Effect of trabeculectomy on pulsatile ocular blood flow.
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Shear force and its effect on cell structure and function.
Cell culture studies of the influence of a laminar flow and the associated wall shear stress on bovine aortic endothelial cells are reviewed. These experiments, taken together with those of others, demonstrate that in response to a steady state flow the cells elongate in shape, orient their major axis with the direction of flow, and reorganize their F-actin structure, with a concomitant increase in cell stiffness. There also is an influence of flow on cell function, including the ability to replicate, to secrete vasoactive substances, and on such processes as endocytosis. Such effects of flow are dependent on the level of shear stress, the duration of exposure, the surface to which the cells are adherent, and the media employed. Furthermore, the use of a 1 Hz sinusoidal, non-reversing pulsatile flow was found to, in general, enhance the effects observed for a steady state flow. Although these studies were motivated by an interest in investigating the role of flow in the initiation and progression of atherosclerosis, the results obtained provide evidence that relatively small physical forces can have an important influence. This suggests it is possible that the unloading represented by placing cells in the microgravity environment of space may be an observable influence. More importantly, it also indicates that cell biology experiments on orbit need to be conducted under conditions where the influence of other forces, e.g., those due to a flowing cell culture system, are negligible.
Animals↗
Hemodynamic changes in recurrent intracranial terminal aneurysm after endovascular treatment.
RATIONALE AND OBJECTIVES: Multiple cases of recurrence of aneurysms after endovascular treatment have been reported. The purpose of the current hemodynamic study was to identify changes in shear stress and pressure associated with the recurrence of terminal intracranial aneurysms after endovascular occlusion. METHODS: Using a finite element method, a pulsed flow with a non-Newtonian viscosity of blood was simulated within the aneurysm cavity. A recurrent terminal intracranial aneurysm of a patient originally treated with balloon occlusion was then studied. This was based on a physiologic pulsatile flow, which was observed in the middle cerebral artery. Before and after the balloon occlusion, local maximum wall shear stress and pressure drop at the neck of the aneurysm were calculated and compared with the normal shear stress. RESULTS: Although the maximum shear stress at the right neck of the aneurysm was significantly reduced after balloon insertion, it was still 2.5 times greater than the normal maximum shear stress. This was attributable to the presence of a portion of the aneurysmal neck (residual neck), which was not obliterated by the balloon. The balloon also helped to reduce the maximum pressure inside the aneurysm by approximately 15%. Hemodynamic changes in the residual aneurysm neck, where the shear stress and the pressure are high, and other factors may be responsible for the recurrence of aneurysms after balloon or coil occlusion. CONCLUSION: Residual necks after balloon occlusion, coil occlusion, or both are attributable to the geometric orientation of the aneurysm with respect to parent and daughter vessels and the variety of configurations of the balloon and coils used to occlude the aneurysms. Inadequate reduction in local shear stress found in these residual necks is an important factor in the recurrence and rupture of the aneurysm after endovascular occlusion.
Blood Flow Velocity↗
Sniffing by a silkworm moth: wing fanning enhances air penetration through and pheromone interception by antennae.
Many organisms increase the air or water flow adjacent to olfactory surfaces when exposed to appropriate chemical stimuli; such 'sniffing' samples fluid from a specific region and can increase the rate of interception of odorant molecules. We used hot-wire anemometry, high-speed videography and flow visualization to study air flow near the feathery olfactory antennae of male silkworm moths (Bombyx mori L.). When exposed to conspecific female sex pheromone, male B. mori flap their wings through a stroke angle of 90-110 degrees at approximately 40 Hz without flying. This behavior generates an unsteady flow of air (mean speed 0.3-0.4 m s(-1)) towards the antennae from the front of the male. A pulse of peak air speed occurs at each wing upstroke. The Womersley number (characterizing the damping of pulsatile flow through the gaps between the sensory hairs on the antennae) is less than 1; hence, pulses of faster air (at 40 Hz) should move between sensory hairs. Calculation of flow through arrays of cylinders suggest that this wing fanning can increase the rate of interception of pheromone by the sensory hairs on the antennae by at least an order of magnitude beyond that in still air. Although wing fanning produces air flow relative to the antennae that is approximately 15 times faster than that generated by walking at top speed (0.023 m s(-1)), air flow through the gaps between the sensory hairs is approximately 560 times faster because a dramatic increase in the leakiness of the feathery antennae to air flow occurs at the air velocities produced by fanning.
