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A computer simulation of the non-Newtonian blood flow at the aortic bifurcation.

A two-dimensional numerical model was developed to determine the effect of the non-Newtonian behavior of blood on a pulsatile flow at the aortic bifurcation. The blood rheology was described by a weak-form Casson equation. The successive-over-relaxation (SOR) method was used to solve both the vorticity and Poisson equations numerically. It was disclosed that the non-Newtonian property of blood did not drastically change the flow patterns, but caused an appreciable increase in the shear stresses and a slightly higher resistance to both flow separations and the phase shifts between flow layers.

Aorta, Abdominal↗

Quantitative flow measurement in phase contrast MR angiography.

The quantitative nature of phase contrast magnetic resonance angiography is explored, and a technique of blood flow measurement that is independent of system and patient parameters is presented. Phantom and patient studies demonstrate that quantitative flow measurements by phase contrast angiography can be routinely obtained with good accuracy despite nonuniform sensitivity profiles, blood flow pulsatility, and patient-to-patient changes in system gain. The calibration method requires the acquisition of only two flow images and thus can be performed as part of an angiographic session. Flow calibration of any flow profile can be accomplished with this technique. The solutions for plug flow and parabolic flow are presented.

Adult↗

Flow separation in the renal arteries.

To determine the nature of the flow in the proximal portion of the renal arteries, a common site for the development of atherosclerosis, we performed pulsatile flow studies in a clear acrylic mold of a normal human aorta and renal arteries. The mold was developed from a cast of the renal arteries prepared in situ during the autopsy of a 27-year-old woman. Flow in the mold was visualized by the illumination of bouyant particles (100 to 300 mu). A range of branch (renal) to trunk (aorta) flow ratios of 0.053 to 0.350 was studied. Flow separation during systole was considered present when particles near the wall reversed direction. Flow separation occurred throughout systole at the superior aspect of the origin of both the left and right renal arteries at a branch-to-trunk flow ratio of 0.053. As the branch-to-trunk flow ratio increased, flow separation occurred during the deceleration phase of right renal flow. At a branch-to-trunk flow ratio of 0.350, flow separation was no longer present. This suggests that flow separation may occur near the renal ostia if renal flow falls appreciably while aortic flow remains elevated. Because flow separation involves low wall shear, mass transfer across the arterial wall may be adversely affected and possibly contribute to the formation of atheroma.

Adult↗

Changes in phasic femoral artery flow induced by various stimuli: a study with percutaneous pulsed Doppler ultrasound.

Transcutaneous blood flow measurements were performed by means of pulsed Doppler ultrasound flowmeter in the femoral artery of healthy subjects. The pulsatile flow pattern was changed characteristically from resting state by postocclusive reactive hyperaemia, by the application of amyl nitrite, xanthinol nicotinate, and angiotensin amide. During reactive hyperaemia systolic flow was increased, diastolic reverse flow was abolished, and the forward flow continued throughout diastole. Amyl nitrite augmented thenegative flow phase and reduced mean flow, while xanthinol nicotinate decreased the negative component and augmented mean flow. Angiotensin amide produced enhancement of the average flow by elevating systolic and diastolic flow equally over the base line. In each of these interventions the changes in flow were determined mainly by variations during the diastolic flow phase.

Adult↗

Effect of valve orientation on flow development past aortic valve prostheses in a model human aorta.

