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PubMed1983

Resting and exercise hyperemic pulsatile arterial blood flow in insulin-dependent diabetic subjects.

Pulsatile arterial blood flow was studied in 20 normal (N), 20 short-term (STIDDM; mean: 5.17 yr), and 20 long-term insulin-dependent diabetic patients (LTIDDM; mean: 14.76 yr) between the ages of 18 and 30 yr with no clinically detectable peripheral vascular disease. Measurements were taken from waveforms obtained noninvasively using an electromagnetic flowmeter at rest and immediately after a 3-min isometric exercise challenge of the right leg. At rest, both groups of diabetics exhibited minute flow values similar to those in the normal group. This was achieved, however, by increased vasodilation in peripheral tissues as indicated by a difference in waveform configuration. Diabetic subjects showed a significantly smaller peak flow, a less steep ascending and descending slope, and a higher minute heart rate than normal controls. After 3 min of isometric exercise, the diabetic groups exhibited significantly less minute flow, flow/pulse, and a more vasodilated flow pattern similar to that recorded at rest. In addition, the LTIDDM group showed significantly less arterial elasticity than N or STIDDM groups as indicated by a shorter propagation time. These findings imply that apparent functional changes in pulsatile arterial blood flow occur early in the time course of diabetes and are independent of duration.

Adult↗
PubMed1994

MR gradient echo imaging of intravascular blood oxygenation: T2* determination in the presence of flow.

The T2* relaxation time of blood varies with its oxygen saturation. To evaluate the feasibility of imaging intravascular blood oxygenation in humans using a conventional 1.5T MR system, we have implemented a method to measure T2* of blood despite the presence of pulsatile flow. The method was tested in a) stationary and flow phantoms, b) blood samples at different levels of oxygen saturation, and c) a human hypoxia model. Our results demonstrate the ability of cardiac-triggered, flow compensated gradient echo imaging to obtain reproducible T2* measurements of flowing blood in vivo.

Artifacts↗
PubMed1990

Effect of compliance mismatch on flow disturbances in a model of an arterial graft replacement.

Flow disturbances in a model of an interposition graft in an arterial segment were measured using an ultrasound Doppler velocimeter. The effect of the degree of compliance mismatch between a stiff' graft' and compliant 'arterial' segments was investigated. In steady flow, disturbances were detected when the compliance ratio (stiff to compliant segments) was less than or equal to 0.1 and the Reynolds number greater than or equal to 2200. A recirculation zone just downstream of the distal anastomosis was observed at a Reynolds number greater than or equal to 2400. Disturbances were also measured under pulsatile flow which consisted of a time-varying component superimposed on a steady flow component. The time-varying flow component was either quasiphysiological or sinusoidal in shape. The Reynolds number was 500 but the frequency parameter varied from 4.2 to 8.5. Significant disturbances were observed for conduits with compliance ratio less than or equal to 0.19. The disturbance intensity tended to increase as the compliance ratio decreased and the frequency parameter increased. The magnitude of the disturbance was also greater with the quasiphysiological than the sinusoidal input flow waveform.

Arteries↗
PubMed1996

Detection of sub-critical arterial stenoses by hyperaemic Doppler.

OBJECTIVES: This study assessed the potential of hyperaemic Doppler to detect sub-critical stenoses using a flowrig model. METHODS: Pulsatile flow of a blood substitute was produced in a compliant circuit. A cadaver carotid artery, constricted by a silk suture produced a variable, focal stenosis. Forty-seven stenoses were created in five arteries. Pressure gradients and Doppler measurements were recorded simultaneously across each stenosis at low (200 ml/min) and high (400 ml/min) flow rates. The change in peak velocities between the arterial segment 2cm proximal to the stenosis (V1), and the stenotic jet (V2) were used to calculate three Doppler indices: (i) V2/V1 ratio, (ii) V2-V1 difference, (iii) a modified 'Bernoulli' value. A high flow pressure gradient of > or = 15% of the resting distal pressure (% delta P), represented a significant stenosis. RESULTS: There was improved correlation between Doppler indices and % delta P at high flow (r = 0.87 to 0.88) compared to low flow rates (r = 0.81 to 0.84). Optimum V2/V1 cut off values were determined by received operator characteristics (ROC) curve analysis. At low flow five sub-critical stenoses were not detected (sensitivity 82.8%) yet all but one of these lesions were identified at high flow (sensitivity of 96.6%). The V2-V1 and Bernoulli indices did not improve on the discriminant ability of the V2/V1 ratio. CONCLUSIONS: The V2/V1 ratio is sensitive to haemodynamic changes at enhanced flow rates across ideal arterial stenoses. The potential of hyperaemic Doppler to detect sub-critical lesions and so avoid intraarterial pressure measurements deserves further in vivo study.