Air↗
The importance of pulsatile and nonpulsatile flow in the design of blood pumps.
The traditional approach of total artificial heart (TAH) and ventricular assist device (VAD) development has been the mimicking of the native heart. Nonpulsatile flow using cardiopulmonary bypass has provided evidence of short-term physiologic tolerances. The design of nonpulsatile TAHs and VADs has eliminated the need for valves, flexing diaphragms, and large ventricular volumes. However, these devices require high efficiency power sources and reliable bearing seals or electromagnetic bearings while simultaneously attempting to avoid thromboemboli. The physiologic response to nonpulsatile flow is complex and variable. When compared to a pulsatile device, a nonpulsatile TAH or VAD needs to produce increased flow and higher mean intravascular pressures to maintain normal organ function. Despite its maintaining normal organ function, nonpulsatile flow does cause alterations in biochemical functions and organ specific blood flow. The combination of bioengineering superiority and the maintenance of physiologic homeostasis has directed future TAH and VAD research towards nonpulsatile systems.
Cardiopulmonary Bypass↗
A new theoretical model for noninvasive quantification of mitral regurgitation.
The most common objective assessments of mitral regurgitation are limited by their invasive or semiquantitative nature. Recent attempts at correlation with jet size from Doppler flow maps have failed to produce a direct measure of regurgitant volume and are fundamentally limited by the dependence of jet dimensions on factors other than flow volume. The purpose of this paper was to develop an equation, based on the physics of turbulent regurgitant jets, for calculating regurgitant volume from quantities that can be measured by Doppler ultrasound. The result is an equation forw flow rate Q as a function of orifice velocity Uo, a downstream centerline velocity Um and the intervening distance chi: Q = pi U2m chi 2/160Uo. This equation can also be modified to obtain total regurgitant volume in clinical pulsatile flow. The assumptions made demand a free turbulent jet for which momentum is conserved, but should otherwise be physiologically applicable. The advantage of this technique compared to correlations with jet size are its theoretical justification and ability to quantify regurgitant volume directly.
Blood Flow Velocity↗
Endothelial cells inhibit flow-induced smooth muscle cell migration: role of plasminogen activator inhibitor-1.
BACKGROUND: The endothelium may play a pivotal role in hemodynamic force-induced vascular remodeling. We investigated the role of endothelial cell (EC) plasminogen activator inhibitor-1 (PAI-1) in modulating flow-induced smooth muscle cell (SMC) migration. METHODS AND RESULTS: Human SMCs cocultured with or without human ECs were exposed to static (0 mL/min) or flow (26 mL/min; shear stress 23 dyne/cm(2)) conditions for 24 hours in a perfused capillary culture system. SMC migration was then assessed with a Transwell migration assay. In the absence but not in the presence of ECs, pulsatile flow significantly increased the migration of SMCs (264+/-26%) compared with SMCs under static conditions, concomitant with a 3- and 4-fold increase in PAI-1 mRNA and protein, respectively, in cocultured ECs. In the presence of PAI-1-/- ECs, flow increased wild-type SMC migration (226+/-25%), an effect that was reversed by exogenous PAI-1. To determine whether the antimigratory activity of PAI-1 was dependent primarily on inhibition of PAs or its association with vitronectin, experiments were conducted with PAI-1R (a mutant PAI-1 that binds to vitronectin but does not inhibit PA) and PAI-1K (a mutant that inhibits PA but has reduced affinity for vitronectin). PAI-1R inhibited both basal and flow-induced migration, whereas PAI-1K inhibited flow-induced migration in the absence of any effect on baseline migration. CONCLUSIONS: Flow-induced EC PAI-1 inhibits flow-induced SMC migration in vitro. EC PAI-1 expression may be one of the predominant mechanisms responsible for controlling the process of vascular remodeling.
