Showing papers on "Pulsatile flow published in 2006"

Biofluid mechanics : the human circulation

Abstract: FLUID AND SOLID MECHANICS AND CARDIOVASCULAR PHYSIOLOGY Fundamentals of Fluid Mechanics Introduction Intrinsic Fluid Properties Hydrostatics Macroscopic Balances of Mass and Momentum Microscopic Balances of Mass and Momentum Bernoulli Equation Dimensional Analysis Fluid Mechanics in a Straight Tube Boundary Layer Separation Introduction to Solid Mechanics Introduction to Mechanics of Materials Analysis of Thin-Walled Cylindrical Tubes Analysis of Thick-Walled Cylindrical Tubes Viscoelasticity Cardiovascular Physiology Introduction Heart Cardiac Valves Systemic Circulation Coronary Circulation Pulmonary Circulation and Gas Exchange in the Lungs Cerebral and Renal Circulations Microcirculation Regulation of the Circulation Atherosclerosis BIOMECHANICS OF THE HUMAN CIRCULATION Rheology of Blood and Vascular Mechanics Rheology of Blood Vascular Mechanics Summary Static and Steady Flow Models Introduction Hydrostatics in the Circulation Applications of the Bernoulli Equation Rigid Tube Flow Models Estimation of Entrance Length and Its Effect on Flow Development in Arteries Flow in Collapsible Vessels Summary Unsteady Flow and Nonuniform Geometric Models Introduction Windkessel Models for the Human Circulation Continuum Models for Pulsatile Flow Dynamics Hemodynamic Theories of Atherogenesis Wall Shear Stress and Its Effect on Endothelial Cells Flow through Curved Arteries and Bifurcations Flow through Arterial Stenoses and Aneurysms Summary Native Heart Valves Introduction Aortic and Pulmonary Valves Mitral and Tricuspid Valves CARDIOVASCULAR IMPLANTS, BIOMECHANICAL MEASUREMENTS, AND COMPUTATIONAL SIMULATIONS Prosthetic Heart Valve Dynamics Introduction Brief History of Heart Valve Prostheses Hemodynamic Assessment of Prosthetic Heart Valves In Vitro Studies of Coagulation Potential and Blood Damage Durability of Prosthetic Heart Valves Current Trends in Valve Design Conclusions Vascular Therapeutic Techniques Vascular Graft Implants Arteriovenous Fistulas Types of Vascular Graft Materials Used Clinical Experience with Vascular Grafts Biomechanics and Anastomotic IH Angioplasty, Stent, and Endoluminal Graft Implants Biomechanics of Stent Implants Fluid Dynamic Measurement Techniques Introduction Blood Pressure Measurement Blood Flow Measurement Impedance Measurement Flow Visualization Ultrasound Doppler Velocimetry Laser Doppler Velocimetry MRI and Velocity Mapping Techniques Computational Fluid Dynamic Analysis of the Human Circulation Introduction Computational Fluid Dynamic (CFD) Analysis Techniques Modeling Considerations for Biofluid Mechanical Simulations Fluid Dynamic Simulations in the Human Circulation Future Directions: Multiscale Modeling Summary CFD Simulation Assignments Index Problems and References appear at the end of each chapter.

Age-related changes in carotid artery flow and pressure pulses: possible implications for cerebral microvascular disease.

Abstract: Background and Purpose— We sought to establish the relation between the pulsatile components of pressure and flow waveforms in the carotid artery and their change with age. Methods— Distention (pressure) and axial flow velocity waveforms were recorded noninvasively and simultaneously from the common carotid artery of 56 healthy subjects aged 20 to 72 years. Results— There was a close relation between the time intervals of pressure and flow waves: from foot to first shoulder or peak, to second shoulder or peak, and to incisura (r=0.97, P<0.0001 for each), which approximated the line of identity. The peak and nadir of flow velocity decreased with age, but late systolic flow augmentation increased substantially (1.6 times in the older group); this can be attributed to earlier wave reflection from the lower body. Pressure augmentation index (PAI) and flow augmentation index (FAI) increased similarly with age (PAI (%)=0.84×age−26.6; FAI (%)=0.75×age+11.9; both P<0.0001). Conclusions— Arterial stiffening with a...

