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The first derivative as a means of synchronizing pulsatile flow velocity and vessel diameter waveforms in the fetal descending aorta.

In order to calculate volume flow, blood flow velocity and pulsatile vessel diameter waveforms in the lower thoracic part of the descending aorta of the fetal lamb and human fetus were matched for identical cardiac cycle length by fetal ECG and the first derivative of these waveforms. Volume flow values were not essentially different using either method. There is simultaneous onset of the blood flow velocity and pulsatile vessel diameter waveforms. The first derivative can reliably replace the fetal ECG as a means of synchronizing blood flow velocity and pulsatile vessel diameter waveforms in the fetal descending aorta.

Animals↗

Pulsatile flow of Casson's fluid through stenosed arteries with applications to blood flow.

The effects of non-Newtonian nature of blood and pulsatility on flow through a stenosed tube have been investigated. A perturbation method is used to analyse the flow. It is of interest to note that the thickness of the viscous flow region is non-uniform (changing with axial distance). An analytic relation between viscous flow region thickness and red cell concentration has been obtained. It is important to mention that some researchers have obtained an approximate solution for the flow rate-pressure gradient equation (assuming the ratio between the yield stress and the wall shear to be very small in comparison to unity); in the present analysis, we have obtained an exact solution for this non-linear equation without making that assumption. The approximate and exact solutions compare well with one of the exact solutions. Another important result is that the mean and steady flow rates decrease as the yield stress theta increases. For the low values of the yield stress, the mean flow rate is higher than the steady flow rate, but for high values of the yield stress, the mean flow rate behaviour is of opposite nature. The critical value of the yield stress at which the flow rate behaviour changes from one type to another has been determined. Further, it seems that there exists a value of the yield stress at which flow stops for both the flows (steady and pulsatile). It is observed that the flow stop yield value for pulsatile flow is lower than the steady flow. The most notable result of pulsatility is the phase lag between the pressure gradient and flow rate, which is further influenced by the yield stress and stenosis. Another important result of pulsatility is the mean resistance to flow is greater than its steady flow value, whereas the mean value of the wall shear for pulsatile flow is equal to steady wall shear. Many standard results regarding Casson and Newtonian fluids flow, uniform tube flow and steady flow can be obtained as the special cases of the present analysis. Finally, some applications of this theoretical analysis have been cited.

Arterial Occlusive Diseases↗

Pulsatile flow and simple flow control method during weaning period in centrifugal pump: toward more expanded usage in open heart surgery.

To expand the usage of the centrifugal pump (CP) in open heart surgery, we performed two studies. In the first, we evaluated pulsatile flow in the CP. In vitro pump performance of the Terumo Capiox pump (TCP) and the Sarns Delphin pump (SDP) and increase of free hemoglobin (mg/dl) after driving 6 h were investigated using bovine blood. A roller pump (RP) was used as a comparison. Equally effective pulsatile flow was obtained in both CPs. Hemolysis was less severe in TCP (120 mg/dl) than SDP (210 mg/dl) and RP (320 mg/dl). In the second study, we evaluated a simple flow control method. Flow rate was easily controlled with step-wise clamping of 3-pronged tubing (Triple-flow) without changing rotational speed, regardless of afterload. Fluctuation of flow was much less with this method than with the rotational speed change method. The use of pulsatile flow of TCP, with its minimum increase of hemolysis and the easier flow control method during the weaning process, may expand the usage of CP in open heart surgery.

Animals↗

MRI and CFD studies of pulsatile flow in healthy and stenosed carotid bifurcation models.

Pulsatile flow was studied in physiologically realistic models of a normal and a moderately stenosed (30% diameter reduction) human carotid bifurcation. Time-resolved velocity measurements were made using magnetic resonance imaging, from which wall shear stress (WSS) vectors were calculated. Velocity measurements in the inflow and outflow regions were also used as boundary conditions for a computational fluid dynamics (CFD) model. Experimental flow patterns and derived WSS vectors were compared qualitatively with the corresponding CFD predictions. In the stenosed phantom, flow in the bulb region of the "internal carotid artery" was concentrated along the outer wall, with a region of low and recirculating flow near the inner wall. In the normal phantom, the converse was found, with a low flow region near the outer wall of the bulb. Time-averaged WSS and oscillatory shear index were also markedly different for the two phantoms.