Arterial Occlusive Diseases↗
PubMed2004

"Smart" baroreception along the aortic arch, with reference to essential hypertension.

Beat-to-beat regulation of heart rate is dependent upon sensing of local stretching or local "disortion" by aortic baroreceptors. Distortions of the aortic wall are due mainly to left ventricular output and to reflected waves arising from the arterial tree. Distortions are generally believed to be useful in cardiac control since stretch receptors or aortic baroreceptors embedded in the adventitia of the aortic wall, transduce the distortions to cardiovascular neural reflex pathways responsible for beat-to-beat regulation of heart rate. Aortic neuroanatomy studies have also found a continuous strip of mechanosensory neurites spread along the aortic inner arch. Although their purpose is now unknown, such a combined sensing capacity would allow measurement of the space and time dependence of inner arch wall distortions due, among other things, to traveling waves associated with pulsatile flow in an elastic tube. We call this sensing capability--"smart baroreception." In this paper we use an arterial tree model to show that the cumulative effects of wave reflections, from many sites far downstream, have a surprisingly pronounced effect on the pressure distribution in the root segment of the tree. By this mechanism global hemodynamics can be focused by wave reflections back to the aortic arch, where they can rapidly impact cardiac control via smart baroreception. Such sensing is likely important to maintain efficient heart function. However, alterations in the arterial tree due to aging and other natural processes can lead in such a system to altered cardiac control and essential hypertension.

Animals↗
PubMed1997

Improved 2D time-of-flight angiography using a radial-line k-space acquisition.

For flow imaging applications, radial-line k-space acquisition methods offer advantages over conventional 2DFT methods. Specifically, radial-line acquisition methods mitigate artifacts resulting from pulsatile flow while offering a potential reduction in scan times. In this paper, radial-line and 2DFT acquisitions are compared in a two-dimensional time-of-flight angiography sequence. The twisting radial-line (TwiRL) trajectory, a variant of 2D projection reconstruction, is used to represent the family of radial-line trajectories. In both phantom and in vivo studies, the TwiRL images demonstrate improved vessel depiction including a more uniform signal intensity and better delineation of the vasculature in comparison with images obtained via the 2DFT method.

Arterial Occlusive Diseases↗
PubMed1989

Measurement of multiple microcirculatory parameters in human nasal mucosa using laser-Doppler velocimetry.

LDV has been modified to measure four microcirculatory responses in human nasal mucosa. Resting nasal blood flow was measured in 115 observations in 23 nonatopic subjects and 111 observations in 21 atopic subjects with allergic nasal disease. Other parameters measured concurrently were the number density of moving red blood cells (RBC), mean RBC speed, and flow pulsatility. Challenges with aerosolized buffered saline or water had no significant effect on any parameter. By contrast, nasal application of alpha-adrenergic agonists, oxymetazoline and phenylephrine, produced significant dose-dependent reductions in flow without any significant change in RBC number density. These results suggest a selective alpha-agonist effect on resistance vessels but not on capacitance vessels. Topical cholinergic stimulation with methacholine selectively reduced the RBC number density without affecting other parameters. These modifications of LDV may prove useful in analyzing nasal responses to provocation and determining the sites of action of vasoactive agents on the microcirculation.

Adult↗
PubMed2002

[Effects of external counterpulsation on the pulsatility of blood pressure and blood flow in dogs].

