and 5 were pulsatile retrograde cerebral perfusion (P-RCP) for 60 minutes each group. The rest of 5 dogs were performed hypothermic circulatory arrest (HCA) without any circulatory assist. Retrograde cerebral perfusion flow rate was regulated to maintain an external jugular vein pressure of 20 mmHg by infusing oxygenated blood by way of bilateral maxillary vein. Regional cerebral blood flow (rCBF), cerebrospinal fluid pressure (CSFP), adenosine triphosphate (ATP) concentration of cerebral tissue, and water content of cerebral tissue were measured. The rCBF were no statistical difference between the two groups. CSFP and ATP concentration in both of NP-RCP and P-RCP were significantly higher than those of HCA. Water content of cerebral tissue in P-RCP were significantly lower than those of NP-RCP. We concluded that retrograde cerebral perfusion for 60 minutes protects the brain as the assistances of circulatory arrest and retrograde cerebral perfusion with pulsatile flow has the possibility to control brain edema as compared with non-pulsatile flow in dogs.

Adenosine Triphosphate↗

Quantitative measurement of volume flow rate (cardiac output) by the multibeam Doppler method.

A new method has been developed for measuring the volume flow rate of blood flowing through large vessels or outflow tracts of the heart. In this article we describe the principle of a method that can reduce the dependence of the Doppler angle of flow measurement by setting the sample points along a line to which every ultrasound beam is perpendicular. To evaluate the accuracy of this method, flow phantom experiments were made for both steady and pulsatile flows. The volume flow rate measured by this method agrees well with that observed by an ultrasound flowmeter (r = 0.99) when the vessel diameter is large (25 mm). However, this method overestimates by 40% when the vessel diameter is small (8 mm). To make this method applicable to small vessels, an improvement in the lateral resolution of Doppler measurement is necessary. It has been concluded that this method can be used to measure the cardiac output or volume flow rates in large vessels.

Algorithms↗

Poststenotic flow velocity changes as a function of stenosis geometry.

We used an in vitro pulsatile flow model to examine the velocity profile distal to a variable nonaxisymmetric stenosis. Using a continuous-wave Doppler velocimeter, the peak systolic frequency was determined distal to the stenosis and in planes parallel and perpendicular to the long axis of the stenosis. In both planes, an exponential regression best describes the relationship between peak systolic frequency and reduction in cross-sectional area. Regressions at each point of insonation diverged as a direct function of reduction in cross-sectional area and as an indirect function of distance from the stenosis. At each point of insonation, regressions representing the relationship in the mutually perpendicular planes diverged in direct proportion to reduction in cross-sectional area. Slopes were greater in parallel planes of insonation. These data demonstrate that two variables, distance and geometry, may influence the results of spectral analytic studies.

Arterial Occlusive Diseases↗

[Measurement of arterial flow in the limbs: plethysmography, isotopes, electromagnetic methods].

Measurement of arterial flow is a very old practice, and intra-arterial recordings of pressure and flow have long served as a reference for experimental studies (fig. 1). The definition of a hemodynamic state is inconceivable unless these two parameters are associated. The electromagnetic method using an intra-arterial sensor measures pulsatile flow. Now, technological advances have led to the appearance of other methods providing measurement of mean (plethysmography) and nonpulsatile flow. As a result, there has been considerable confusion between mean arterial and pulsatile arterial flow (Fig. 2). Various studies have emphasized the physiological importance of pulsatile arterial flow and thus the interest in measuring it. The recording of mean flow has often proved disappointing because values are comparable in groups of normal subjects and those with arterial disease. Mean arterial flow can be measured by isotopic methods and plethysmography. Xenon-133 clearance is the isotopic method most often used. Since determination of microcirculatory flow at rest proved of no use, it was necessary to add a hyperemia test reactive to ischemia to differentiate patients with artery disease from normal subjects. Methods involving technetium and thallium have been little used since they require the presence of a nuclear medicine center and are not easily reproducible. There are numerous plethysmographic methods, but only those are studied here which allow measurement of arterial flow. Plethysmography by venous occlusion measures arterial flow by recording the increase in limb volume. The sensor is a mercury strain gauge.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗

Velocity profile method for time varying resistance in minimal cardiovascular system models.

