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PubMed1999

Balloon pump-induced pulsatile perfusion during cardiopulmonary bypass does not improve brain oxygenation.

BACKGROUND: Whether pulsatile flow offers substantial advantages for brain protection during cardiopulmonary bypass is controversial. The purpose of this study is to determine whether differences exist between pulsatile and nonpulsatile bypass concerning the effects on internal jugular venous saturation and on the state of regional cerebral oxygenation during normothermia. METHODS: Twenty-two patients undergoing elective coronary artery bypass grafting were randomly divided into 2 groups: group 1 (n = 11) received nonpulsatile perfusion during cardiopulmonary bypass and group 2 (n = 11) received pulsatile perfusion during bypass. We used an intra-aortic balloon pump to generate pulsatility. A spectrophotometric probe (INVOS 3100R, Somanetics, Troy, Mich) was used to assess the state of regional cerebral oxygenation. A 4F fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb to monitor jugular venous oxygen saturation. Hemodynamic variables, arterial and jugular venous blood gases, and regional cerebral oxygenation were measured at 7 times points. RESULTS: In both groups, jugular venous oxygen saturation decreased at the early stage of the cardiopulmonary bypass (P =.03). Five patients in group 1 and 6 in group 2 had a jugular venous oxygen saturation of less than 50%. In both groups, the regional cerebral oxygenation value decreased during cardiopulmonary bypass (P =.04). CONCLUSIONS: The present results showed that pulsatility generated through the use of intra-aortic balloon pumping did not produce any beneficial effects on jugular venous oxygen saturation and regional cerebral oxygenation at normothermia.

Aged↗
PubMed1982

Turbulence measurements with pulsed Doppler ultrasound employing a frequency tracking method.

A phase lock loop method of tracking doppler ultrasound frequencies is applied to the measurement of turbulent velocities. A pulsed Doppler ultrasound system capable of detecting two velocity components was employed to resolve axial and radial velocity components at the centerline of turbulent pipe flows and distal to stenoses in pulsatile flow. Measurements with the ultrasound system are compared with laser Doppler and hot film anemometer data. The results demonstrate that the phase lock loop method of tracking accurately follows turbulent velocity fluctuations for turbulence intensities up to approx. 20%, after which signal dropout becomes a significant factor. An important application of the method is that of detecting flow disturbances created by mild to moderate degrees of stenosis in arterial disease.

Animals↗
PubMed1996

Three-dimensional power Doppler imaging: a phantom study to quantify vessel stenosis.

This study investigated whether three-dimensional (3D) power Doppler imaging can be used to quantify arterial stenosis and its potential as an alternative to x-ray angiography. Three-dimensional power Doppler images of in vitro stenotic vessels were generated under different hemodynamic conditions with a 3D power Doppler imaging system. This system includes: a Macintosh Quadra 840AV computer used to perform 3D imaging acquisition, reconstruction and display; a computer-controlled motor-driven translation assembly used to move the transducer; and an ATL Ultramark 9 HDI ultrasound system. Three vascular- and tissue-mimicking phantoms containing three wall-less stenotic vessels with area reduction of 80%, 50% and 30% were imaged with different flow rates under both steady and pulsatile flow conditions and with different Doppler angles under steady flow condition. With the use of the blood mimic, experimental results demonstrated that power Doppler imaging is nearly independent on flow velocity and Doppler angle. It was also demonstrated that 3D power Doppler imaging can produce nonpulsatile angiographic-like 3D images of the flow field. The stenotic vessels were quantified with an overall accuracy of 8.3% of the vessel area and an overall precision of 7% of the vessel area under the conditions described in this paper. It is believed that 3D power Doppler imaging can be used to quantify arterial stenosis, and in some applications it could be an alternative to x-ray angiography.

Blood Flow Velocity↗
PubMed1999

Staging of twin-twin transfusion syndrome.