The effect of valve orientation on flow development in a model human aorta was studied by means of a qualitative flow visualization technique. The model replicated the geometry of the human aorta and the experiment simulated a physiologically realistic pulsatile flow. The following valves were studied: Starr-Edwards Stellite, Starr-Edwards silicone, Björk-Shiley spherical disc, Björk-Shiley convexo-concave disc, and Hall-Kaster tilting disc. All the valves had a tissue anulus diameter of 27 mm. With the ball-in-cage valves, the flow in the ascending aorta was predominantly axial and uniform throughout systole, while vortex formation was observed downstream from the ball. With the tilting disc valves, the flow development in the aorta was a function of the orientation of the valves. With the major flow orifice directed toward the commissure between the right and noncoronary cusps, the fluid motion was predominantly in the axial direction through early systole. A vortex developed along the wall of lesser curvature of the aorta with the progression of systole. In early diastole, a well-defined flow reversal was observed along the lesser curvature of the aorta. With the major flow orifice directed toward the left coronary cusp, the fluid motion, although predominantly axial, was not uniform in the ascending aorta. Regions of relative stasis present near the wall of greater curvature subsequently developed into a trapped vortex throughout the cardiac cycle. With the major flow orifice directed more posteriorly, an improved fluid dynamic characteristic was observed, and there was no trapped vortex present near the wall of greater curvature. The flow visualization study in the model human aorta suggests that, from a fluid dynamic point of view, orientation of the major flow orifice of the tilting disc valve toward the wall of lesser curvature is not advisable.

Aortic Valve↗

Pulsatile ocular blood flow of choroidal neovascularization in asymmetric age-related macular degeneration after transpupillary thermotherapy.

PURPOSE: A previous study has shown that the pulsatile ocular blood flow (POBF) in eyes with asymmetric age-related macular degeneration (AMD) differs. Whereas eyes with drusen have higher POBF than contralateral eyes with disciform scarring, the POBF of eyes with drusen is lower relative to contralateral eyes with choroidal neovascularization (CNV). This study was designed to assess whether the POBF of eyes with CNV changes after transpupillary thermotherapy (TTT), using the contralateral eyes with drusen or scarring without TTT as controls. METHODS: In total, 26 patients with CNV in one eye and drusen or scarring in the other were enrolled in this prospective case series. Eyes with CNV were treated with TTT. POBF was measured monthly in both eyes of each subject. RESULTS: Before TTT, the POBF of eyes with CNV was 1179+/-317 microl/min. After TTT, the POBF of CNV eyes had decreased at 1 month (1015+/-273 microl/min, P=0.002) and 2 months (945+/-398 microl/min, P=0.011) of follow-up, but had rebounded at 3 months (P=0.441) and 6 months (P=0.084). CONCLUSIONS: These findings suggest that TTT decreases the pulsatile choroidal blood flow in eyes with CNV in patients with asymmetric AMD and the effects persist for 2 months. POBF may be used as a modality to monitor the therapeutic effects of CNV in asymmetric exudative AMD.

Aged↗

Effect of latanoprost 0.005% and brimonidine tartrate 0.2% on pulsatile ocular blood flow in normal tension glaucoma.

AIM: To determine the effect of brimonidine tartrate 0.2% and latanoprost 0.005% on pulsatile ocular blood flow (POBF) in patients with normal tension glaucoma (NTG). METHOD: NTG patients with progressive optic neuropathy, new disc haemorrhage, or field defects that threatened fixation were enrolled into a randomised, investigator masked, crossover study. Group I patients received 4 weeks each of latanoprost, lubricant, and brimonidine, while group II patients received 4 weeks each of brimonidine, lubricant, and latanoprost. Diurnal POBF was measured at baseline and after each 4 week treatment. RESULTS: 25 patients completed the study and had reliable POBF measurement at each visit. There was no significant diurnal change in baseline POBF (p = 0.768). Latanoprost increased POBF by 213 (SD 257) micro l/min (22.8%, p <0.001) while brimonidine increased it by 97 (183) micro l/min (10.4%, p = 0.014). POBF increased at 8 am (p = 0.004), 12 noon (p = 0.002), and 4 pm (p <0.001) with latanoprost, while it increased only at 8 am (p = 0.016) with brimonidine. After adjusting for the factor of IOP, neither latanoprost nor brimonidine increased POBF significantly. CONCLUSIONS: Latanoprost increases the mean POBF that is related to its IOP lowering effect. The increase in POBF noted after brimonidine is within the range of long term variation and may not be attributable to the drug effect.

Adult↗

Flow-mediated regulation of endothelin receptors in cocultured vascular smooth muscle cells: an endothelium-dependent effect.