Pulsatile blood flow plays an important role in maintaining normal vascular endothelial function. Quantitative measurement of pulsatility of artery blood pressure and blood flow in dogs and effects of enhanced external counterpulsation (EECP) on the pulsatility were taken in this study. Common carotid artery blood pressure and blood flow were measured in 6 beagle dogs that had suffered from an acute myocardial infarction 6 weeks before. A 6F tip transducer catheter was inserted into the right common carotid artery to measure blood pressure, and blood flow was measured in the left common carotid artery by an electromagnetic blood flow probe under anesthesia before and during EECP. Blood pulse pressure, pulsatility index (ratio of peak pressure to end diastolic pressure) and standard deviation of blood pressure were calculated to evaluate the pulsatility of arterial blood pressure. Blood pulse flow, pulsatility index (ratio of peak flow to trough flow) and standard deviation of blood flow were calculated to evaluate the pulsatility of blood flow. Mean vascular resistance (MVR) was calculated as MVR = mean blood pressure/mean blood flow. Blood pulse pressure, pulsatility index and standard deviation of blood pressure were elevated from 30 +/- 9 mmHg, 1.26 +/- 0.05 and 8.7 +/- 2.5 mmHg to 43 +/- 8 mmHg (P < 0.05), 1.54 +/- 0.13 and 12.4 +/- 2.0 mmHg (P < 0.05) before and during EECP, respectively. Blood pulse flow, pulsatility index and standard deviation of blood flow were elevated from 317 +/- 48 ml/min, 2.85 +/- 0.21 and 96 +/- 21 ml/min to 447 +/- 88 ml/min, 4.56 +/- 0.90 and 131 +/- 39 ml/min before and during EECP (P < 0.05). MVR was decreased from 578 +/- 72 before EECP to 476 +/- 85 Wood units during EECP(P < 0.05). These data demonstrate that EECP gives an elevation of pulsatility to blood pressure and blood flow, thus it may lead to the decrease of vascular resistance.

Animals↗
PubMedDate not supplied

OPS imaging of human microcirculation: a short technical report.

Despite the pivotal role of microcirculation in numerous diseases, techniques for the direct assessment of human microcirculation are limited. A new approach based on orthogonal polarization spectral (OPS) imaging (Cytoscan microscope) allows noninvasive observation of human microcirculation in all accessible tissue surfaces. Limitations remain: application of pressure with the instrument affects blood flow, lateral movement of tissue precludes continuous investigation of a given microvascular region, and blood flow velocities above 1 mm/s cannot be measured. We addressed these problems by (a) constructing an attachment to the probe, preventing direct contact of the instrument with the observed tissue area and allowing fixation of the tissue, and (b) implementing a double-flash spatial correlation technique extending the measuring range for blood flow velocities up to approximately 40 mm/s. The modified approach was tested in vitro and in vivo. Velocity readings correlated well with velocities of an external standard (r(2) = 0.99, range 1.9-33.8 mm/s). Pulsatile flow patterns synchronous with heart rate with maximal velocities of about 10 mm/s could be detected in arterioles of the human sublingual mucosa. The modified instrument may prove useful to investigate the microcirculation in the context of research, diagnosis and therapy control.

Adult↗
PubMed2003

Physiological flow analysis in significant human coronary artery stenoses.

To evaluate the local hemodynamics in flow limiting coronary lesions, computational hemodynamics was applied to a group of patients previously reported by Wilson et al. (1988) with representative pre-angioplasty stenosis geometry (minimal lesion size d(m)=0.95 mm; 68% mean diameter stenosis) and with measured values of coronary flow reserve (CFR) in the abnormal range (2.3+/-0.1). The computations were at mean flow rates (Q) of 50, 75 and 100 ml/min (the limit of our converged calculations). Computed mean pressure drops Deltap were approximately 9 mmHg for basal flow (50 ml/min), approximately 27 mmHg for elevated flow (100 ml/min) and increased to an extrapolated value of approximately 34 mmHg for hyperemic flow (115 ml/min), which led to a distal mean coronary pressure p(rh) of approximately 55 mmHg, a level known to cause ischemia in the subendocardium (Brown et al., 1984), and consistent with the occurrence of angina in the patients. Relatively high levels of wall shear stress were computed in the narrow throat region and ranged from about 600 to 1500 dyn/cm(2), with periodic (phase shifted) peak systolic values of about 3500 dyn/cm(2). In the distal vessel, the interaction between the separated shear layer wave, convected downstream by the core flow, and the wall shear layer flow, led to the formation of vortical flow cells along the distal vessel wall during the systolic phase where Reynolds numbers Re(e)(t) were higher. During the phasic vortical mode observed at both basal and elevated mean flow rates, wide variations in distal wall shear stress occurred, distal transmural pressures were depressed below throat levels, and pressure recovery was larger farther along the distal vessel. Along the constriction (convergent) and throat segments of the lesion the pulsatile flow field was principally quasi-steady before flow separation occurred. The flow regimes were complex in the narrow mean flow Reynolds number range Re(e)=100-230 and a frequency parameter of alphae=2.25. The shear layer flow disturbances diminished in strength due to viscous damping along the distal vessel at these relatively low values of Re(e), typical of flow through diseased epicardial coronary vessels. The distal hyperemic flow field was likely to be in an early stage of turbulent flow development during the peak systolic phase.

Blood Flow Velocity↗
PubMed1994

MRA studies of arterial stenosis: improvements by diastolic acquisition.

