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PubMed1990

Normal and stenotic human aortic valve opening: in vitro assessment of orifice area changes with flow.

The ability to measure aortic valve area clinically has emphasized the need to understand the changes in aortic valve orifice area during flow. To compare the performance of normal and stenotic human aortic valves we used a pulsatile flow model that simulated in vivo flow conditions. Five normal autopsy specimens and 15 stenotic valves removed at operation were mounted into the model. Valve function was assessed by analysis of video recordings of valve leaflet motion during flow. Over the flow rates tested normal valves demonstrated a linear increase in orifice area. There was no resistance to leaflet opening and valve closure was rapid. The majority of stenotic valves demonstrated an increase in orifice area at low flow rates. No valve showed any increase in maximal area beyond flow rates of 3 l min-1. Increased leaflet resistance of these abnormal valves resulted in notably slower opening and closing rates. In patients with a high cardiac output and severe stenosis, overestimation of the anatomic orifice area derived by the Gorlin equation can result. This is not related to variability in maximal orifice area.

Aortic Valve↗
PubMed1996

[Determining the effectiveness of percutaneous cava filters: experimental studies].

PURPOSE: In vitro clot-trapping capacity of 16 different caval filters should be evaluated under varying experimental conditions. MATERIAL AND METHODS: In a flow model simulating in vivo conditions (soft latex tube, dextran solution at 37 degrees C, pulsatile flow at a mean rate of 3 1/min) the efficiency of 16 caval filters was evaluated in horizontal and vertical position by using 640 or 1280 clots/filter (8 sizes). Non-self centering filters were tested in centric and in tilted position. RESULTS: Efficiency of optimally centered caval filters varied between 97.8 and 69.4%. The largest thrombi were captured by all optimal centered filters. A change from vertical to horizontal position of the flow model resulted in a variation of filter efficiency by about 4.8%. Efficiency of non-self centering filters decreased significantly when placed in a tilted position (mean decrease 15.5%; range 2.7%-37.7%) resulting in a deterioration of the capture rate by as much as 43.2%. CONCLUSION: Under optimal study conditions efficiency of all evaluated caval filters was high. Tilting of caval filters resulted in a significant efficiency decrease.

Animals↗
PubMed1991

Postural studies in pulsatile ocular blood flow: II. Chronic open angle glaucoma.

The pulsatile ocular blood flow (POBF) has been recorded in 15 patients with chronic open angle glaucoma. Measurements were performed during regular treatment with timolol 0.25% eyedrops, two weeks after withdrawal of this treatment, and then a further two weeks after its reinstitution. Readings were taken with subjects in both the erect and supine positions by means of a pneumotonometric probe to measure intraocular pressure (IOP), linked to a Langham ocular blood flow system. Assumption of the supine posture was associated with a significant increase in IOP in all phases of the study. Treatment with timolol lowered the mean IOP in comparison with the untreated phase (-4.4 (SEM 0.6) mmHg, p less than 0.001) but had no effect on the postural change. A significant reduction in POBF was recorded on assumption of the supine posture (-66 (SEM 18) microliters/min, p less than 0.001), representing a mean decrement of 19%. However, there were no significant differences in POBF between treated and untreated phases of the study. Comparison of the values obtained in patients with glaucoma (COAG) after withdrawal of treatment with those in subjects with ocular hypertension revealed that there was no significant difference in intraocular pressure between the two groups. However, both POBF (-68 (SEM 29) microliters/min) and the pulse amplitude of the intraocular pressure (ocular pulse: -0.45 (SEM) 0.14 mmHg) were significantly lower in the COAG patients. Pulsatile ocular blood flow is significantly lower in patients with chronic open angle glaucoma. Furthermore, the POBF and the postural response of these patients is not improved by the use of topical timolol therapy.

Adult↗
PubMed1994

Comparison of transit-time and Doppler ultrasound methods for measurement of flow in aortocoronary bypass grafts during cardiac surgery.