OBJECTIVE: The purpose of this study was to evaluate the prognostic value of sonographic and clinical parameters to develop a staging classification of twin-twin transfusion syndrome (TTTS). STUDY DESIGN: Severe TTTS was defined as the presence of polyhydramnios (maximum vertical pocket of > or = 8 cm) and oligohydramnios (maximum vertical pocket of < or = 2 cm). Nonvisualization of the bladder in the donor twin (-BDT) and absence of presence of hydrops was also noted. The middle cerebral artery, umbilical artery, ductus venosus, and umbilical vein in both fetuses were assessed with pulsed Doppler. Critically abnormal Doppler studies (CADs) were defined as absent/reverse end-diastolic velocity in the umbilical artery, reverse flow in the ductus venosus, or pulsatile flow in the umbilical vein. TTTS was staged as follows: stage I, BDT still visible; stage II, BDT no longer visible, no CADs; stage III, CADs; stage IV, hydrops; stage V, demise of one or both twins. Laser photocoagulation of communicating vessels (LPCV) or umbilical cord ligation was performed depending on the severity of the condition. The study was approved by the Institutional Review Board of St. Joseph's Hospital in Tampa and by the Fetal Therapy Board at Hutzel Hospital, Detroit, and all patients gave informed consent. RESULTS: A total of 80 of 108 referred patients met criteria for surgery, but only 65 were treated surgically: 48 with LPCV and 17 with umbilical cord ligation. Complete Doppler data were obtainable in 41 of 48 LPCV patients. Survival rates by stage for one or two fetuses were statistically different (chi-squared analysis = 12.9, df = 6, p = 0.044). Neither percent size discordance nor gestational age at diagnosis were predictive of outcome. CONCLUSION: Staging of TTTS using the proposed criteria has prognostic significance. This staging system may allow comparison of outcome data of TTTS with different treatment modalities.

Amniocentesis↗
PubMed1988

Evaluation of angiogenesis in chronic inflammation by laser-Doppler flowmetry.

1. A non-invasive method is described for the assessment of angiogenesis in chronic inflammation using laser-Doppler flowmetry. 2. Significant increases in capillary blood flow were seen on days 5 and 7 after induction of subcutaneous granulomatous lesions, as compared with control skin. 3. Changes in blood flow were accompanied by changes in pulsatile flow pattern and by an intense angiogenic response observed by light microscopy. 4. The potential application of laser-Doppler flowmetry to quantitative and qualitative studies of evolving angiogenesis in pathological responses is discussed.

Animals↗
PubMed1976

Transcutaneous measurement of blood flow velocity in the human aorta.

A Doppler velocity meter for measuring blood flow velocity in the human aorta is described. Using pulsed ultrasound, this instrument allows the velocity to be measured at selected depths. The instrument has been tested in laboratory experiments, and appears to give accurate estimates of mean flow velocity for both steady and pulsatile flows. Flow velocities and estimates of stroke volume have been obtained from the ascending aorta in 18 patients. It is suggested that at present only relative values for flow and flow velocity can be measured. A method for obtaining absolute values for these parameters, based on scanning in the aortic arch, is proposed.

Angina Pectoris↗
PubMed1988

Mixing problems of low flow hepatic artery infusion. Improvement with small caliber double lumen balloon catheters.

The problem of inhomogeneous mixing encountered during hepatic artery (HA) chemotherapy infusion was assessed and a practical solution examined. A glass model of the human HA distribution was used to determine mixing homogeneity of low flow (1.4 mL/minute) dye infusion into pulsatile flow (280-300 mL/minute) of a fluid isoviscous to blood. Dye concentration in each of 16 HA branches was determined by photospectrometry. Dye infusion was carried out through 2-2.5F double lumen end hole or proximal side hole balloon catheters without balloon inflation, with balloon inflation maintaining full HA flow, and with the balloon inflated so that HA flow was reduced by 50%. The measurements taken without balloon inflation showed gross inhomogeneity of dye concentration in various branches. The inhomogeneity was not improved during balloon inflation as long as full HA flow was maintained. After balloon inflation reduced HA flow by 50%, dye mixing was improved significantly, with infusion through side hole catheters (alpha = .002) but not significantly (alpha = .2) with infusion through end hold catheters. This investigation suggests that the proposed technique might be useful for clinical application and deserves further evaluation in an in vivo system.