The objective of this study was to determine the effect of pulsatile flow on endothelin (ET) receptor expression in vascular smooth muscle cells (VSMC) cocultured with endothelial cells (EC). Using a perfused transcapillary coculture system which permits the chronic exposure of cultured EC and VSMC to physiological shear stresses, cocultures were exposed to stepwise increases in flow up to (1) 2 ml/min (low flow: 0.5 dyn/cm2) or (2) 44 ml/min (high flow: 15 dyn/cm2) and maintained for 72 h before SMC and EC were harvested separately. There was a significant increase in [125I]-ET-1 binding in cocultured VSMC exposed to high flow as compared to low flow (Bmax: 75 +/- 22 vs. 152 +/- 10 fmol [125I]ET-1 bound/mg protein) in the absence of any change in the affinity (KD) of ET-1 for its receptor. ET-1 peptide mRNA levels were significantly decreased in EC exposed to high flow. The increase in [125I]ET-1 binding was associated with an increase in ET-A and ET-B receptor mRNA levels and was EC dependent as [125I]ET-1 binding in monocultured VSMC was the same, regardless of flow conditions. However, the amount of [125I]ET-1 binding on VSMC cultured in the absence of EC was significantly greater than that on cocultured VSMC. High flow caused a significant increase in endothelial nitric oxide synthase (NOS) activity in EC and prostacyclin levels in the perfusing medium. Flow-mediated upregulation of ET receptors was diminished by treatment with NG-nitro-L-arginine-methyl ester, a NOS inhibitor, whereas indomethacin, a cyclooxygenase inhibitor, had no significant effect. Collectively, these data suggest that flow-induced changes in ET receptor expression in VSMC are endothelium dependent and are in part mediated by nitric oxide. Modulation of ET receptor expression by EC may thus represent an important mechanism whereby hemodynamic forces regulate vessel wall function.

6-Ketoprostaglandin F1 alpha↗

Fast measurement of intracardiac pressure differences with 2D breath-hold phase-contrast MRI.

Intracardiovascular blood pressure differences can be derived from velocity images acquired with phase-contrast (PC) MRI by evaluating the Navier-Stokes equations. Pressure differences within a slice of interest can be calculated using only the in-plane velocity components from that slice. This rapid exam is proposed as an alternative to the lengthy 3D velocity imaging exams. Despite their good spatial coverage, the 3D exams are prone to artifacts and errors from respiratory motion and insufficient temporal resolution, and are unattractive in the clinical setting due to their excessive scan times (>10 min of free breathing). The proposed single-slice approach requires only one or two breath-holds of acquisition time, and the velocity data can be processed for the calculation of pressure differences online with immediate feedback. The impact of reducing the pressure difference calculation to two dimensions is quantified by comparison with 3D data sets for the case of blood flow within the cardiac chambers. The calculated pressure differences are validated using high-fidelity pressure transducers both in a pulsatile flow phantom and in vivo in a dog model. There was excellent agreement between the transducer and PC-MRI results in all of the studies.

Animals↗

Velocity distributions in glottal models.

Velocity distributions within three models of the human larynx, namely, a rigid plexiglas model, an excised canine larynx, and a computational model are investigated with experimental and theoretical analyses. A plexiglas wind tunnel with interchangeable glottal constrictions was used as a two-dimensional steady-flow model to measure velocity and pressure for various glottal shapes. A canine excised larynx was used as a prototype pulsatile flow model to study pressure and velocity variations during phonation. Results of the plexiglas modelling indicated a parabolic laminar velocity profiles upstream of the glottal constriction and turbulent and asymmetric velocity profile downstream of the glottal constriction. The time-averaged velocities of the excised larynx had similarities with the plexiglas model results, and instabilities and asymmetries were also demonstrated by the computational method.

Animals↗

Evaluation of a turbine flow meter (Ventilometer Mark 2) in the measurement of ventilation.