To evaluate the accuracy of flow measurements in aortocoronary bypass grafts with the ultrasound transit-time method, an in vitro and in vivo comparison was carried out. The in vitro comparison with evaluation against both true flow and the ultrasound Doppler method, was carried out with a fresh saphenous vein mounted in a pulsatile flow rig. The two flow probes were placed on the graft 4-5 cm apart to avoid acoustic interference, and blood was pumped through the system at different flow rates. The comparison between the methods showed excellent agreement with a linear correlation coefficient of 0.996, and a mean error of -2.9 ml/min with limits of agreement +/- 13.1 ml/min (+/- 2 SD = 95% of measured differences between these limits). However, against true flow, both methods overestimated flow slightly with mean error 4.4 and 7.3 ml/min for the transit-time and Doppler, respectively. Both methods showed excellent correlation with true flow (correlation coefficient 0.998 for the transit-time and 0.997 for the Doppler method). The in vivo accuracy was evaluated by comparison of the two methods in 9 patients. The two probes were placed on the same saphenous vein grafts 4-5 cm apart, and a total of 34 measurements in 17 grafts were carried out including measurements at baseline and after papaverine injection. The correlation coefficient was 0.990 and linear regression analysis gave the equation: Transit-time flow = 1.00 x Doppler flow + 1.3. In terms of flow, the mean error was 1.5 ml with limits of agreement +/- 17.2 ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1991

Separated flow demonstrated by digitized cineangiography compared with LDV.

In order to demonstrate separated flow in vivo, a method for the computerized analysis of cineangiographies has been developed, tested in vitro, and compared with LDV. A pulsatile flow was created in a glass model bifurcation, and velocity profiles were obtained with LDV at several phase angles. The flow was cinefilmed during contrast injection and the images were digitized. The computer then transformed the image sequence into parametric images representing arrival times of the contrast. The separation regions demonstrated with LDV were identified as areas with delayed contrast arrival. A preliminary analysis of a cineangiography in vivo is also included.

Arteries↗
PubMed1992

Quantification of Doppler color flow images from a stenosed carotid artery model.

Velocity fields at and downstream of graded, axisymmetric stenoses of 0%, 20%, 40%, 60% and 80% diameter reduction were obtained under pulsatile flow conditions simulating that in a carotid artery (Re(mean) = 379, Re(peak) = 1137 and alpha = 5.36) using an ultrasonic Doppler Color Flow Imager. Characteristic features of flow disturbances associated with degree of stenosis, such as jetting, flow separation and reversal and turbulence were quantified using nondimensional indices at peak systole, t0, and early diastole, t1. It was found that the Reverse Area Index (RAI), the Field Profile Index (FPI) and the Velocity Gradient Indices (VGIz and VGIr) were sensitive to these changes, especially at time t1. In particular, the mean values of RAI and VGIr were significantly different for all stenotic cases. These findings may provide a more quantitative and reproducible method of interpreting flow patterns in the region of stenosed carotid arteries.

Blood Flow Velocity↗
PubMed1994

The piezoelectric pulse sensor device: a prospective evaluation.

The goal of this prospective study of the piezoelectric pulse sensor device was to determine its technical applications and its ability to detect lower extremity occlusive arterial disease. Ten extremities (five volunteers) were evaluated to assess the ability to place the sensor in the correct anatomic position on a foot without a palpable pulse during cuff occlusion so that pulsatile flow would be detected following cuff deflation; its sensitivity as an end-point detector for pulsatile perfusion; and whether there is a linear qualitative pulse wave response with increasing perfusion pressures. Forty extremities (20 patients) with suspected occlusive arterial disease were studied to evaluate its capability of detecting perfusion as compared with the presence of a palpable pulse, an audible Doppler signal, and a foot volume waveform. The placement of the sensor on 10 normal limbs with temporary arterial occlusion resulted in a recordable waveform following cuff deflation in 100% of the dorsalis pedis arteries and in 10% of the posterior tibial arteries. The piezoelectric pulse sensor was as sensitive for detecting pulsatile perfusion as an audible Doppler signal and demonstrated a linear change in the waveform's amplitude and shape with incremental changes in perfusion pressure. In the 40 extremities with ankle/brachial indices ranging from 0.00 to 1.35, there was uniform agreement between pulse volume and Pulse Check waveforms. The piezoelectric pulse sensor is a sensitive method for monitoring lower extremity arterial perfusion when supplied by the dorsalis pedis artery; however, it is inadequate for the posterior tibial artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial Occlusive Diseases↗
PubMed1991

Postural studies in pulsatile ocular blood flow: I. Ocular hypertension and normotension.