This paper investigates the fluid dynamics governing arterial flow used in lumped parameter cardiovascular system (CVS) models, particularly near the heart where arteries are large. Assumptions made in applying equations conventionally used in lumped parameter models are investigated, specifically that of constant resistance to flow. The Womersley number is used to show that the effects of time varying resistance must be modelled in the pulsatile flow through the large arteries near the heart. It is shown that the equation commonly used to include inertial effects in fluid flow calculations is inappropriate for including time varying resistance. A method of incorporating time varying resistance into a lumped parameter model is developed that uses the Navier-Stokes equations to track the velocity profile. Tests on a single-chamber model show a 17.5% difference in cardiac output for a single-chamber ventricle model when comparing constant resistance models with the velocity profile tracking method modelling time varying resistance. This increase in precision can be achieved using 20 nodes with only twice the computational time required. The method offers a fluid dynamically and physiologically accurate method of calculating large Womersley number pulsatile fluid flows in large arteries around the heart and valves. The proposed velocity profile tracking method can be easily incorporated into existing lumped parameter CVS models, improving their clinical application by increasing their accuracy.

Animals↗

Low background, pulsatile, in vitro flow circuit for modeling coronary implant thrombosis.

We have developed an in vitro method for creating pulsatile flows to mimic coronary type flow patterns on a beat-to-beat basis. The flow is created by accelerating fluid loops about an axis, inducing relative wall motion. Using this technique, a variety of oscillating flow patterns can be generated and modulated. Such flow generation offers the potential to monitor sensitive, flow-dependent, biological parameters like thrombosis while minimizing background disturbances from pump action and circuit effects. We examined this potential by measuring the loop occlusion time for loops stented with stainless steel 7-9 NIR stents and stentless control loops.

Adult↗

A perturbation model for the oscillatory flow of a Bingham plastic in rigid and periodically displaced tubes.

An approximate analytical model for the pulsatile flow of an ideal Bingham plastic fluid in both a rigid and a periodically displaced tube has been developed using regular perturbation methods. Relationships are derived for the velocity field and dimensionless flow rate. The solution compares adequately with available experimentally measured oscillatory non-Newtonian fluid flow data. These solutions provide useful analytical models supporting experimental and computation studies of arterial blood flow.

Blood Flow Velocity↗

Pulsatile and steady flow induces c-fos expression in human endothelial cells.

The effects of pulsatile and steady fluid flow on the mRNA levels of proto-oncogenes c-fos, c-jun, and c-myc in cultured human umbilical vein endothelial cells (HUVEC) were investigated. c-fos mRNA levels in stationary cultures were very low. A 1 Hz pulsatile flow with an average shear stress of 16 dynes/cm2 induced a dramatic increase of c-fos mRNA levels in HUVEC 0.5 h after the onset of flow, which declined rapidly to basal levels within 1 h. Steady flow with a similar shear stress also induced a transient increase of c-fos mRNA levels, but to a lesser extent. In addition, increased c-fos mRNA levels were observed when low shear (2-6 dynes/cm2) was replaced by high shear (16-33 dynes/cm2). Pulsatile and steady flow caused a slight increase of c-jun and c-myc mRNA levels. The role of pulsatility was also investigated in platelet-derived growth factor (PDGF) expression. Pulsatile flow induced a transient increase of PDGF A- and B-chain mRNA levels with peaks at 1.5-2 h. Pulsatile flow, which was more stimulatory in mediating c-fos expression, however, was less stimulatory than steady flow in mediating PDGF expression. By using various inhibitors, protein kinase C was found to be an important mediator in flow-induced c-fos expression, with the involvement of G proteins, phospholipase C, and intracellular calcium. Protein kinase C was previously shown as a possible major mediator in flow-induced PDGF expression which, at least partly, appeared to follow the induction mechanism of c-fos, suggesting a possible connection between c-fos and PDGF induction. However, the c-fos antisense treatment, which significantly inhibited c-fos transcription, failed to block the flow-induced PDGF expression, suggesting that flow-induced c-fos expression may not play an important role in the mechanism of flow-induced PDGF expression. The difference in the induction of c-fos and PDGF expression under pulsatile as compared to steady flow indicates that a complex, flow-mediated regulatory mechanism of gene expression exists in HUVEC. The increased expression of these proto-oncogenes mediated by flow may be important in regulating long-term cellular responses.