Animals↗
Wound irrigation in musculoskeletal injury.
Wound irrigation to remove debris and lessen bacterial contamination is an essential component of open fracture care. However, considerable practice variation exists in the details of technique. Volume is an important factor; increased volume improves wound cleansing to a point, but the optimal volume is unknown. High-pressure flow has been shown to remove more bacteria and debris and to lower the rate of wound infection compared with low-pressure irrigation, although recent in vitro and animal studies suggest that it may also damage bone. Pulsatile flow has not been demonstrated to increase efficacy. Antiseptic additives can kill bacteria in the wound, but host-tissue toxicities limit their use. Animal and clinical studies of the use of antiseptics in contaminated wounds have yielded conflicting outcomes. Antibiotic irrigation has been effective in experimental studies in some types of animal wounds, but human clinical data are unconvincing due to poor study design. There are few animal or clinical studies of musculoskeletal wounds. Detergent irrigation aims to remove, rather than kill, bacteria and has shown promise in animal models of the complex contaminated musculoskeletal wound.
Animals↗
Investigation of transverse oscillation method.
Conventional ultrasound scanners can display only the axial component of the blood velocity vector, which is a significant limitation when vessels nearly parallel to the skin surface are scanned. The transverse oscillation (TO) method overcomes this limitation by introducing a TO and an axial oscillation in the pulse echo field. The theory behind the creation of the double oscillation pulse echo field is explained as well as the theory behind the estimation of the vector velocity. A parameter study of the method is performed, using the ultrasound simulation program Field II. A virtual linear-array transducer with center frequency 7 MHz and 128 active elements is created, and a virtual blood vessel of radius 6.4 mm is simulated. The performance of the TO method is found around an initial point in the parameter space. The parameters varied are: flow angle, transmit focus depth, receive apodization, pulse length, transverse wave length, number of emissions, signal-to-noise ratio (SNR), and type of echo-canceling filter used. Using an experimental scanner, the performance of the TO method is evaluated. An experimental flowrig is used to create laminar parabolic flow in a blood mimicking fluid, and the fluid is scanned under different flow-to-beam angles. The relative standard deviation on the transverse velocity estimate is found to be less than 10% for all angles between 50 degrees and 90 degrees. Furthermore, the TO method is evaluated in the flowrig using pulsatile flow, which resembles the flow in the femoral artery. The estimated volume flow as a function of time is compared to the volume flow derived from a conventional axial method at a flow-to-beam angle of 60 degrees. It is found that the method is highly sensitive to the angle between the flow and the beam direction. Also, the choice of echo canceling filter affects the performance significantly.
Algorithms↗
Hemodynamics of high-performance bileaflet valves: comparison to simulated clinical Doppler measurements.