Antineoplastic Agents↗
PubMed1979

Continuous measurement of flow rate and volume in the nanoliter range.

A simple transducer which is based on changes of electrical capacity with volume is described. The system accomodates fluid volumes of several microliters and the resolution is below one nanoliter. The response time of the transducer is about 10 ms. The system is applicable for continuous recording of flow rates in renal collecting tubules. Pulsatile flow in the duct of Bellini is demonstrated.

Animals↗
PubMed2001

Biosynthetic activity in heart valve leaflets in response to in vitro flow environments.

The development of bioreactors for tissue engineered heart valves would be aided by a thorough understanding of how mechanical forces impact cells within valve leaflets. The hypothesis of the present study is that flow may influence the biosynthetic activity of aortic valve leaflet cells. Porcine leaflets were exposed to one of several conditions for 48 h, including steady or pulsatile flow in a tubular flow system at 10 or 20 l/min, and steady shear stress in a parallel plate flow system at 1, 6, or 22 dyne/cm2. Protein, glycosaminoglycan, and DNA synthesis increased during static incubation but remained at basal levels after exposure to flow. The modulation of synthetic activity was attributed to the presence of a shear stress on the leaflet surface, which may be transmitted to cells within the leaflet matrix through tensile forces. The alpha-smooth muscle (alpha-SM) actin distribution observed in fresh leaflets was proportionately decreased after exposure to antibiotics and not recovered by either static incubation or exposure to flow. These results indicate that exposure to flow maintains leaflet synthetic activity near normal levels, but that the inclusion of another force, such as bending or backpressure, may be necessary to preserve alpha-SM actin immunoreactive cells.

Actins↗
PubMed1992

Numerical simulation for the propagation of nonlinear pulsatile waves in arteries.

The behavior of nonlinear pulsatile flow of incompressible blood contained in an elastic tube is examined. The theory takes into account the nonlinear convective terms of the Navier-Stokes equations. The motion of the arterial wall is characterized by a set of linearized differential equations. The region bounded by the flexible arterial wall is mapped into a fixed area in which numerical discretization takes place. The finite element method (Galerkin weighted residual approach) is used for the solution of this nonlinear system. The results obtained are pressure distribution, velocity profile, flow rate and wall displacements along the elastic tube (20 cm long).

Blood Flow Velocity↗
PubMed2004

Flow volume and shunt quantification in pediatric congenital heart disease by real-time magnetic resonance velocity mapping: a validation study.

BACKGROUND: Flow quantification in real time by phase-contrast MRI (PC-MRI) may provide unique hemodynamic information in congenital heart disease, but available techniques have important limitations. We sought to validate a novel real-time magnetic resonance flow sequence in children. METHODS AND RESULTS: In 14 pediatric patients (mean age 5.2+/-2.0 years) with cardiac left-to-right shunt, pulmonary (Q(p)) and aortic (Q(s)) flow rates were determined by nontriggered free-breathing real-time PC-MRI with single-shot echo-planar imaging combined with sensitivity encoding, which yielded 25 phase images per second at 2.7x2.7-mm in-plane resolution (field of view 30x34 cm2). Over a 9.5-second period that included 2 to 5 respiratory cycles, 16.6+/-2.6 subsequent stroke volumes (range 13 to 22) were acquired in each vessel. Results were compared with conventional retrospectively ECG-gated PC-MRI. Mean Q(p)/Q(s) by conventional PC-MRI was 1.91+/-0.64, and it was 1.94+/-0.68 (mean+/-SD) by real-time PC-MRI. For blood flow rate through pulmonary artery and aorta, we found differences of 2% to 3% (Bland-Altman analysis), with lower limits of agreement of -11% to -13% (mean-2 SD) and upper limits of 18% to 19% (mean+2 SD), which demonstrated good agreement between both methods. Mean difference for Q(p)/Q(s) was 1%, with limits of agreement ranging between -18% and 22% (mean+/-2 SD). High repeatability but some flow overestimation was observed in vitro (pulsatile flow phantom) with real-time PC-MRI, whereas conventional PC-MRI was accurate. Beat-to-beat stroke-volume variation was 6.1+/-2.3% in vivo and 3.7+/-0.3% in vitro. CONCLUSIONS: Beat-to-beat quantification of pulmonary and aortic flows and hence left-to-right shunt within a few seconds is reliable by nontriggered real-time PC-MRI with echo-planar imaging and sensitivity encoding. Good spatial/temporal resolution and a large field of view may render the sequence valuable for multiple applications in congenital heart disease.