Base Sequence↗

Influence of pressure, flow rate, and pulsatility on release of 6-keto-PGF1 alpha and thromboxane B2 in ex vivo-perfused canine veins.

The influence of pressure, flow, and pulsatility on the release of prostacyclin (measured as 6-keto-PGF1 alpha) and thromboxane (measured as TxB2) was assessed in canine jugular veins perfused ex vivo with Hanks' balanced salt solution for five consecutive 15-minute periods. Control segments were perfused at 7 mm Hg with nonpulsatile flow at a rate of 90 ml/min, whereas experimental segments were perfused with pulsatile flow as well as nonpulsatile flow at pressures of 50 or 100 mm Hg and flow rates of 60 or 130 ml/min. Prostacyclin release from control segments during the first 15-minute period was 49.5 +/- 7.4 pg/mm2/15 min, which declined to 13.9 +/- 2.5 pg/mm2/15 min after 60 minutes (p less than 0.002). Arachidonic acid stimulation during the last 15-minute perfusion period increased the release to 56.1 +/- 9.4 pg/mm2/15 min (p less than 0.002). Thromboxane release from control segments was initially 4.4 +/- 1.2 pg/mm2/15 min, which declined to 0.8 +/- 0.2 pg/mm2/15 min after 60 minutes (p less than 0.002), and subsequently increased with arachidonic acid stimulation to 1.3 +/- 0.1 pg/mm2/15 min (p less than 0.01). In contrast to control perfusion conditions, changes in nonpulsatile flow rates did not affect prostacyclin release, whereas thromboxane release was lower when perfused at 60 ml/min. Pressures of 50 and 100 mm Hg increased the initial release of prostacyclin. Similarly, pulsatile flow enhanced prostacyclin release at both low and high pressures, being more pronounced with the latter.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗

Accuracy of intravascular microcatheter pressure measurements: an experimental study.

Intravascular pressure measurements are considered useful for the monitoring and assessment of endovascular treatment effects in intracranial vascular malformations. Experimental data on the accuracy of these measurements are limited. A flow phantom with defined intraluminal pressures and pulsatility flow waveforms was used in this study. Microcatheters commercially available for neuroendovascular procedures (length 140-155 cm), with different outer (0.5-0.83 mm) and inner (0.3-0.53 mm) diameters, were introduced into the phantom in the direction of flow. In a static experiment, pressure values from 0 to 75 mmHg were applied, and in the dynamic part of the experiment mean pressure values from 25 to 65 mmHg, with a pulsatile amplitude from 70 to 170 mmHg were employed. In the static experiment, there was a linear relationship between the pressure values obtained through the microcatheters and the local transducer of the flow phantom. The pulsatile experiments showed increased damping of the pressure waveforms with decreasing inner diameter of the microcatheters. However, the mean pressure values remained accurate. This experimental study has shown that mean pressure values can be accurately measured through microcatheters from 0.3-0.5 mm inner diameter and more than 140 cm in length. In vivo pressure measurements during interventional procedures are therefore reproducible and can be used for monitoring of embolization effects in patients.

Blood Flow Velocity↗

Evaluation of hemolysis in a pulsatile assist device for centrifugal pump.

To evaluate the blood trauma caused by a new device for producing a pulsatile flow of the centrifugal pump, the pulsatile assist device for the centrifugal pump (PAD-CP) that we have developed, a hemolysis study was performed in vitro and in animal experimentation. For the in vitro testing, 2 identical sets of hemolysis test circuits were prepared with 2,400 ml of bovine blood. The 2 circuits were pumped simultaneously. Plasma total hemoglobin levels were less than 40 mg/dl after 3 h, under a pump flow of 2 L/min. Hemolysis increased to a severe level after 4 h of 4 L/min pump flow. The cause of this hemolysis was thought to be a vibration of the circuit because of incomplete compression of the polyurethane tube in the PAD-CP. Five adult sheep (average body weight, 47 kg) were used for in vivo evaluation of hemolysis. Hemolysis was less than 30 mg/dl of plasma hemoglobin after 4 h of open chest extracorporeal circulation with 3.0-3.6 L/min of flow rate using the PAD-CP. Other hematologic changes after PAD-CP driving were within normal limits. We conclude that the PAD-CP has proven to have possible clinical applications.