BACKGROUND AND AIM OF THE STUDY: The newly designed, so-called 'high performance' bileaflet heart valve prostheses are suggested to be especially beneficial in small sizes. Herein, valvular energy loss and transvalvular gradients were evaluated using an in-vitro pulsatile flow model for aortic prostheses (St. Jude Medical Regent and On-X, sizes 19-23 mm). Gradients were compared with simulated clinically derived Doppler gradients to determine the extent of pressure recovery. METHODS: Valves were analyzed using a pulsatile circulatory mock loop simulator at heart rates of 70 and 110 bpm, and at cardiac outputs of 2, 4, 5, and 7 l/min, respectively (FDA requirements). Measurements consisted of computed calculation of energy loss and determination of mean pressure gradient by pressure transducers. A Doppler probe was mounted into the device for simultaneous measurement of Doppler gradient according to the Bernoulli equation. RESULTS: The systolic energy loss of the SJM Regent valve averaged 5.0 +/- 4.6% (range: 0.2 to 14.9%) of the effective forward energy, while that for the On-X valve was 6.5% (range: 0.7-22.8%). Total energy loss was 9.9% (range: 4.8-22.1%) for the SJM Regent valve, and 12.7% (range: 6.5-27.7%) for the On-X valve. The average extent of pressure recovery was 64% for both valve types. CONCLUSION: All tested valves were characterized by excellent hemodynamic performance, with overall low systolic and total energy losses, but results were slightly favorable for the SJM Regent valve. Valve performance was concluded to be much better than expected by clinical routine Doppler measurements, which significantly overestimates transvalvular gradients; this effect was explained by pressure recovery. Nevertheless, Doppler gradient remains a valuable follow up technique for patients with heart valve prostheses.
Biomechanical Phenomena↗
ATP-content in muscular interstitial fluid during pulsatile and non-pulsatile cardiopulmonary bypass in pigs.
The potential benefit of pulsatile flow during cardiopulmonary bypass (CPB) has been discussed extensively, but the debate is still unsettled. Release of intracellular ATP is a useful indicator of cellular damage; we have measured the ATP content in perfusates from muscles in pigs undergoing pulsatile or non-pulsatile CPB for 100 min at 37 degrees C. In 5 pigs the Polystan Pulsatile Pump was used and in 5 pigs a conventional roller pump. 11 pigs served as controls; 6 received heparin like the animals subjected to CPB, whereas the remaining 5 animals were not heparinized. ATP was measured by the firefly luminescence technique. At the start of the CPB or control period the ATP content was very low in all 4 groups. In the non-heparinized controls ATP continued to decrease, whereas in the other 3 groups ATP increased linearly during the 100 min of CPB or control period. It is concluded that, by this method, there was no significant difference between pulsatile and non-pulsatile CPB regarding damage to vascular endothelial or smooth muscle cells. However, heparinization per se caused a marked leakage of blood cells into the extravascular space even after the initial leakage from the cannulation had disappeared. This leakage was enhanced by non-pulsatile but not by pulsatile CPB.
Adenosine Triphosphate↗
Left ventricular oxygen consumption and organ blood flow distribution during pulsatile ventricular assist.
One goal of left ventricular assistance is the reduction of left ventricular myocardial oxygen consumption while delivering adequate organ blood flow. The effect of assist device operation control mode and uptake cannulation method on the achievement of this goal was studied in six acutely prepared calves with healthy hearts. All combinations of left ventricular assistance significantly reduced the myocardial oxygen consumption; the reduction was independent of control mode. During ventricular assistance, regional organ blood flow distribution and myocardial endocardial/epicardial blood flow ratio were not different from values during the control, unassisted condition. Regardless of the left ventricular assist device uptake method or operational control mode, significant reduction in myocardial oxygen consumption was achieved while maintaining organ blood flow distribution.
Animals↗
Hydrodynamic simulation of arterial networks which include compliant and rigid bypass grafts.