Measurements of pulsatile ocular blood flow (POBF) have been recorded in a group of healthy, ocular normotensive volunteers and ocular hypertensive patients recruited from outpatients. Use of a pneumotonometric probe linked to a Langham ocular blood flow system enabled readings of intraocular pressure and its variation with heart rate (ocular pulse) to be taken in erect and supine positions. Pulsatile ocular blood flow was calculated from these values by means of the pressure-volume relationship previously described for living human eyes. Assumption of the supine posture was accompanied by a significant rise in intraocular pressure; in normal eyes (mean, with SEM) (3.1 (0.4) mmHg, p less than 0.0001) and to a greater extent in ocular hypertensive eyes (4.7 (0.6) mmHg, p less than 0.0001). The POBF did not differ significantly between normotensive and ocular hypertensive groups in either the erect or supine postures. In both groups, however, assumption of the supine posture was accompanied by a significant fall in POBF (normals: -121 (21) microliters/min, p less than 0.0001; ocular hypertensives: -75 (16) microliters/min, p less than 0.0002). These reductions in POBF represent decrements of 27.5 (3.0)% and 17.1 (3.8)% respectively. Pulsatile ocular blood flow is reduced in the supine posture, and this may result in tissue hypoxia in subjects at risk of developing glaucoma. A companion paper describes the measurement of POBF in a group of patients with chronic open angle glaucoma treated with topical timolol 0.25%.

Adult↗
PubMed2005

Hemodynamic evaluation of the peripheral pulmonary circulation by cine phase-contrast magnetic resonance imaging.

PURPOSE: To describe the normal flow patterns in peripheral pulmonary vessels with phase-contrast (PC) magnetic resonance imaging (MRI). MATERIALS AND METHODS: Twelve healthy adults (age = 33 +/- 7 years) underwent cine PC MRI of the segmental and central pulmonary arteries and veins by means of a breath-held segmented k-space technique. Flow patterns were analyzed on time-velocity curves and compared between the peripheral and central vessels. RESULTS: The pulsatile flow patterns in the segmental arteries and veins were similar among individuals. When compared with the central pulmonary arteries, the segmental arteries had a delay in the systolic and diastolic flow velocity waves, and an increased magnitude of the diastolic peaks, in relation to the systolic peaks. A prominent notch was present during the deceleration phase of the systolic flow velocity wave in 79% of the segmental arteries investigated. The segmental veins showed a typical pulmonary venous flow pattern, as seen in the central veins, with similar systolic-to-diastolic peak velocity ratios. CONCLUSION: Noninvasive evaluation of blood flow in intraparenchymal pulmonary vessels is feasible with PC MRI. This first description of normal flow patterns in segmental pulmonary arteries and veins can serve as basis for further investigation in the setting of altered pulmonary blood flows.

Adult↗
PubMedDate not supplied

Theory of transcapillary (transmembrane) exchange.

Some aspects of the hypothesis formulated earlier by the authors concerning the dual character of transcapillary (transmembrane) exchange are discussed. A physiological and mathematical basis is presented for the fact that transmembrane flow of liquid into interstitial space (that part of it which does not depend on the functioning of the endothelium) is carried out both by steady-state flow, according to Starling's hypothesis, and by pulsatile flow as a result of the pressure of pulse in a capillary as recorded by Widerhielm, et al. in 1964. The authors believe that the pulsatile (fluctuating) character of transmembrane flow is efficient because of the possibility of a more versatile process of regulation within homeostatic control, which in turn is also extremely efficient from the standpoint of attaining the most effective system with the lowest energy expenditures, which are self-adjusting during the performance of specific physiological tasks and when responding to various disturbing influences.