Animals↗

Intraaortic balloon pumping during cardioplegic arrest preserves lung function in patients with chronic obstructive pulmonary disease.

BACKGROUND: Linear flow during cardiopulmonary bypass is considered a potential mechanism of lung damage in patients with chronic obstructive pulmonary disease (COPD). We evaluated differences in lung function of patients with COPD undergoing preoperative intraaortic balloon pumping (IABP), between linear flow during cardiopulmonary bypass (IABP-off) and maintenance of pulsatile flow (IABP-on at automatic 80 bpm) during cardioplegic arrest. METHODS: Fifty patients with COPD undergoing preoperative IABP were randomized between January 2004 and July 2005 to receive nonpulsatile cardiopulmonary bypass with IABP discontinued during cardioplegic arrest (25 patients; group A), or IABP-induced pulsatile cardiopulmonary bypass (25 patients; group B). Hospital outcome, need for noninvasive ventilation, oxygenation (partial pressure of oxygen, arterial to fraction of inspired oxygen [Pao(2)/Fio(2])), respiratory system compliance, and scoring of chest radiographs were compared. RESULTS: There were no hospital deaths, no IABP-related complications, and no differences in postoperative noninvasive ventilation (group A: 6 of 25, 24.0% vs group B: 5 of 25, 20%; p = not significant [NS]). One patient in both groups developed pneumonia (p = NS). Intensive care and hospital stay were comparable (p = NS). Group B showed lower intubation time (8.3 +/- 5.1 hours versus group A: 13.2 +/- 6.0; p = 0.001), better Pao(2)/Fio(2) at aortic declamping (369.5 +/- 93.7 mm Hg vs 225.7 +/- 99.3; p = 0.001) at admission in intensive care (321.3 +/- 96.9 vs 246.2 +/- 109.7; p = 0.003), and at 24 hours (349.8 +/- 100.4 vs 240.8 +/- 77.3; p = 0.003). The respiratory system compliance was better in group B at the end of surgery (56.4 +/- 8.2 mL/cm H(2)O vs 49.4 +/- 7.0; p = 0.004) and 8 hours postoperatively (76.4 +/- 8.2 vs 59.4 +/- 7.0; p = 0.0001), as well as scoring of chest radiograph at intensive care admission (0.20 +/- 0.41 vs 0.38 +/- 0.56; p = 0.05) and on the first day (0.26 +/- 0.45 vs 0.50 +/- 0.67; p = 0.025). CONCLUSIONS: Automatic 80 bpm IABP during cardioplegic arrest preserves lung function in patients with COPD.

Aged↗

Pulse-wave velocity measured in one heartbeat using MR tagging.

A noninvasive method for measuring the aortic pulse-wave velocity (PWV) in a single heartbeat is introduced. The method sinusoidally tags a column of blood within the vessel, and rapidly acquires a series of 1D projections of the tags as they move (in practice, 64 projections at 4-ms intervals). From these projections, the relative motion of blood at different positions along the vessel is measured. The PWV is obtained by fitting a mathematical model of blood flow to the tag trajectories. Tests of this method in a pulsatile flow phantom are presented using latex and polyurethane tubes. The PWV measured in these tubes was (mean +/- standard deviation) 4.4 +/- 0.5 m/s and 2.3 +/- 0.2 m/s, respectively. The distensibility of each tube was calculated from the PWV (latex = (7 +/- 2) 10(-3) mm Hg(-1), poly. = (25 +/- 4) 10(-3)mmHg(-1)) and found to agree within error with distensibility measurements based on the change of tube area with pressure (latex = (6.3 +/- 0.3) 10(-3)mmHg(-1), poly. = (27 +/- 1) 10(-3) mmHg(-1)). To test its feasibility, the PWV measurement was applied to four normal volunteers. The measured PWV values were 3.9 +/- 0.8 m/s, 3.6 +/- 0.9 m/s, 3.9 +/- 0.5 m/s, and 5.3 +/- 0.8 m/s. By acquiring an independent PWV measurement each heartbeat, errors introduced by arrhythmia and trigger variability appear to be avoided with this method.

Aorta↗

Effect of tilting disk, heart valve orientation on flow through a curved aortic model.