The conditions required to produce an ideal bypass graft have not yet been determined. In order to understand the hemodynamic impact of bypass grafts on cardiovascular function, a hydrodynamic model for the part of the human arterial network below the renal arteries has been constructed. The results from this physical model were used to validate a digital computer model of the arterial network developed by the authors, that incorporated loops which occur due to bypass grafts. The hydrodynamic model was designed to study the interaction between an arterial stenosis and bypass graft and, in particular, the effect of the compliance of the graft on their function. In the model, similarity laws have been maintained with regard to geometry, viscosity, peripheral resistance, wall elastic properties, pulse shape, and blood flow rate. Measured and predicted pressure and flow wave-forms showed an increase in their mean and peak values for the healthy leg when the bypass graft was closed. There was also a severe pressure drop across the stenosis and a marked decrease in mean and pulsatile flow in the stenotic leg. The stenosis in the hydrodynamic model produced similar behaviour to published results obtained on animals. When the graft was open, the agreement between our experimental and theoretical model was within 5% and both the pressure and flow waves were almost similar at the maxima and minima in both legs. Although the arterial system is non-linear, the non-linearities are shown to be of insignificant magnitude and therefore, we have concluded that the pressure flow relationship is essentially linear. The effect of the degree of compliance of the graft and the 'steal' phenomenon due to the graft have been investigated. It was found that there were no significant differences in the flow delivery between the compliant graft and stiff graft. Also, there was no 'steal'. Thus the compliance of the graft is not a significant factor in promoting its patency.
Arteries↗
Abdominal aortic hemodynamics in young healthy adults at rest and during lower limb exercise: quantification using image-based computer modeling.
Localization of atherosclerotic lesions in the abdominal aorta has been previously correlated to areas of adverse hemodynamic conditions, such as flow recirculation, low mean wall shear stress, and high temporal oscillations in shear. Along with its many systemic benefits, exercise is also proposed to have local benefits in the vasculature via the alteration of these regional flow patterns. In this work, subject-specific models of the human abdominal aorta were constructed from magnetic resonance angiograms of five young, healthy subjects, and computer simulations were performed under resting and exercise (50% increase in resting heart rate) pulsatile flow conditions. Velocity fields and spatial variations in mean wall shear stress (WSS) and oscillatory shear index (OSI) are presented. When averaged over all subjects, WSS increased from 4.8 +/- 0.6 to 31.6 +/- 5.7 dyn/cm2 and OSI decreased from 0.22 +/- 0.03 to 0.03 +/- 0.02 in the infrarenal aorta between rest and exercise. WSS significantly increased, whereas OSI decreased between rest and exercise at the supraceliac, infrarenal, and suprabifurcation levels, and significant differences in WSS were found between anterior and posterior sections. These results support the hypothesis that exercise provides localized benefits to the cardiovascular system through acute mechanical stimuli that trigger longer-term biological processes leading to protection against the development or progression of atherosclerosis.
Adult↗
[Doppler echocardiography determination of the orifice area in aortic valve stenosis using a continuity equation].
The continuity equation, derived from the study of fluid mechanics, may serve as the basis for calculation of orifice area of stenosed cardiac valves. As applied to aortic stenosis, the continuity equation states that the flow across the narrowed valve is equal to the flow in the left ventricular (LV) outflow tract such that A1 X v1 = A2 X v2, where A1 = LV outflow tract area, v1 = prestenotic velocity, A2 = stenotic orifice area and v2 = poststenotic velocity. Accordingly, at each point in time during pulsatile flow, the respective valve orifice area can be calculated. Hence, from the sum of all areas throughout the ejection time, the mean valve orifice area can be constructed as integral of A2/ET = A1 X integral of (v1/v2)/ET, assuming A1 to be constant, where integral of denotes the integral over the ejection time ET. To assess the usefulness of this method with respect to its clinical relevance, in 36 patients with aortic stenosis, the Doppler echocardiographically-determined orifice areas were compared with those calculated by the Gorlin formula based on invasively-obtained data. LV outflow tract area A1 was measured by echocardiography from a parasternal long-axis view. Prestenotic velocity v1 was recorded in the LV outflow tract by pulsed Doppler from an apical transducer position, whereby care was taken in positioning the sample volume not too close to the stenotic valve to avoid the prestenotic area of increased velocity. Continuous-wave Doppler was used, usually from an apical or right parasternal transducer position, to record the stenotic jet velocity v2.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Pulsatile ocular blood flow in asymmetric age-related macular degeneration.