Animals↗
PubMed1992

Doppler assessment of prosthetic valve orifice area. An in vitro study.

BACKGROUND: Although Doppler echocardiography has been shown to be accurate in assessing stenotic orifice areas in native valves, its accuracy in evaluating the prosthetic valve orifice area remains undetermined. METHODS AND RESULTS: Doppler-estimated valve areas were studied for their agreement with catheter-derived Gorlin effective orifice areas and their flow dependence in five sizes (19/20-27 mm) of St. Jude, Medtronic-Hall, and Hancock aortic valves using a pulsatile flow model. Doppler areas were calculated three ways: using the standard continuity equation; using its simplified modification (peak flow/peak velocity); and using the Gorlin equation with Doppler pressure gradients. The results were compared with Gorlin effective orifice areas derived from direct flow and catheter pressure measurements. Excellent correlation between Gorlin effective orifice areas and the three Doppler approaches was found in all three valve types (r = 0.93-0.99, SEE = 0.07-0.11 cm2). In Medtronic-Hall and Hancock valves, there was only slight underestimation by Doppler (mean difference, 0.003-0.25 cm2). In St. Jude valves, however, all three Doppler methods significantly underestimated effective orifice areas derived from direct flow and pressure measurements (mean difference, 0.40-0.57 cm2) with differences as great as 1.6 cm2. In general, the modified continuity equation calculated the largest Doppler areas. When orifice areas were calculated from the valve geometry using the area determined from the inner valve diameter reduced by the projected area of the opened leaflets, Gorlin effective orifice areas were much closer to the geometric orifice areas than Doppler areas (mean difference, 0.40 +/- 0.31 versus 1.04 +/- 0.20 cm2). In St. Jude and Medtronic-Hall valves, areas calculated by either technique did not show a consistent or clinically significant flow dependence. In Hancock valves, however, areas calculated by both the continuity equation and the Gorlin equation decreased significantly (p less than 0.001) with low flow rates. CONCLUSIONS: Doppler echocardiography using either the continuity equation or Gorlin formula allows in vitro calculation of Medtronic-Hall and Hancock effective valve orifice areas but underestimates valve areas in St. Jude valves. This phenomenon is due to localized high velocities in St. Jude valves, which do not reflect the mean velocity distribution across the orifice. Valve areas are flow independent in St. Jude and Medtronic-Hall prostheses but decrease significantly with low flow in Hancock valves, suggesting that bioprosthetic leaflets may not open fully at low flow rates.

Aortic Valve↗
PubMed2006

Neonatal cavopulmonary assist: pulsatile versus steady-flow pulmonary perfusion.

BACKGROUND: Morbidity and mortality associated with single-ventricle physiology decrease substantially once a systemic venous, rather than systemic arterial, source of pulmonary blood flow is established. Cavopulmonary assist has potential to eliminate critical dependence on the problematic systemic-to-pulmonary shunt as a source of pulmonary blood flow in neonates. We have previously demonstrated feasibility of neonatal cavopulmonary assist under steady-flow conditions. We hypothesized that pulsatile pulmonary perfusion would further improve pulmonary hemodynamics. METHODS: Lambs (weight 7.2 +/- 1.1 kg, age 7.9 +/- 1.5 days) underwent total cavopulmonary diversion using bicaval venous-to-main pulmonary artery cannulation. A miniature centrifugal pump was used to augment cavopulmonary flow. Pulsatility was created with an intermittently compressed compliance chamber in the circuit. Hemodynamic and gas exchange data were measured for 8 hours. Pulsatile (n = 6), steady-flow (n = 13), and control (n = 6) groups were compared using two-way analysis of variance with repeated measures. RESULTS: All animals remained physiologically stable with normal gas exchange function. Mean pulmonary arterial pressure was elevated in pulsatile and steady-flow groups compared with the control group and within-group baseline values. Pulmonary vascular resistance was elevated initially in both assist groups but decreased significantly over the last 4 hours of the study and normalized after hour 4 in the pulsatile perfusion group. Pulmonary vascular resistance also normalized to control in the steady-flow group after hour 7. CONCLUSIONS: Both steady-flow and pulsatile pulmonary perfusion demonstrated normalization of pulmonary vascular resistance to control in a neonatal model of univentricular Fontan circulation. These results suggest that there is no benefit to pulsatile flow in this model.