The influence of tilting disk valve orientation on pulsatile flow through a curved tube model of the human aorta was studied. Simultaneous, two-component laser Doppler velocimeter measurements were made in a tube having a 22 mm diameter and 41 mm radius of curvature which simulated the average dimensions of the adult aorta. The blood analog fluid had a viscosity of 3.0 cp and matched the refractive index of the glass model aorta. Results at mid-arch showed low turbulence levels in early systole and no influence of valve orientation. During mid-systole, fluid from the ventricle reached mid-arch exhibiting strong influence of valve orientation and increased turbulence levels. With the major orifice of the valve adjacent to the inner curved wall, the peak turbulent shear stress was 307 dynes/cm2 at mid-arch during mid-systole. When the major orifice was rotated 180 degrees, the peak value was reduced to 91 dynes/cm2 at the same location and time. At the exit of the curved section, the flow was independent of the valve orientation and the turbulent shear the flow was independent of the value orientation and the turbulent shear stress levels were an order of magnitude lower than the peak value at the inlet. This study demonstrated that orienting the major orifice of a tilting disk valve adjacent to the outer curved wall minimized turbulent shear stress levels.

Aorta↗

Transport phenomena in pulsating post-stenotic vortex flow in arteries. An interactive concept of fluid-dynamic, haemorheological and biochemical processes in white thrombus formation.

Blood in its native state is a highly "non-Newtonian" or anomalous fluid; this notwithstanding, in its native state, all cellular and plasmatic components remain in isolation and do not interact with each other or with the endothelial cells. The rheological behaviour of flowing blood, and that of blood components during the formation of thrombi, coagulate and thrombotic deposits, can be using a three-step procedure. The present paper deals with these, by delineating: the flow conditions under which flow occurs in various vessels, in stenoses, bifurcations under the influence of variable haemodynamic and geometric conditions; the so-called "flow properties" of blood components such as apparent viscosity, behaviour in shear, their behaviour in non-laminar flow, i.e. that occurring near and at sites of secondary flow. As a subsequent step, it is necessary to design appropriate test devices to assay the rheological behaviour in vitro of blood components under closely controlled fluid-dynamic, physico-chemical and biochemical conditions. The present review outlines the characteristic details of microflow in secondary flow (short-lived vortices) such as they prevail in pulsatile flow in arterial segments with "non-cylindrical configuration". In honour of the late Alexander Naumann, one of the founders of contemporary biofluid dynamics in Germany, the characteristic and functionally inseparable fluid-mechanical and rheological peculiarities of flow in eddies or vortices are termed Alexander Naumann vortex flow. They consist of a combination of high shear, recirculation and stagnation point flow. The micro-rheological, cytological and biochemical behaviour of blood platelets in such vortices is described, the integral effects of which render to the vortex the characteristics of a short-lived flow reactor for rapid pro-coagulatory processes and deposition of activated blood components onto the vessel wall.

Arterial Occlusive Diseases↗

Estimation of volume flow rate by surface integration of velocity vectors from color Doppler images.

A new Doppler echocardiographically based method has been developed to quantify volume flow rate by surface integration of velocity vectors (SIVV). Electrocardiographic-gated color Doppler images acquired in two orthogonal planes were used to estimate volume flow rate through a bowl-shaped surface at a given time and distance from the probe. To provide in vitro validation, the method was tested in a hydraulic model representing a pulsatile flow system with a restrictive orifice. Accurate estimates of stroke volume (+/- 10%) were obtained in a window between 1.2 and 1.6 cm proximal to the orifice, just before the region of prestenotic acceleration. By use of the Bernoulli's equation, the estimated flows were used to generate pressure gradient waveforms across the orifice, which agreed well with the measured flows. To demonstrate in vivo applicability, the SIVV method was applied retrospectively to the determination of stroke volume and subaortic flow from the apical three-chamber and five-chamber views in two patients. Stroke volume estimates along the left ventricular outflow tract showed a characteristic similar to that in the in vitro study and agreed well with those obtained by the Fick oxygen method. The region where accurate measurements can be obtained is affected by instrumental factors including Nyquist velocity limit, wall motion filter cutoff, and color flow sector angle. The SIVV principle should be useful for quantitative assessment of the severity of valvular abnormalities and noninvasive measurement of pulsatile volume flows in general.

Animals↗