PURPOSE: Ocular perfusion abnormalities have been proposed in the pathogenesis of age-related macular degeneration (AMD) with differences in pulsatile ocular blood flow (POBF) in eyes with asymmetric AMD in Japanese and Taiwanese patients. The purpose of our study was to observe POBF difference in the fellow eyes of Caucasians with asymmetric AMD. METHODS: This was a cross-sectional study comparing POBF in three groups of patients with asymmetric AMD in the fellow eyes: Group 1 (n=21) with drusen and active choroidal neovascularisation (CNV); Group 2 (n=18) with drusen and disciform scar; Group 3 (n=8) with CNV and disciform scar. The POBF was adjusted for intraocular pressure (IOP), pulse rate (PR), and axial length using multiple regression analysis. Generalised estimation equation model was used to include both eyes in each group. RESULTS: The geometric mean (95% confidence interval) POBF values were as follows: Group 1 with drusen 1097.9 microl/min (957.0, 1259.7) in one eye and the fellow eye with CNV 1090.1 microl/min (932.3, 1274.7); Group 2 with drusen 946.0 microl/min (794.2, 1126.7) and disciform scar 966.2 microll/min (780.3, 1196.4); Group 3 with CNV 877.1 microl/min (628.3, 1224.6) and disciform scar 767.2 microl/min (530.5, 1109.7). Adjusting for differences in axial length, pulse rate and intraocular pressure, no statistically significant difference in POBF was found between fellow eyes in the same subject. CONCLUSIONS: POBF is not different between fellow eyes of Caucasian patients with asymmetric AMD.
Aged, 80 and over↗
A new method for flow velocity measurement: frequency encoded NMR.
We demonstrate a new rapid NMR method to measure the average velocity and the velocity distribution of a flowing fluid. We use a truncated Carr-Purcel-Meiboom-Gill pulse sequence, pi/2-T-pi-2T-pi-T-echo, in the presence of a static magnetic field gradient. The pi/2 pulse is selective and tags a narrow slice of nuclei. The second echo from the tagged nuclei is Fourier transformed after the nuclei have evolved for a time 4T to give the velocity distribution modified by the initial slice selection profile. In this way, average velocities up to 54 cm/s were measured for water flowing in a plastic tube with either a plug or a developed velocity distribution. Each measurement required about 20 ms but this could be reduced with larger field gradients. Thus, this method is fast enough to apply to such problems as measuring pulsatile flow in arteries.
Animals↗
Direct computation of multiple 3D flow convergence isovelocity surfaces from digital 3D reconstruction of colour Doppler data of the flow convergence region: an in vitro study with differently shaped orifices.
AIMS: Evaluation of the accuracy of direct computation of multiple three-dimensional (3D) flow convergence (FC) isovelocities by using digital reconstruction of colour Doppler data of the flow convergence region. METHODS AND RESULTS: We used a conventional ultrasound system (ATL HDI 3000) connected to a computer workstation via Ethernet link. The digital 3D datasets were directly transferred to a Silicon Graphic Imaging Octane workstation for later measurement. We generated nine pulsatile flows (20-60 ml/beat), with peak flow rates (67-180 ml/s), through three orifices (circular, rectangular and triangular, S=0.24 cm(2)). The 3D reconstructions of FC surface areas from multi-threshold velocities, including aliasing velocities were analysed to quantify the peak flow rate. For all orifices, linear regression demonstrated excellent correlation between the 3D calculated and electromagnetic flow meter recorded data. While there was a high correlation for 3D computation of flow rate from the single best Nyquist of 24 cm/s (r=0.97-0.98, SEE=7 .75-12.58 ml/s), the ability to average three threshold velocities (15, 18 and 24 cm/s) yielded an improved correlation (r=0.98-0.99, SEE=5.70-7.73 ml/s). CONCLUSIONS: Direct computation of multiple 3D FC isovelocities from digital reconstruction of colour Doppler data of the FC region provides the potential to accurately quantify the complex asymmetric spatial flow events at any selected velocity.
Blood Flow Velocity↗