Animals↗
PubMed1992

Two-dimensional color-mapping of turbulent shear stress distribution downstream of two aortic bioprosthetic valves in vitro.

Since artificial heart valve related complications such as thrombus formation, hemolysis and calcification are considered related to flow disturbances caused by the inserted valve, a thorough hemodynamic characterization of heart valve prostheses is essential. In a pulsatile flow model, fluid velocities were measured one diameter downstream of a Hancock Porcine (HAPO) and a Ionescu-Shiley Pericardial Standard (ISPS) aortic valve. Hot-film anemometry (HFA) was used for velocity measurements at 41 points in the cross-sectional area of the ascending aorta. Three-dimensional visualization of the velocity profiles, at 100 different instants during one mean pump cycle, was performed. Turbulence analysis was performed as a function of time by calculating the axial turbulence energy within 50 ms overlapping time windows during the systole. The turbulent shear stresses were estimated by using the correlation equation between Reynolds normal stress and turbulent (Reynolds) shear stress. The turbulent shear stress distribution was visualized by two-dimensional color-mapping at different instants during one mean pump cycle. Based on the velocity profiles and the turbulent shear stress distribution, a relative blood damage index (RBDI) was calculated. It has the feature of combining the magnitude and exposure time of the estimated shear stresses in one index, covering the entire cross-sectional area. The HAPO valve showed a skewed jet-type velocity profile with the highest velocities towards the left posterior aortic wall. The ISPS valve revealed a more parabolic-shaped velocity profile during systole. The turbulent shear stresses were highest in areas of high or rapidly changing velocity gradients. For the HAPO valve the maximum estimated turbulent shear stress was 194 N m-2 and for the ISPS valve 154 Nm-2. The RBDI was the same for the two valves. The turbulent shear stresses had magnitudes and exposure times that might cause endothelial damage and sublethal or lethal damage to blood corpuscules. The RBDI makes comparison between different heart valves easier and may prove important when making correlation with clinical observations.

Aortic Valve↗
PubMed1996

The influence of open leaflet geometry on the haemodynamic flow characteristics of polyurethane trileaflet artificial heart valves.

In vitro velocity data were obtained downstream of two versions of the Leeds polyurethane trileaflet heart valve in a simulated pulsatile flow regime using laser Doppler velocimetry. The main difference between the two valves studied was the manufacturing method used to create the valves. The film-fabricated valve was constructed from solvent-cast sheets of polyurethane, thermally formed into the correct leaflet geometry. The dip-cast valve used a stainless steel mould which was dipped into a polyurethane solution to produce the valve leaflets. Significant differences were visible between the fully open leaflet shape of each valve. The distribution of mean axial velocity and Reynolds normal stress (RNS) was shown to be dependent on the shape of the fully open valve orifice. For the film-fabricated valves, flow recirculation and high values of RNS were present downstream of the frame posts. The maximum value of RNS obtained downstream of the film-fabricated valve at peak systole was 147 N/m2. Results for the dip-cast valve showed a more uniform distribution of mean axial velocity and RNS resulting from the more circular central orifice produced by the dip-cast leaflets. The maximum value of RNS obtained downstream of the dip-cast valve at peak systole was 109 N/m2. These results demonstrate the effect of the open valve geometry on the flow characteristics downstream of trileaflet valves and that minor changes to the open leaflet geometry can significantly affect the flow characteristics and the possibility of flow-related blood damage occurring in vivo.

Aortic Valve↗
PubMed2006

A validated system for simulating common carotid arterial flow in vitro: alteration of endothelial cell response.