An evaluation of the benefits of pulsatile versus nonpulsatile perfusion during cardiopulmonary bypass procedures in pediatric and adult cardiac patients.

Abstract: The controversy over the benefits of pulsatile and nonpulsatile flow during cardiopulmonary bypass procedures continues. The objective of this investigation was to review the literature in order to clarify the truths and dispel the myths regarding the mode of perfusion used during open-heart surgery in pediatric and adult patients. The Google and Medline databases were used to search all of the literature on pulsatile vs. nonpulsatile perfusion published between 1952 and 2006. We found 194 articles related to this topic in the literature. Based on our literature search, we determined that pulsatile flow significantly improved blood flow of the vital organs including brain, heart, liver, and pancreas; reduced the systemic inflammatory response syndrome; and decreased the incidence of postoperative deaths in pediatric and adult patients. We also found evidence that pulsatile flow significantly improved vital organ recovery in several types of animal models when compared with nonpulsatile perfusion. Several investigators have also shown that pulsatile flow generates more hemodynamic energy, which maintains better microcirculation compared with nonpulsatile flow. These results clearly suggest that pulsatile flow is superior to nonpulsatile flow during and after open-heart surgery in pediatric and adult patients.

Amplitude and phase of cerebrospinal fluid pulsations: Experimental studies and review of the literature

Abstract: Object A recently developed model of communicating hydrocephalus suggests that ventricular dilation may be related to the redistribution of pulsations in the cranium from the subarachnoid spaces (SASs) into the ventricles. Based on this model, the authors have developed a method for analyzing flow pulsatility in the brain by using the ratio of aqueductal to cervical subarachnoid stroke volume and the phase of cerebrospinal fluid (CSF) flow, which is obtained at multiple locations throughout the cranium, relative to the phase of arterial flow. Methods Flow data were collected in a group of 15 healthy volunteers by using a series of images acquired with cardiac-gated, phase-contrast magnetic resonance imaging. The stroke volume ratio was 5.1 ± 1.8% (mean ± standard deviation). The phase lag in the aqueduct was −52.5 ± 16.5° and the phase lag in the prepontine cistern was −22.1 ± 8.2°. The flow phase at the level of C-2 was +5.1 ± 10.5°, which was consistent with flow synchronous with the arterial pulse. The...

Stress analysis in a layered aortic arch model under pulsatile blood flow

Abstract: Background Many cardiovascular diseases, such as aortic dissection, frequently occur on the aortic arch and fluid-structure interactions play an important role in the cardiovascular system. Mechanical stress is crucial in the functioning of the cardiovascular system; therefore, stress analysis is a useful tool for understanding vascular pathophysiology. The present study is concerned with the stress distribution in a layered aortic arch model with interaction between pulsatile flow and the wall of the blood vessel.

The Frequency Dependent Response of the Vascular Endothelium to Pulsatile Shear Stress

Abstract: As a result of the complex blood flow patterns that occur in the arterial tree, certain regions of the vessel wall experience fluctuations in shear stress that are dominated by harmonic frequencies higher than the heart rate (11). To assess whether variations in frequency affect endothelial gene expression, the gene expression patterns of cultured porcine aortic endothelium exposed to three sinusoidal waveforms (1, 2, and 3 Hz; amplitude = 15 dyn/cm(2)) and one physiological waveform were compared with the expression profiles elicited by steady flow. At each frequency, including steady flow, three levels of mean shear stress (0, 7.5, and 15 dyn/cm(2)) were used. After 24 h shear exposure, RNA was extracted for microarray analysis against 10,665 Sus scrofa oligonucleotides. A two-way ANOVA identified 232 genes of which their transcription was differentially modulated by frequency, while mean shear significantly affected the expression of approximately 3,000 genes. One-way ANOVAs showed that the number of frequency-dependent genes increased as the mean shear stress was reduced. At 1 Hz, several inflammatory transcripts were repressed relative to steady flow, including VCAM and IL-8, whereas several atheroprotective transcripts were induced. The anti-inflammatory response at 1 Hz was reversed at 2 Hz. The proinflammatory response evoked by the higher frequency was most pronounced under reversing and oscillatory shear. This study suggests that arterial regions subject to both shear reversal and dominant frequencies that exceed the normal heart rate are at greater risk for atherosclerotic lesion development.