Blood Circulation↗
PubMed1977

[Effect of catecholamines in blood flow in arteries of distribution].

In large arteries, distributing blood to an area (hind leg of dog), the vasomotor substances (catecholamines) induce differences in flow. In case of state of vasoconstriction, the mean velocity of flow decreases, while the amplitude of pulsatile flow and the pressure increase. The radial expansion is wider. In case of state of dilatation, inverse reactions are observed.

Animals↗
PubMedDate not supplied

Comparison of in vitro valve pressure drop results from different investigators.

Steady-state pressure-drop vs flow-rate measurements on prosthetic valves have been shown to correlate well with mean cyclic pressure drops vs RMS flow rate during systolic ejection from pulsatile flow data. The use of steady-state data is therefore validated as a means of assessing performance characteristics. Pressure-drop results reported in the literature were compared for valves of the same size and manufacture. Significant differences were noted, which are attributed to: (a) different geometries in the region of the valves, (b) different approach flow conditions, (c) different placement of pressure measurement taps, and (d) different methods of pressure measurement. Differences in pressure drop were observed to vary by as much as a factor of five among different investigators. The exponent n in the relation delta p infinity Q" was also observed to vary, depending on the above factors. The reasons for and some quantitative calculations on the observed differences are presented here.

Aortic Valve↗
PubMed1984

[Noninvasive determination by Doppler flow velocity recording of changes in peripheral resistance during epidural anesthesia].

Using bidirectional CW Doppler flowmetry, transcutaneous recordings of flow velocity pulses were performed on the femoral artery of 11 patients before and during peridural anaesthesia. Compared to those obtained before peridural injection of bupivacaine the pulse contours exhibited characteristic changes 10 min after the injection. The backward flow wave during diastole decreased or disappeared. There was a marked increase in the steady flow at the expense of the pulsatile flow peaks. 20 min after injection these changes were slightly more pronounced. These phenomena can theoretically be explained by the alteration in pulse wave transmission in the arterial system caused by the diminished peripheral resistance. From the results it can be concluded that ultrasonic Doppler flowmetry is a reliable method, suitable for recording the influence of regional anaesthesia on peripheral haemodynamics.

Adolescent↗
PubMed1991

Quantification of vascular stenosis with color Doppler flow imaging: in vitro investigations.

The accuracy of quantifying the degree of vascular stenosis with color Doppler flow imaging (7.5-MHz, linear array system) was determined in an experimental study carried out on six concentric and five eccentric model stenoses (cross-sectional area reduction, 13.4%-93.8%). The measurements were made with use of pulsatile flow at four different flow rates (70.8-339.0 mL/min). The degree of stenosis was calculated from the ratio of prestenotic to intrastenotic flow velocity. The most exact measurement of the degree of stenosis could be achieved with Doppler spectral analysis by determining the maximum peak systolic velocity (r = .994, y = 0.98x - 3.2). With the velocity values derived only from the color-coded image, it was also possible to find the most exact degree of stenosis (r = .995, y = 0.99x - 2.9). For quantification of stenosis, pre- and intrastenotic Doppler spectral analysis is no longer necessary if the stenosis can be imaged sufficiently with color Doppler.