Cardiac-phase-specific data acquisition is used to reduce signal loss in MR Angiography resulting from disturbed flow. RF pulses are delivered continuously throughout the cardiac cycle, but incrementation of phase-encoding gradients and data storage are enabled only during the chosen part of the cycle. Studies in a stenotic pulsatile flow phantom demonstrate that poststenotic signal loss is primarily determined by the mean flow velocity, and is not appreciably affected by acceleration or deceleration of the mean flow rate. The signal loss is least in diastole. In vivo studies in patients with carotid artery disease show that data acquisition in diastole reduces the apparent degree and extent of carotid bifurcation stenosis and provides a crisper definition of the vascular lumen. The additional time required for cardiac-phase-specific acquisition can be reduced by gating only the lower-order phase-encoding lines while retaining acceptable image quality.

Blood Flow Velocity↗
PubMed2004

Arterial MR imaging phase-contrast flow measurement: improvements with varying velocity sensitivity during cardiac cycle.

To reduce noise in velocity images of magnetic resonance (MR) phase-contrast measurements, the authors implemented and evaluated a pulse sequence that enables automatic optimization of the velocity-encoding parameter V(enc) for individual heart phases in pulsatile flow on the basis of a rapid prescan. This sequence was prospectively evaluated by comparing velocity-to-noise ratios with those from a standard MR flow scan obtained in the carotid artery in eight volunteers. This sequence was shown to improve velocity-to-noise ratios by a factor of 2.0-6.0 in all but the systolic heart phase and was determined to be an effective technique for reducing noise in phase-contrast velocity measurements.

Adult↗
PubMed2006

Numerical model study of flow dynamics through an end-to-side anastomosis: choice of anastomosis angle and prosthesis diameter.

The purpose of this numerical model study was to determine the angle of anastomosis and prosthesis-to-artery diameter ratio that theoretically limits development of myointimal hyperplasia (MIH). Blood flow patterns were investigated in a model simulating a distal end-to-side anastomosis on a 2-mm-diameter artery. Tests were carried out under steady and pulsatile flow conditions with and without taking into account the non-Newtonian behavior of blood and compliance. The wall shear stress gradient (WSSG), a potential factor for development of MIH, was analyzed as a function of the angle of anastomosis (18 degrees , 25 degrees , 35 degrees , and 45 degrees ) and prosthesis diameter (4, 5, and 6 mm). The angle of anastomosis that minimized WSSG was 18 degrees . Prosthesis diameter had no effect on WSSG, with similar results for all three diameters. These findings suggest that surgeons should choose as acute an angle of anastomosis as possible. Prosthesis diameter played no role in reducing WSSG values.

Anastomosis, Surgical↗
PubMed1990

Peripheral vascular and abdominal applications of MR flow imaging techniques.

Many MR flow imaging techniques that have been successfully applied in the carotid arteries and intracranial circulation have been tested in the peripheral and abdominal vasculature. The results have been variable. The lack of success can be attributed to different imaging requirements as well as different patterns of blood flow. These requirements include a large field of view, sensitivity to a wide range of blood flow velocities and complex flow directions, and suppression of overlapping vascular structures and stationary tissue. We have designed strategies using phase contrast MR angiography (MRA) for imaging the arteries and veins of the lower extremity and the abdominal vasculature in normal subjects. This strategy takes advantage of the pulsatile flow pattern present in normal arteries. Overlapping blood flow and stationary tissue were suppressed by a combination of spatial presaturation, optimization of the amplitude and duration of the velocity sensitive gradients, and postprocessing techniques.

Blood Flow Velocity↗
PubMedDate not supplied

Flow patterns and endothelial cell morphology in a simplified model of an artificial ventricle.

The aim of this study was to delineate the flow patterns in a non-unidirectional flow field inside a ventricle-shaped cell culture chamber, and examine the resulting morphology and integrity of the endothelium in select regions of the monolayer. The chamber was perfused by pulsatile flow, and the coherent motion of the fluid was studied using flow visualization aided by image analysis. Four distinct flow patterns were discerned and examined: central jet, flow impingement, flow separation, and recirculating eddies. The influence of these patterns on endothelial cell morphology was assessed after 20 h of exposure to flow. There were no signs of damage to the endothelium in the jet region nor was there evidence of cell alignment with the flow. Yet, there were changes in cell morphology and cytoskeletal architecture as compared to control. By contrast, within the eddies where the flow was highly disturbed, there was apparent damage to the endothelium. Thus, exposure of cells to random velocity fluctuations in regions of quasi-static flow compromises the integrity of the monolayer. Identification of such sites and acquisition of the knowledge necessary to protect the cells from denudation will be valuable for the endothelialization efforts of cardiac prostheses.