Blood flow dynamics in saccular aneurysm models of the basilar artery.

Abstract: Blood flow dynamics under physiologically realistic pulsatile conditions plays an important role in the growth, rupture, and surgical treatment of intracranial aneurysms. The temporal and spatial variations of wall pressure and wall shear stress in the aneurysm are hypothesized to be correlated with its continuous expansion and eventual rupture. In addition, the assessment of the velocity field in the aneurysm dome and neck is important for the correct placement of endovascular coils. This paper describes the flow dynamics in two representative models of a terminal aneurysm of the basilar artery under Newtonian and non-Newtonian fluid assumptions, and compares their hemodynamics with that of a healthy basilar artery. Virtual aneurysm models are investigated numerically, with geometric features defined by beta = 0 deg and beta = 23.2 deg, where beta is the tilt angle of the aneurysm dome with respect to the basilar artery. The intra-aneurysmal pulsatile flow shows complex ring vortex structures for beta = 0 deg and single recirculation regions for beta = 23.2 deg during both systole and diastole. The pressure and shear stress on the aneurysm wall exhibit large temporal and spatial variations for both models. When compared to a non-Newtonian fluid, the symmetric aneurysm model (beta = 0 deg) exhibits a more unstable Newtonian flow dynamics, although with a lower peak wall shear stress than the asymmetric model (beta = 23.2 deg). The non-Newtonian fluid assumption yields more stable flows than a Newtonian fluid, for the same inlet flow rate. Both fluid modeling assumptions, however, lead to asymmetric oscillatory flows inside the aneurysm dome.

Experimental fluid mechanics of pulsatile artificial blood pumps

Abstract: The fluid mechanics of artificial blood pumps has been studied since the early 1970s in an attempt to understand and mitigate hemolysis and thrombus formation by the device. Pulsatile pumps are characterized by inlet jets that set up a rotational “washing” pattern during filling. Strong regurgitant jets through the closed artificial heart valves have Reynolds stresses on the order of 10,000 dynes/cm 2 and are the most likely cause of red blood cell damage and platelet activation. Although the flow in the pump chamber appears benign, low wall shear stresses throughout the pump cycle can lead to thrombus formation at the wall of the smaller pumps (10–50 cc). The local fluid mechanics is critical. There is a need to rapidly measure or calculate the wall shear stress throughout the device so that the results may be easily incorporated into the design process.

Peripheral vascular reactivity in patients with pulsatile vs axial flow left ventricular assist device support.

Abstract: Background Left ventricular assist devices (LVADs) are either pulsatile or axial flow devices. The latter can be operated at a low-speed setting to allow pulsatility or at a high-speed setting to create continuous flow. The purpose of this study was to compare the effect of continuous flow and pulsatile flow on peripheral vascular reactivity. Methods Twenty consecutive patients were divided into two groups based on the type of LVAD they received. Ten patients had a pulsatile flow LVAD, and 10 had an axial flow LVAD. For the purpose of the study protocol, the axial flow devices were operated at a high speed to ensure continuous flow. The patients’ peripheral artery vasoreactivity was assessed with an ultrasound vascular transducer that measured flow-mediated dilation (FMD). Results The FMD of the patients supported with pulsatile flow (15.6 ± 5%) was higher than the FMD of the patients supported with temporary continuous flow (1.8 ± 3%). The difference was statistically significant (p Conclusions Pulsatile flow is associated with a better peripheral vascular reactivity than continuous flow. Patients supported by axial flow devices should be kept on the lowest speed setting to allow maximum pulsatility.

Pulsatile flow of Herschel–Bulkley fluid through stenosed arteries—A mathematical model

Abstract: In this paper, the pulsatile flow of blood through stenosed artery is studied. The effects of pulsatility, stenosis and non-Newtonian behavior of blood, assuming the blood to be represented by Herschel–Bulkley fluid, are simultaneously considered. A perturbation method is used to analyze the flow assuming the thickness of plug core region to be non-uniform changing with axial distance. An expression for the variation of plug core radius with time and axial distance is obtained. The variation of pressure gradient with steady flow rate is given. Also the variation of wall shear stress distribution as well as resistance to flow with axial distance for different values of time and for different values of yield stress is given and the results analyzed.