Pulsations in blood flow alter gene and protein expressions in endothelial cells (EC). A computer-controlled system was developed to mimic the common carotid artery flow waveform and shear stress levels or to provide steady flow of the same mean shear stress in a parallel plate flow chamber. The pseudo-steady state shear stress was determined from real-time pressure gradient measurements and compared to the Navier-Stokes equation solution. Following 24 h of steady flow (SF: 13 dyne/cm2), pulsatile arterial flow (AF: average = 13 dyne/cm2, range = 7-25 dyne/cm2) or static conditions, heme oxygenase-1 (HO-1) and prostaglandin H synthase-2 (PGHS-2) mRNA and protein expressions from human umbilical vein endothelial cells were measured. Relative to steady flow, pulsatile arterial flow significantly attenuated mRNA upregulation of HO-1 (SF: 7.26 +/- 2.70-fold over static, AF: 4.84 +/- 0.37-fold over static; p < 0.01) and PGHS-2 (SF: 6.11+/-1.79-fold over static, AF: 3.54+/-0.79-fold over static; p < 0.001). Pulsatile arterial flow (4.57+/-0.81-fold over static, p < 0.01) also significantly reduced the steady-flow-induced HO-1 protein upregulation (7.99 +/- 1.29-fold over static). These findings reveal that EC can discriminate between different flow patterns of the same average magnitude and respond at the molecular level.

Carotid Artery, Common↗
PubMed2005

Rapid measurement of renal artery blood flow with ungated spiral phase-contrast MRI.

PURPOSE: To verify the potential of ungated spiral phase-contrast (USPC), which has been shown to provide accurate and reproducible time-averaged measurements of pulsatile flow, for rapid measurement of renal artery blood flow (RABF) in vivo. MATERIALS AND METHODS: The RABF rates of 11 normal human subjects and one patient with renal failure were measured with USPC within six seconds. RESULTS: Rapid USPC scans produced reproducible RABF measurements (SD < or = 9%) that agreed with the normal RABF rates known from the literature. The RABF rates of the patient with renal failure were substantially less (<50-65%) than the normal RABF rates. CONCLUSION: The results demonstrate that it is now possible to obtain rapid and consistent RABF measurements within six seconds with USPC.

Adult↗
PubMed1993

Doppler color flow images of iliofemoral graft end-to-side distal anastomotic models.

Hemodynamics within the distal anastomoses of iliofemoral bypass grafts were simulated using Plexiglas models (2.5 cm ID) within a pulsatile flow loop system (Re(mean) = 92, Re(peak) = 459 and alpha = 3.56). End-to-side distal anastomoses were constructed with angles of 30 degrees, 45 degrees and 60 degrees to bypass proximal artery segments with stenoses of 60% and 100% diameter reduction. Velocities were obtained over a two-dimensional field within the artery using an ultrasonic Doppler color flow imager operating at 5 MHz at positions from 1.5 diameters upstream to 3 diameters downstream of the anastomosis. Flow patterns downstream of an occlusion demonstrated definite skewing effects toward the outer wall with resultant flow separation along the inner wall. Presence of a partial (60% diameter reduction) arterial stenosis upstream of the anastomosis produced flow separation along both artery walls and a more symmetric profile downstream. Measurement of a separation area index (SAI) along each arterial wall demonstrated a minimum area exposed to low velocities for the 30 degrees anastomotic angle compared to the 45 degrees and 60 degrees anastomotic angles and for the occluded proximal artery cases compared to corresponding stenotic artery cases. The SAI values were minimal at peak systole compared to successive quarter cycle intervals. The findings of this study provide further information regarding the relationship between local fluid mechanics and predominant sites for intimal hyperplasia formation.

Anastomosis, Surgical↗
PubMed2003

Localization of bypass-induced changes in flow in coronary artery models.

Right coronary artery bypass restores blood flow through heart tissues. This also induces changes in flow leading to its failure. By this work the sites which are prone to such changes are localized. The bypass models are developed from transparent silicon rubber of elastic properties similar to arterial tissues. Flow visualization is carried out by photoelasticity technique by using dilute solution of vanadium pentoxide. This analysis carried out under pulsatile flow conditions shows that the proximal stenotic region continues to contribute to the alteration in flow in the hood region of the bypass. Thus making its proximal and distal regions prone to flow-induced changes, which may lead to its blockage over the long duration.

Blood Flow Velocity↗