Blood Flow Velocity↗

Morphological and functional analysis of rat hepatocyte spheroids generated on poly(L-lactic acid) polymer in a pulsatile flow bioreactor.

Liver neo-tissue suitable for transplantation has not been established. Primary rat hepatocytes were cultured on three-dimensional biodegradable polymer matrices in a pulsatile flow bioreactor with the intention of inducing tissue formation and improving cell survival. Functional and structural analysis of the hepatocytes forming liver neo-tissue was performed. Biodegradable poly(L-lactic acid) (PLLA) polymer discs were seeded with 4 x 10(6) primary rat hepatocytes each, were exposed to a pulsatile medium flow of 24 mL/min for 1, 2, 4, or 6 days and were investigated for monoethylglycinexylidine (MEGX) formation, ammonia detoxification, Cytokeratin 18 (CK18) expression, and preserved glycogen storage. Fine structural details were obtained using scanning and transmission electron microscopy. Spheroids of viable hepatocytes were formed. MEGX-specific production was maintained and ammonia removal capacity remained high during the entire flow-culture period of 6 days. CK18 distribution was normal. Periodic-acid- Schiff reaction demonstrated homogenous glycogen storage. The hepatocytes reassembled to form intercellular junctions and bile canaliculi. Functional and morphological analysis of rat hepatocytes forming spheroids in a pulsatile flow bioreactor indicated preserved and intact hepatocyte morphology and specific function. Pulsatile flow culture on PLLA scaffolds is a promising new method of hepatic tissue engineering leading to liver neo-tissue formation.

Animals↗

Pulsatile flow in a model carotid bifurcation.

Pulsatile flow in an in vitro model of the human carotid bifurcation was studied by flow visualization using hydrogen bubble techniques. A glass model was constructed after determining an average geometry from 57 biplanar angiograms of 22 subjects ranging from 34 to 77 years of age. The flow pulse used was a half-sine wave superimposed upon a mean flow. Maximum and minimum values of the instantaneous Reynolds number were 1200 and 400, respectively, based upon conditions in the common carotid model artery; the frequency parameter was 6.0. The division of flow into the internal external branches was 70:30. Visualization by hydrogen bubbles demonstrated significant deviations from steady flow behavior. Flow separated in the carotid sinus over the entire cycle, but the location and extent of separation varied strongly. The direction of flow near the walls of the model changed sharply during the cycle except for the region near the apex of the bifurcation where the orientation of streaklines was more nearly unidirectional at all times. Bubbles entering the separated flow region tended to remain entrapped there for several cycles. Rapid dispersion of bubbles occurred in the internal branch near the end of systole, suggesting the presence of flow disorder. The location of low wall shear stresses, directionally varying stresses, and longer residence times for fluid elements appears to coincide with the localization of early atheromatous plaques in human carotid specimens.

Adult↗

Contractions of postmortem human saphenous veins perfused with pulsatile flow.

The aim of this study was to evaluate the contractions of postmortem human saphenous veins under pulsatile flow conditions as a simulation of coronary-aortic bypass graft (CABG) surgery. Twenty-five cylindrical specimens of veins, obtained from 20 cadavers several hours after death, were mounted in a pulsatile flow system with a pulse rate of 80/min and a mean flow rate of 7 ml/min at various perfusion pressures. Prostaglandin F2 alpha(PGF2 alpha) was then applied to the outer physiological salt solution at a concentration of 3 X 10(-6) mol. Of the 25 veins, 18 (72%) contracted and seven did not. Contractions were observed at a mean perfusion pressure of less than 60 mmHg but not at higher pressures. Three contraction patterns were observed: One caused pressure gradients between the proximal and distal sites of the vein and showed periodic contractions (P); one showed only tonic contractions (T); the other showed pulse pressure increase without developing the pressure gradients (PP). The incidences of P, T, and PP in the 18 instances of contraction were 50%, 33%, and 17%, respectively. Repeated applications of PGF2 alpha to the same vein with the same and/or increased perfusion pressure caused changes of pattern in the direction of P to T, to PP, and to no response, whereas decreasing perfusion pressure caused the patterns to change in the reverse direction. The pressure gradients that developed in veins showing P and T patterns correlated well with the mean perfusion pressure (r = 0.68, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Flow dynamics in anatomical models of abdominal aortic aneurysms: computational analysis of pulsatile flow.