Computational fluid dynamics: hemodynamic changes in abdominal aortic aneurysm after stent-graft implantation.

Abstract: The aim of this study was to demonstrate quantitatively and qualitatively the hemodynamic changes in abdominal aortic aneurysms (AAA) after stent-graft placement based on multidetector CT angiography (MDCT-A) datasets using the possibilities of computational fluid dynamics (CFD). Eleven patients with AAA and one patient with left-side common iliac aneurysm undergoing MDCT-A before and after stent-graft implantation were included. Based on the CT datasets, three-dimensional grid-based models of AAA were built. The minimal size of tetrahedrons was determined for grid-independence simulation. The CFD program was validated by comparing the calculated flow with an experimentally generated flow in an identical, anatomically correct silicon model of an AAA. Based on the results, pulsatile flow was simulated. A laminar, incompressible flow-based inlet condition, zero traction-force outlet boundary, and a no-slip wall boundary condition was applied. The measured flow volume and visualized flow pattern, wall pressure, and wall shear stress before and after stent-graft implantation were compared. The experimentally and numerically generated streamlines are highly congruent. After stenting, the simulation shows a reduction of wall pressure and wall shear stress and a more equal flow through both external iliac arteries after stenting. The postimplantation flow pattern is characterized by a reduction of turbulences. New areas of high pressure and shear stress appear at the stent bifurcation and docking area. CFD is a versatile and noninvasive tool to demonstrate changes of flow rate and flow pattern caused by stent-graft implantation. The desired effect and possible complications of a stent-graft implantation can be visualized. CFD is a highly promising technique and improves our understanding of the local structural and fluid dynamic conditions for abdominal aortic stent placement.

Flow-dependent re-endothelialization of tissue-engineered heart valves.

Abstract: BACKGROUND AND AIM OF THE STUDY The generation of a functional, non-immunogenic, non-thrombogenic construct based on autologous cells seeded onto an acellular extracellular matrix is the major goal in heart valve tissue engineering. The study aim was to identify culturing conditions required to achieve a stable endothelial cell (EC) layer under physiological flow conditions, a prerequisite for the requested characteristics. METHODS Eleven detergent-decellularized ovine pulmonary valves (PVs) were statically reseeded in special bioreactors with ovine venous ECs (1.2x10(7) cells per valve). The dynamic culture was started with 0.1 l/min in eight bioreactors. In four bioreactors the initial flow rate was slow, and increased by 0.1 l/min twice each day until maximal flow was 0.5 l/min and pulsation rate (PR) was 20 beats/min; in four other bioreactors the flow was increased by 0.7 l/min/day and reached 2.0 l/min with a PR of 50 beats/min. The mean system pressure was maintained at 25 +/- 5 mmHg during the whole dynamic cultivation in both groups. Three statically reseeded valves served as baseline. After achieving maximal appointed flow, the valves were investigated morphologically (hematoxylin and eosin staining, electron microscopy, von Willebrand factor, endothelial nitric oxide synthase immunostaining) and for metabolic activity (MTS assay). RESULTS After reseeding, the endothelium appeared on the luminal surface of the PV as a non-confluent monolayer. Moderate pulsatile circulation induced complete confluence of EC monolayers on both cusp sides and the pulmonary wall. A high flow rate led to a partial loss of cells on the wall surface with large defects, and to complete cell wash-off from cusps. Cusp and wall metabolic activity was significantly higher after culture under moderate flow (p < 0.001) than in other groups, and was absent from cusps in high-flow bioreactors. CONCLUSION Moderate pulsatile flow with small increments stimulates EC proliferation on the ovine decellularized valve scaffold. A rapid increase in bioreactor flow to physiological levels leads to significant damage of the reseeded endothelium and complete loss of cusp cellularity. This effect may be responsible for the in-vivo failure of static reseeded tissue-engineered valves exposed to physiological hemodynamic forces.