We have evaluated a turbine flow meter (Ventilometer Mark 2, PK Morgan, Kent, UK) at low flow rates and levels of ventilation which are likely to be encountered during exercise in patients with chronic respiratory disease. Pulsatile flows were generated from a volume-cycled mechanical ventilator, the flow wave-form was modified by damping to simulate a human breathing pattern. Comparative measurements of ventilation were made whilst varying tidal volume (VT) from 0.22 to 1.131 and respiratory rate (fR) from 10 to 35 min-1. At lower levels of ventilation the instrument tended to underread especially with increasing fR. The calibration factor must be adjusted to match the level of ventilation if the measurement errors are to be within 5%.

Calibration↗

Flow disturbances at the apex and lateral angles of a variety of bifurcation models and their role in development and manifestations of arterial disease.

Dye flow patterns were studied in 12 glass model bifurcations with angles of 45, 90, 135, and 180 degrees, and area ratios of 0.78, 1.03 and 1.27. At the apex, the dye formed a saddle zone, and streamlines from the core which entered this region were swept over the upper and lower surfaces to enter the lateral angles. Qualitatively, the shape and size of the apex played a key role in this effect. Boundary layer separation occurred in the lateral angles, and increased as flow into the branch was reduced. If the branch was occluded, a complex vortex developed in the first few diameters of the branch, and no flow occurred beyond this, even though the occlusion was about 20 diameters downstream. The results were comparable with steady and pulsatile flow. The implications of these results for the localization of atherosclerosis are discussed.

Arterial Occlusive Diseases↗

The dependency of expiratory airway collapse on pump system and flow rate in liquid ventilated rabbits.

PURPOSE: To evaluate the influence of pump system and flow pattern on expiratory airway collapse (EAC) in total perfluorocarbon ventilation. - METHODS: Prospective, controlled, randomized animal trial for determination of (1) post-mortem changes by repeated expiration procedures (EP) with a constant flow piston pump (PP) before and after sacrifice (n = 8 rabbits), (2) differences between pump systems by subjecting animals to both PP and roller pump (RP) circuits for expiration (n = 16 rabbits). EP were performed using a servo-controlled shut-off at airway pressures < 25 cm H subset 2O randomly with either pump at different flows. - RESULTS: Expired volumes before and after sacrifice were not significantly different. PP and RP revealed identical mean flows, while significantly more liquid was drained using PP (p<0.05). Increasing differences towards higher flow rates indicated profound flow pulsatility in RP. - CONCLUSIONS: (1) post-mortem changes in expired volumes are not significant, (2) EAC is related to flow rate and pump system; (3) relationship between expiratory flow rate and drainable liquid volume is linear inverse; (4) PP provides higher drainage than RP. - SUMMARY STATEMENT: Expiratory airway collapse is related to flow rate and pump system, post mortem changes in expirable volumes are not significant. Relationship between expiratory flow rate and drainable liquid volume is linear inverse, piston pump expiration provides higher drainage volumes than roller pump expiration.

Animals↗

Development of an in-vitro circulatory system with known resistance and capacitance.

An in-vitro (hydrodynamic) model of the circulatory system was developed. The model consisted of a pump, compliant tubing, and valves for resistance. The model is used to simulate aortic pressure and flow. These parameters were measured using a Konigsburg Pressure transducer and a Triton ART2 flow probe. In addition, venous pressure and flow were measured on the downstream side of the resistance. The system has a known compliance and resistance. Steady and pulsatile flow tests were conducted to determine the resistance of the model. A static compliance test was used to determine the compliance of the system. The aortic pressure and flow obtained from the hydrodynamic model will be used to test the accuracy of parameter estimation models such as the 2-element and 4-element Windkessel models and the 3-element Westkessel model. Verifying analytical models used in determining total peripheral resistance (TPR) and systemic arterial compliance (SAC) is important because it provides insight into hemodynamic parameters that indicate baroreceptor responsiveness to situations such as changes in gravitational acceleration.

Animals↗

A proposed model of cerebrospinal fluid circulation: observations with radionuclide cisternography.