Animals↗
PubMed1998

Effect of non-pulsatile renal blood flow on plasma erythropoietin.

Erythropoietin is a hormone responsible for regulation of red blood cell production. Circulating erythropoietin values are regulated by renal oxygen supply, which is determined by hemoglobin concentration, hemoglobin oxygen saturation, and renal blood flow. Previous animal and human studies regarding erythropoietin regulation have assumed pulsatile renal blood flow. During cardiopulmonary bypass, non-pulsatile renal perfusion has been shown to result in decreased glomerular filtration rate and decreased renal blood flow in comparison to pulsatile perfusion. Repair of congenital heart disease during cardiopulmonary bypass is an attractive circumstance in which to study the effect of non-pulsatile blood flow on erythropoietin production. The hypothesis in this study was that non-pulsatile perfusion would result in increased erythropoietin production because of decreased renal oxygen supply. Fourteen children with congenital heart disease and without preoperative renal insufficiency or anemia were enrolled in the study. All patients underwent cardiopulmonary bypass with non-pulsatile flow. In addition, 10 control patients without congenital heart disease were enrolled. Six cardiopulmonary bypass patients had 1.5- to 6-fold increases in plasma erythropoietin concentrations from baseline. These patients had longer cardiopulmonary bypass times, more commonly performed under low flow deep hypothermic conditions. The remaining 8 patients with congenital heart disease, and all control patients, did not develop increased postoperative erythropoietin concentrations. The conditions under which cardiopulmonary bypass are performed appear to influence postoperative circulating erythropoietin concentrations.

Cardiopulmonary Bypass↗
PubMed1996

Flow dynamics in a fatal aneurysm of the basilar artery.

PURPOSE: To examine the flow dynamics in a fatal aneurysm of the basilar artery in humans. METHODS: We made transparent elastic replicas of the vertebrobasilar arteries of an elderly patient who died of a ruptured aneurysm in the basilar artery. Using non-Newtonian fluid, physiological pulsatile flow volumes and profiles, and isobaric dyes and particles, we observed and recorded the slipstreams as they entered the aneurysm while changing relative flow in the vertebral arteries. Finally, we placed clips on the aneurysm, leaving residuals (or dog-ears), and observed the slipstreams. RESULTS: The aneurysm originated laterally from the greater curvature of a tortuous basilar artery, measured 19 x 11 x 12 mm, and had a Murphy's teat at the apex, the rupture site. The neck measured 10 x 4 mm, about the diameter of the basilar artery. Slipstreams joined at the confluence of the vertebral arteries, formed helical flow patterns, and entered the aneurysm violently, striking the apex. They then passed proximally around the sac walls, then centrally, and finally reentered the basilar artery to pass distally. Altering the relative flows in the vertebral arteries could modify and prevent slipstream flow into the aneurysm. When a dog-ear was created by incorrect placement of an aneurysm clip, slipstreams entered only dog-ears that lay distal to the clip. Correctly placed clips excluded the aneurysm from the circulation, but did not return the flow dynamics to normal. CONCLUSION: High-velocity slipstreams strike aneurysms at their rupture site and have an impact on distal but not proximal dog-ears. Modifying relative flow may prevent aneurysmal filling. Further, a knowledge of flow dynamics may allow us to predict which aneurysms are at risk of enlarging and rupturing, and may help guide proper therapy.

Aged↗
PubMedDate not supplied

Ultrasound measurement of the effect of temperature on microperfusion in the eye.

Recent developments in ultrasound (US) technology have allowed the study of microperfusion in the anterior segment of the eye. Our aim was to determine the effect of the thermal environment on blood flow in the anterior segment. We measured blood flow in the major arterial circle of five rabbits. A 38-MHz US transducer was coupled to the eye with a normal saline water-bath with temperature controlled from 1 degrees C to 38 degrees C. The major arterial circle was localized and imaged using the swept-scan technique and M-mode data were then acquired for measurement of pulsatile flow. Peak systolic and mean velocity averaged 4.51 and 1.32 mm/s, respectively. Positive correlations were found between peak systolic (1.69%/ degrees C) and mean (1.76%/ degrees C) velocities and temperature. Vessel diameter (mean = 178 microm) did not show any significant change with temperature. High-resolution US flowmetry demonstrated decreasing flow rates in the iris with decreasing temperature.

Animals↗