Non-Newtonian blood flow dynamics in a right internal carotid artery with a saccular aneurysm

Abstract: Flow dynamics plays an important role in the pathogenesis and treatment of cerebral aneurysms. The temporal and spatial variations of wall shear stress in the aneurysm are hypothesized to be correlated with its growth and rupture. In addition, the assessment of the velocity field in the aneurysm dome and neck is important for the correct placement of endovascular coils. This work describes the flow dynamics in a patient-specific model of carotid artery with a saccular aneurysm under Newtonian and non-Newtonian fluid assumptions. The model was obtained from three-dimensional rotational angiography image data and blood flow dynamics was studied under physiologically representative waveform of inflow. The three-dimensional continuity and momentum equations for incompressible and unsteady laminar flow were solved with a commercial software using non-structured fine grid with 283 115 tetrahedral elements. The intra-aneurysmal flow shows complex vortex structure that change during one pulsatile cycle. The effect of the non-Newtonian properties of blood on the wall shear stress was important only in the arterial regions with high velocity gradients, on the aneurysmal wall the predictions with the Newtonian and non-Newtonian blood models were similar. Copyright © 2005 John Wiley & Sons, Ltd.

Pulsatile blood flow in the entire coronary arterial tree: theory and experiment

Abstract: The pulsatility of coronary circulation can be accurately simulated on the basis of the measured branching pattern, vascular geometry, and material properties of the coronary vasculature. A Womersley-type mathematical model is developed to analyze pulsatile blood flow in diastole in the absence of vessel tone in the entire coronary arterial tree on the basis of previously measured morphometric data. The model incorporates a constitutive equation of pressure and cross-section area relation based on our previous experimental data. The formulation enables the prediction of the impedance, the pressure distribution, and the pulsatile flow distribution throughout the entire coronary arterial tree. The model is validated by experimental measurements in six diastolic arrested, vasodilated porcine hearts. The agreement between theory and experiment is excellent. Furthermore, the present pulse wave results at low frequency agree very well with previously published steady-state model. Finally, the phase angle of flow is seen to decrease along the trunk of the major coronary artery and primary branches toward the capillary vessels. This study represents the first, most extensive validated analysis of Womersley-type pulse wave transmission in the entire coronary arterial tree down to the first segment of capillaries. The present model will serve to quantitatively test various hypotheses in the coronary circulation under pulsatile flow conditions.

Irrigated ablation catheter system with pulsatile flow to prevent thrombus

Abstract: The invention relates to an ablation catheter which controls the temperature and reduces the coagulation of biological fluids on an electrode of a catheter, prevents the impedance rise of tissue in contact with the electrode, and maximizes the potential energy transfer to the tissue, thereby allowing an increase in the lesion size produced by the ablation. The electrode includes passages positioned to allow saline flow out of an inner cavity of the electrode. This fluid flow is pulsatile to increase turbulence, reducing areas of stagnant flow, and produces a desired cooling effect.

The occurrence of the Coanda effect in pulsatile flow through static models of the human vocal folds

Abstract: Pulsatile flow through a one-sided diffuser and static divergent vocal-fold models is investigated to ascertain the relevance of viscous-driven flow asymmetries in the larynx. The models were 7.5 times real size, and the flow was scaled to match Reynolds and Strouhal numbers, as well as the translaryngeal pressure drop. The Reynolds number varied from 0–2000, for flow oscillation frequencies corresponding to 100 and 150Hz life-size. Of particular interest was the development of glottal flow skewing by attachment to the bounding walls, or Coanda effect, in a pulsatile flow field, and its impact on speech. The vocal folds form a divergent passage during phases of the phonation cycle when viscous effects such as flow separation are important. It was found that for divergence angles of less than 20degrees, the attachment of the flow to the vocal-fold walls occurred when the acceleration of the forcing function was zero, and the flow had reached maximum velocity. For a divergence angle of 40degrees, the fully ...

Neurocognitive function in patients with ventricular assist devices: a comparison of pulsatile and continuous blood flow devices.