PURPOSE: To determine the mechanisms of the tracer distribution at radionuclide cisternography (RC). METHODS: Ten patients with venous vasculitis were studied with RC. Flow phantom studies were performed mimicking cerebrospinal fluid (CSF) circulation with and without a main outlet comparable to the pacchionian granulations. RESULTS: Nine of the 10 patients had normal findings on RC images, including a maximum uptake over the vertex at 24 hours. In all patients, a second maximum occurred in the lumbosacral area. The flow phantom studies showed no tracer accumulation at an open outlet corresponding to the pacchionian granulations. On the contrary, a maximum arose without such an outlet. A maximum always arose at the closed dead ends of the phantom, including the lumbosacral area. CONCLUSION: The commonly accepted flow model for CSF circulation needs to be revised. The pattern of the normal RC cannot be explained by a bulk flow transport of the tracer to an outlet at the pacchionian granulations but rather by a primary mixing caused by pulsatile flow with a secondary dilution by newly formed CSF from the ventricular system. We suggest that the main absorption of the CSF is through the central nervous system to the blood.

Adult↗

Effect of oscillatory flow on the performance of a novel cross-flow affinity membrane device.

This paper presents the results of an investigation into the effect of oscillatory flow in a membrane-based affinity contactor. This device was designed to accommodate a tubular affinity membrane, and the flow direction of working fluid was tangential to the surface of the membrane. Cibacron Blue F3G-A was utilized as the capturing ligand and bovine serum albumin as the target molecule. The dye molecules were immobilized covalently via spacer molecules (polyethylenimine) onto the pores of a microfiltration membrane with a pore size rating of 0.45 micron. Bovine serum albumin was pumped through the annular space between the concentric screw-threaded insert and the tubular membrane in oscillatory flow with a mean flow component. The effects of pulsation frequency and stroke length were investigated. It was found that, as a result of the pulsatile flow, the protein recovery was increased by a factor of 2. To make the interpretation of the results easier, various dimensionless groups were defined specifically for this system and the experimental data were reported in terms of these groups.

Ligands↗

A physiologic in vitro model of the inferior vena cava with a computer-controlled flow system for testing of inferior vena cava filters.

RATIONALE AND OBJECTIVES: The authors develop a physiologic in vitro model of the inferior vena cava (IVC) for testing of filters. METHODS: The model is driven by a centrifugal pump. A computer-controlled electromagnetic valve is used for generation of different flow patterns. Limitation of the pressure increase in case of IVC occlusion is achieved by a bypass circuit. A glycerin solution is used for perfusion. Artificial clots are made from polyacrylamide gel. Data acquisition includes continuous monitoring of flow and difference pressure over the filter and video recording of the testing events. RESULTS: The model can generate constant and pulsatile flows. The pressure increase can be limited to 70 mm Hg in case of occlusion. Calculation of the flow velocities in the IVC is possible. A classification of thrombus capturing is presented. The testing of most of the results are reproducible. CONCLUSIONS: The in vitro model simulates the physiologic conditions in the IVC. It can be used for comparative testing of different filters and the evaluation of new filter designs.

Blood Flow Velocity↗

Reverse flow as an option in microvascular recipient anastomoses.

This study was designed to investigate the retrograde arterial pressures in the distal ends of the superior thyroid (n = 20) and facial arteries (n = 8). These pressures were compared with mean systemic arterial pressure (n = 20) as well as retrograde pressure in the radial artery (n = 8). The mean retrograde arterial pressure in the radial artery was 50 to 60 percent of normal arterial pressure. Similar pressures were recorded from the distal ends of both the superior thyroid and facial arteries. Because we know that the radial artery can support a skin flap through retrograde or reverse flow (reverse radial forearm flap), it was concluded that both the superior thyroid and facial arteries could also support flaps based on reverse flow. This has proved to be the case clinically. In circumstances where pedicle geometry favors it and in the presence of pulsatile flow from the distal ends of either of these arteries, a retrograde anastomosis is now the practice of the authors in selected cases.

Aged↗