Blood Flow Velocity↗
PubMed2005

Computational study of fluid mechanical disturbance induced by endovascular stents.

Arterial restenosis following stent deployment may be influenced by the local flow environment within and around the stent. We have used computational fluid dynamics to investigate the flow field in the vicinity of model stents positioned within straight and curved vessels. Our simulations have revealed the presence of flow separation and recirculation immediately downstream of stents. In steady flow within straight vessels, the extent of flow disturbance downstream of the stent increases with both Reynolds number and stent wire thickness but is relatively insensitive to stent interwire spacing. In curved vessels, flow disturbance downstream of the stent occurs along both the inner and outer vessel walls with the extent of disturbance dependent on the angle of vessel curvature. In pulsatile flow, the regions of flow disturbance periodically increase and decrease in size. Non-Newtonian fluid properties lead to a modest reduction in flow disturbance downstream of the stent. In more realistic stent geometries such as stents modeled as spirals or as intertwined rings, the nature of stent-induced flow disturbance is exquisitely sensitive to stent design. These results provide an understanding of the flow physics in the vicinity of stents and suggest strategies for stent design optimization to minimize flow disturbance.

Animals↗
PubMed2002

Particle image velocimetry assessment of stent design influence on intra-aneurysmal flow.

Endovascular stenting appears to be an appealing treatment modality to selected complex intracranial aneurysms. However, stents currently used for endovascular treatment are not specifically designed for the cerebrovasculature. Stent parameters, such as porosity and filament size, have to be carefully optimized for long-term successful treatment. We investigated the influence of the stent filament size on the intraaneurysmal flow dynamics in a sidewall aneurysm model in vitro. Three helical stents with 76% porosity but different filament sizes of 178, 153, and 127 microm were studied using particle image velocimetry. Twenty-four pulsatile flow conditions were investigated. The results show that stenting significantly reduces intra-aneurysmal vorticity and the mean circulation inside the aneurysm is reduced to less than 3% of its value before stenting. For constant porosity, a further reduction of the mean circulation, up to 30% can be obtained by reducing the filament diameter. For a constant Womersley number, this further reduction is accentuated with increase in the peak Reynolds number. Further reduction in the mean circulation inside the aneurysm was not achieved for the 127 microm stent. With further reduction in filament diameter, the helical stent filaments positioned against the aneurysm neck started wavering with the flow transferring added momentum into the aneurysm. For stents of smaller filament diameter, a supporting ultrastructure is required.

Alloys↗
PubMedDate not supplied

A non-conventional reniform heart valve bioprosthesis with improved performance.

Conventional bioprosthetic heart valves have been designed with circular mounting rings. This article describes a mitral bioprosthetic valve consisting of three bovine pericardial leaflets with a "reniform" base. Its shape resembles that of the mitral anulus, and therefore, it provides a better anatomic fit. Hydrodynamic comparisons were made between conventional valves (CV) and equivalent sized reniform valves (ERV) that would adapt to the same anulus. Under steady flow of 30 L/min, pressure drops were compared in CVs and ERVs. For CV sizes 27, 29, and 31mm, the ratios of pressure drops compared with ERVs were 2, 1.49, and 1.30, respectively. With the same flow rate, the ratios of effective orifice areas (EOA) for CVs and ERVs in sizes 27, 29, and 31mm were 1.41, 1.21, and 1.14, respectively. Under pulsatile flow (mean flow, 5 L/min, 100 beats/min [bpm]), the pressure drop across CVs was averaged for sizes 27, 29, and 31mm, and found to be 1.51-fold the averaged pressure drops for ERVs. In addition, ERV sizes 27, 29, and 31mm had EOAs averaging 1.24-fold those of CVs. Similarly, for an 80 bpm frequency, the pressure drops across CVs for the three sizes averaged 1.48-fold that of ERVs. The EOAs of ERVs were 1.22-fold those of CVs averaged for the three sizes.

Animals↗