Abstract: The effect of successful ventricular assist device (VAD) implantation on neurocognitive function in terminal heart failure is uncertain. Additionally, the different impact of continuous versus pulsatile blood flow devices is unknown. A total of 29 patients (mean age 53 years), surviving implantation of a ventricular assist device as bridge to transplantation were prospectively followed (continuous flow: Micromed DeBakey, n = 11; pulsatile flow: Thoratec and Novacor, n = 18). Normative data were obtained in 40 age- and sex-matched healthy subjects (mean age 54 years). Neurocognitive function was objectively measured by means of cognitive P300 auditory evoked potentials before operation (baseline), at intensive care unit (ICU) discharge, and at the 8-week and 12-week follow-up. Before implantation of the VAD, cognitive P300 evoked potentials were impaired (prolonged) compared with age- and sex-matched healthy subjects (p < 0.001). After successful VAD implantation, P300 evoked potentials markedly improved compared with before operation (ICU discharge, p = 0.007; 8-week follow-up, p = 0.022; 12-week follow-up, p < 0.0001). Importantly, there was no difference between continuous and pulsatile VADs (before operation, p = 0.676; ICU discharge, p = 0.736; 8-week follow-up, p = 0.911 and 12-week follow-up, p = 0.397; respectively). Nevertheless, P300 peak latencies did not fully normalize at 12-week follow-up compared with healthy subjects (p = 0.012). Successful VAD implantation improves neurocognitive impairment in patients with terminal heart failure. Importantly, this effect is independent of the type of VAD (pulsatile vs. continuous blood flow).

Numerical simulation of cardiovascular dynamics with left heart failure and in-series pulsatile ventricular assist device.

Abstract: This article presents a numerical model for investigations of the human cardiovascular circulation system response, where the function of the impaired left ventricle is augmented by the pumping action of a pulsatile ventricular assist device (VAD) connected in series to the native heart. The numerical model includes a module for detailed heart valve dynamics, which helps to improve the accuracy of simulation in studying the pulsatile type VAD designs. Simulation results show that, for the case with left ventricular (LV) failure, the VAD support successfully compensates the impaired cardiovascular response, and greatly reduces the after-load of the diseased ventricle, thus assisting possible recovery of the ventricle from the diseased condition. The effects of these conditions on pulmonary circulation are also shown. To investigate the effect of different pumping-activation functions (VAD motion profiles) on the cardiovascular response, three different VAD motion profiles are investigated. The numerical results suggest that Hermitian type motion profiles (smooth curves skewed toward early systole) have the advantage of requiring minimum power to the VAD, and producing the minimum after-load to the left ventricle, minimum ventricular wall stress, and minimum ventricular work to the diseased ventricle; while sawtooth type motions need slightly more power input, and induce slightly increased aortic pressure in diastole, thus improving coronary perfusion.

Non-invasive continuous estimation of blood flow changes in human patellar bone

Abstract: A photoplethysmographic (PPG) technique to assess blood flow in bone tissue has been developed and tested. The signal detected by the PPG consists of a constant-level (DC) component—which is related to the relative vascularization of the tissue—and a pul- satile (AC) component—which is synchronous with the pumping action of the heart. The PPG probe was ap- plied on the skin over the patella. The probe uses near- infrared (804 nm) and green (560 nm) light sources and the AC component of the PPG signals of the two wavelengths was used to monitor pulsatile blood flow in the patellar bone and the overlying skin, respec- tively. Twenty healthy subjects were studied and arte- rial occlusion resulted in elimination of PPG signals at both wavelengths, whereas occlusion of skin blood flow by local surface pressure eliminated only the PPG signal at 560 nm. In a parallel study on a physical model with a rigid tube we showed that the AC com- ponent of the PPG signal originates from pulsations of blood flow in a rigid structure and not necessarily from volume pulsations. We conclude that pulsatile blood flow in the patellar bone can be assessed with the present PPG technique.

Effects of pulsatile and nonpulsatile perfusion on vital organ recovery in pediatric heart surgery: a pilot clinical study.