Blood flow in human arteries is dominated by time-dependent transport phenomena. In particular, in the abdominal segment of the aorta under a patient's average resting conditions, blood exhibits laminar flow patterns that are influenced by secondary flows induced by adjacent branches and in irregular vessel geometries. The flow dynamics becomes more complex when there is a pathological condition that causes changes in the normal structural composition of the vessel wall, for example, in the presence of an aneurysm. An aneurysm is an irreversible dilation of a blood vessel accompanied by weakening of the vessel wall. This work examines the importance of hemodynamics in the characterization of pulsatile blood flow patterns in individual Abdominal Aortic Aneurysm (AAA) models. These patient-specific computational models have been developed for the numerical simulation of the momentum transport equations utilizing the Finite Element Method (FEM) for the spatial and temporal discretization. We characterize pulsatile flow dynamics in AAAs for average resting conditions by means of identifying regions of disturbed flow and quantifying the disturbance by evaluating wall pressure and wall shear stresses at the aneurysm wall.

Aorta, Abdominal↗

Effects of a vascular graft/natural artery compliance mismatch on pulsatile flow.

Attempts have been made to correlate small-diameter vascular graft patency with compliance matching between the graft and the host artery. Without knowledge about the mechanisms of failure by compliance mismatch, however, such correlations remain empirical. We have developed a flow system which mimics the flow in peripheral arteries and techniques to model a compliance mismatch in a straight elastic tube, as might occur with vascular repair. Our goal was to investigate one proposed mechanism of graft failure by compliance mismatch, that of a blood flow disturbance. Flow visualization experiments showed that, under pulsatile flow, a compliance mismatch caused trapping of 40 microns microspheres at the wall near the distal or downstream anastomosis. This suggests that the presence of a microscopic flow separation or stagnant zone in vivo may contribute to the intimal hyperplasia and thrombosis seen in failed grafts.

Acceleration↗

Pulsatile flow in a constricted channel.

A nonuniform channel is used as a simple model of a constricted arterial vessel. Flow patterns have been calculated for pulsatile flow with both sinusoidal and nonsinusoidal flow rates for a range of Reynolds number, Re, and Strouhal number, St. The results show that even for relatively low frequency flows a strong vortex wave will be generated with a complex wall shear stress distribution and peak values much greater than those found in steady or unsteady parallel flow. The vortex wave increases in strength with increasing Re and St, with its total length and wavelength independent of Re but inversely proportional to St. The form of the imposed flow rate is found to have an important effect on the flow and the shear stress distribution.

Arteries↗

Nonquasi-steady character of pulsatile flow in human coronary arteries.

This experiment was conducted to determine if the pulsatile flow through the proximal portion of the left coronary artery system in man exhibits quasi-steady characteristics. Steady and pulsatile flows were passed through an idealized model whose dimensions were based on a vascular cast. The mean Reynolds number was 180 and the unsteadiness number was 2.7. Velocity profiles were measured by laser Doppler anemometry at several locations along diameters in the parent and both daughter channels in the neighborhood of the "left main" bifurcation. Analysis of the results along one diameter in the "left main" channel shows that unsteady flow in the larger coronary arteries may not be simulated by a series of steady flow experiments.

Biomechanical Phenomena↗

Thromboxane and prostacyclin changes during cardiopulmonary bypass with and without pulsatile flow.

Nonpulsatile cardiopulmonary bypass, in patients with coronary artery disease, produces a significant increase in thromboxane, a potent platelet aggregant and putative coronary vasoconstrictor. Pulsatile flow may decrease the incidence of perioperative infarction and the hormonal stress response to bypass. This study assessed the effect of pulsatile blood flow on plasma thromboxane and prostacyclin profiles during cardiopulmonary bypass by serial measurement of their stable metabolites, thromboxane B2 (TxB2) and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha). Two groups of eight patients each were studied before, during, and after cardiopulmonary bypass. Eight patients had routine (nonpulsatile) bypass and eight had pulsatile flow. In the nonpulsatile group, the TxB2 concentration significantly increased during bypass (65 +/- 39 to 1,224 +/- 306 pg/ml, p less than 0.01) and rapidly returned to control. Prostacyclin also rose (53 +/- 20 to 613 +/- 132 pg/ml, p less than 0.01). In the pulsatile group, TxB2 rose during bypass (53 +/- 18 to 693 +/- 130 pg/ml, p less than 0.01), but peak concentration was significantly lower than in the nonpulsatile group (1,224 +/- 306 versus 693 +/- 130 pg/ml, p less than 0.05). Prostacyclin rose sharply during cardiopulmonary bypass in the pulsatile group (53 +/- 22 to 1,033 +/- 136 pg/ml, p less than 0.01) and was higher than in the nonpulsatile group (1,033 +/- 136 versus 325 +/- 33 pg/ml, p less than 0.01). There were no intragroup differences of plasma hemoglobin, hematocrit, or platelet count. These data demonstrate that pulsatile flow significantly alters prostacyclin and thromboxane profiles during cardiopulmonary bypass and favors production of the coronary vasodilator and platelet disaggregant prostacyclin. This may be an important factor in some of the clinical advantages previously reported with this modality.