Abstract: The use of pulsatile flow during cardiopulmonary bypass (CPB) with regard to improved patient outcomes is controversial. We evaluated pulsatile perfusion in pediatric patients undergoing CPB in a clinical setting. Fifty consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and randomly assigned to either the pulsatile perfusion group (group P, n 25) or the nonpulsatile perfusion group (group NP, n 25). Study parameters included intubation time, duration of intensive care unit (ICU) stay and hospital stay, need for inotropic support, preoperative and postoperative enzymes, creatinine, C-reactive protein, blood count, mean urine output, and total drainage. Group P, compared with group NP, had significantly less

Quantification of perfusion modes in terms of surplus hemodynamic energy levels in a simulated pediatric CPB model.

Abstract: The objective of this investigation was to compare pulsatile versus nonpulsatile perfusion modes in terms of surplus hemodynamic energy (SHE) levels during cardiopulmonary bypass (CPB) in a simulated neonatal model. The extracorporeal circuit consisted of a Jostra HL-20 heart-lung machine (for both pulsatile and nonpulsatile modes of perfusion), a Capiox Baby RX hollow-fiber membrane oxygenator, a Capiox pediatric arterial filter, 5 feet of arterial tubing and 6 feet of venous tubing with a quarter-inch diameter. The circuit was primed with a lactated Ringers solution. The systemic resistance of a pseudo-patient (mean weight, 3 kg) was simulated by placing a clamp at the end of the arterial line. The pseudo-patient was subjected to five pump flow rates in the 400 to 800 ml/min range. During pulsatile perfusion, the pump rate was kept constant at 120 bpm. Pressure waveforms were recorded at the preoxygenator, postoxygenator, and preaortic cannula sites. SHE was calculated by use of the following formula {SHE (ergs/cm) = 1,332 [((integral fpdt) / (integral fdt)) - Mean Arterial Pressure]} (f = pump flow and p = pressure). A total of 60 experiments were performed (n = 6 for nonpulsatile and n = 6 for pulsatile) at each of the five flow rates. A linear mixed-effects model, which accounts for the correlation among repeated measurements, was fit to the data to assess differences in SHE between flows, pumps, and sites. The Tukey multiple comparison procedure was used to adjust p values for post hoc pairwise comparisons. With a pump flow rate of 400 ml/min, pulsatile flow generated significantly higher surplus hemodynamic energy levels at the preoxygenator site (23,421 +/- 2,068 ergs/cm vs. 4,154 +/- 331 ergs/cm, p < 0.0001), the postoxygenator site (18,784 +/- 1,557 ergs/cm vs. 3,383 +/- 317 ergs/cm, p < 0.0001), and the precannula site (6,324 +/- 772 ergs/cm vs. 1,320 +/- 91 ergs/cm, p < 0.0001), compared with the nonpulsatile group. Pulsatile flow produced higher SHE levels at all other pump flow rates. The Jostra HL-20 roller pump generated significantly higher SHE levels in the pulsatile mode when compared with the nonpulsatile mode at all five pump flow rates.

Measurement of volumetric flow.

Abstract: Objective The purpose of this study was to evaluate a 3-dimensional (3D) sonographic method for the measurement of volumetric flow under conditions of known flow rates and Doppler angles. Methods A GE/Kretz Voluson 730 system (GE Healthcare, Milwaukee, WI) and RAB2-5 probe were used to acquire 3D Doppler measurements in a custom flow phantom. Blood-mimicking fluid circulated by a computer-controlled pump provided a range of flow velocities (2-15 mL/s). A 6-axis positioning system maneuvered the ultrasound probe through a range of angles (40 degrees-70 degrees and 110 degrees -140 degrees) with respect to the tube (orthogonal to the tube being 90 degrees). Volume data sets were obtained spanning 29 degrees lateral and 20 degrees elevational angles encompassing the flow tube in a scanning time of less than 10 seconds. Power Doppler data were used to correct for partial volume effects. Results Using a single angle (110 degrees) with respect to the flow tube, measured and actual volume flow rates were within the 95% confidence interval over the full range of flow rates. At flow rates of 5 and 10 mL/s, the measured volume flow rates were all within +/-15% of actual values for the range of angles tested and also stayed within the 95% confidence interval. Conclusions Direct comparisons of volume flow rates estimated with 3D sonography and known flow rates showed that the method has good accuracy. Subsequent comparisons under pulsatile and in vivo conditions will be needed to verify this performance for clinical applications.