6-Ketoprostaglandin F1 alpha↗

Model of pulsatile-flow of aqueous humor through the iris-lens canal.

PURPOSE: To present a model of pulsatile-flow of aqueous humor from posterior (PC) to anterior chamber (AC) and to analyze the sensitivity of this novel model in detecting typical high risk conditions predisposing to pupillary block. METHODS: The model assumes noncontinuous flow of aqueous through the iris-lens canal. Aqueous that fills the canal will be ejected toward the AC-side of the canal at certain time intervals, and between 2 events of aqueous ejection there is no actual flow through this canal. Pupillary pumping rate (PPR) was calculated from the aqueous flow rate and the calculated volume of iris-lens canal. RESULTS: PPR values were generated by incorporating pupillary diameter (1 to 8 mm), aqueous flow rate (1 to 2.5 microL/min), and iris-lens canal width (0.5 to 2 mm) and height (3-9 microm) in numerical experimentation with the present model. PPR showed inverse dependence on iris-lens canal height and pupillary diameter and was directly proportional to aqueous flow rate, in agreement with the steady-flow model. However, contrary to the steady-flow model, PPR showed inverse dependence on iris-lens canal width and predicted the anticipated PC-AC pressure gradient changes at simulated light-dark transition in eyes of patients with clinically narrow angles and ultrasound biomicroscopy evidenced pupillary block. CONCLUSIONS: Upon the incorporation of real ultrasound biomicroscopy measurements in numerical experimentations with both models, the present pulsatile-flow model, contrary to the steady-flow model, showed good predictability of PC-AC pressure gradient changes in a typical condition predisposing to pupillary block.

Anterior Chamber↗

Non-invasive flow estimation in an implantable rotary blood pump: a study considering non-pulsatile and pulsatile flows.

Non-invasive estimation of flow was investigated in an implantable rotary blood pump (iRBP) with a hydrodynamic bearing. The effects of non-pulsatile and pulsatile flows were studied using in vitro mock loops, and acute (N = 3) and chronic (N = 6) ovine experiments. Using the non-pulsatile and pulsatile mock loops an average flow estimation algorithm was derived from root mean square (RMS) pump impeller speed and RMS input power. These algorithms were programmed into the iRBP controller for subsequent validation in vivo. In the acute experiments, venous return and systemic vascular resistance were adjusted through pharmacological intervention and exsanguination to produce an average range of pump flows from 0.0 to 2.6 l min(-1). Over this range the RMS estimation error was 88 +/- 12 ml, with a linear correlation slope of 0.992 +/- 0.006 (R2 = 0.986 +/- 0.004). In the chronic experiments, animals were monitored daily for up to three months and an average range of flows from 2.8 to 4.8 l min(-1) recorded. A linear correlation between the estimated and measured pump flows yielded a slope of 1.005 +/- 0.006 (R2 = 0.966 +/- 0.004). The RMS estimation error was 120 +/- 11 ml. Using this algorithm it is possible to effectively estimate flow in a rotary blood pump without implanting additional invasive sensors.

Algorithms↗

Design and performance of a physiologic pulsatile flow neonate-infant cardiopulmonary bypass system.

The authors have designed an alternative infant cardiopulmonary bypass (CPB) system using the University of Texas neonatal pulsatile pump, which produces physiologic pulsatile flow and allows a low priming volume. This system has been tested with normothermic CPB (n = 8), and deep hypothermic circulatory arrest (n = 14) in 3 kg piglets. Data obtained during these studies suggest that this system can produce flow characteristics that approximate normal physiologic values. Unlike other pulsatile pumps, this pump can produce a very small stroke volume, ranging from 0.5 to 7.1 ml with a pump rate of 120 beats/min. These stroke volumes correspond to our target value of 1 ml/kg body weight. This system is designed to cause minimal hemodilution and minimal exposure of blood to foreign surface areas. The pump does not produce negative pressure, and therefore the venous reservoir is not essential, and only a cardiotomy reservoir is required. Conclusions after in vivo testing are, first, that physiologic pulsatile flow can be achieved readily with this system using a 10 Fr aortic cannula in 3 kg piglets; and second, that a significant reduction in priming volume and hemodilution can be obtained using this system.

Animals↗

Flush-mounted hot film anemometer accuracy in pulsatile flow.

The accuracy of a flush-mounted hot film anemometer probe for wall shear stress measurements in physiological pulsatile flows was evaluated in fully developed pulsatile flow in a rigid straight tube. Measured wall shear stress waveform based on steady flow anemometer probe calibrations were compared to theoretical wall shear stress waveforms based on well-established theory and measured flow rate waveforms. The measured and theoretical waveforms were in close agreement during systole (average deviation of 14 percent at peak systole). As expected, agreement was poor during diastole because of flow reversal and diminished frequency response at low shear rate.

Blood Circulation↗

Minimal enteral feeding, fetal blood flow pulsatility, and postnatal intestinal permeability in preterm infants with intrauterine growth retardation.

OBJECTIVE: To study the effect of minimal enteral feeding (MEF) on intestinal permeability and feeding tolerance in preterm infants with intrauterine growth retardation (gestational age < 37 weeks, birth weight for gestational age p < 10). Furthermore, to determine whether fetal blood flow pulsatility or intestinal permeability predict feeding tolerance in these infants. DESIGN: Randomised controlled trial. METHODS: Within 48 hours of birth, infants were randomised to MEF or no enteral feeding (NEF) for five days in addition to parenteral feeding. Intestinal permeability was measured by the sugar absorption test before (SAT1) and after (SAT2) the study. The sugar absorption test measured the urinary lactulose/mannitol (LM) ratio after oral ingestion of a solution (375 mosm) containing mannitol and lactulose. Charts of all infants were assessed for measures of feeding tolerance. Fetal blood flow pulsatility index (U/C ratio) was measured within the seven days before birth. RESULTS: Of the 56 infants enrolled, 42 completed the study: 20 received MEF and 22 NEF. The decrease in LM ratio (LM ratio 1 - LM ratio 2) was not significantly different between the two groups (0.25 v 0.11; p = 0.14). Feeding tolerance, growth, and incidence of necrotising enterocolitis were not significantly different between the two groups. Neither the U/C nor the LM ratio 1 predicted feeding tolerance. CONCLUSIONS: The results suggest that MEF of preterm infants with intrauterine growth retardation has no effect on the decrease in intestinal permeability after birth. Neither fetal blood flow pulsatility nor intestinal permeability predicts feeding tolerance.

Blood Flow Velocity↗

Evaluation of steady and pulsatile flow with dynamic MRI using limited flip angles and gradient refocused echoes.

Magnetic resonance imaging sequences utilizing limited flip angles and gradient echoes yield rapid (less than 2 min) dynamic images of the cardiovascular system. These images contain both accurate anatomical and functional information. Using a gradient refocused acquisition in the steady state (GRASS) in the CINE mode, we studied the relationship between gradient echo signal intensity and velocity of steady and pulsatile flow in a phantom simulating medium to large vessels. Images were acquired on a 1.5 Tesla system (repetition time = 21 ms, echo time = 12 ms, flip angle = 30 degrees). Data from each pulse interval were sorted in 16 images. Signal intensities from flow tube lumina and surrounding stationary water jacket were used to calculate contrast ratios which were compared to velocity measurements made with electromagnetic (EM) flow probes outside the magnet room. During steady flow, signal intensity contrast ratios increased with increasing flow and in a 10 mm thick slice, reached a peak at 48 cm/s, and declined for velocities up to 90 cm/s. Changes in instantaneous velocity during pulsatile flow correlated well (r greater than .88) with signal intensity changes up to a maximum mean velocity of 17 cm/s. Total signal intensity from the lumen for an "R to R" interval correlated extremely well (r greater than .97) with mean pulsatile flow velocities up to 30 cm/s. The excellent correlation between gradient echo signal intensity and actual flow velocities suggests that this imaging sequence might be useful for evaluating normal and pathologic flow phenomena.

Blood Circulation↗