Theoretical analysis of rest and exercise hemodynamics in patients with total cavopulmonary connection

The objective of this study was to determine the impact of a total cavopulmonary connection on the main hemodynamic quantities, both at rest and during exercise, when compared with normal biventricular circulation. The analysis was performed by means of a mathematical model of the cardiovascular system. The model incorporates the main parameters of systemic and pulmonary circulation, the pulsating heart, and the action of arterial and cardiopulmonary baroreflex mechanisms. Furthermore, the effect of changes in intrathoracic pressure on venous return is also incorporated. Finally, the response to moderate dynamic exercise is simulated, including the effect of a central command, local metabolic vasodilation, and the "muscle pump" mechanism. Simulations of resting conditions indicate that the action of baroreflex regulatory mechanisms alone can only partially compensate for the absence of the right heart. Cardiac output and mean systemic arterial pressure at rest show a large decrease compared with the normal subject. More acceptable hemodynamic quantity values are obtained by combining the action of regulatory mechanisms with a chronic change in parameters affecting mean filling pressure. With such changes assumed, simulations of the response to moderate exercise show that univentricular circulation exhibits a poor capacity to increase cardiac output and to sustain aerobic metabolism, especially when the oxygen consumption rate is increased above 1.2-1.3 l/min. The model ascribes the poor response to exercise in these patients to the incapacity to sustain venous return caused by the high resistance to venous return and/or to exhaustion of volume compensation reserve.     

Visualization of the intracavitary blood flow in systemic ventricles of Fontan patients by contrast echocardiography using particle image velocimetry

Objectives

Two-dimensional strain echocardiography (2DSE) technique has enabled accurate quantification of regional myocardial function. This experimental study was aimed to investigate the value of 2DSE in detection of segmental regional myocardial dysfunction induced by fibrosis following myocardial infarction in a small animal (rat) model.

Methods

A rat model of myocardial infarction was established by ligation of the proximal left anterior descending coronary artery in 17 SD rats. Regional myocardial function was detected by 2DSE at baseline and 4-weeks post-infarction, including end-systolic radial strain and strain rate (SR and SrR) and end-systolic circumferential strain and strain rate (SC and SrC) of each of six segments at papillary level. According to the size of scar found by histologic Masson staining, the optimal cutoff points of parameters for detecting scar area were analyzed and the sensitivity and specificity of every parameter to detect myocardial scar were obtained using ROC.

Results

(1) Comparing with parameters measured at baseline, there were significant decreases in SR, SrR, SC and SrC of each segment at 4 weeks post-infarction, with the worst in the infarct area (32.90 ± 8.79 vs 11.18 ± 3.89, 6.28 ± 1.35 vs 3.18 ± 0.47, -14.46 ± 2.21 vs -6.30 ± 2.17 and 4.93 ± 0.95 vs 2.59 ± 1.16, respectively) (all P < 0.05). (2)By 4 weeks, the myocardium of infarct area (anteroseptum, anterior and anterolateral) had fibrosis (31.33 ± 9.89, 73.42 ± 13.21 and 13.99 ± 3.24%, respectively) with minimal fibrosis in inferoseptal segment (0.32 ± 0.19%), no fibrosis was found in the inferior and inferolateral segments. (3)Significant negative correlations were found between the size of segmental scar and 2DSE parameters (r-value -0.61 ~ -0.80, all P < 0.01) with the strongest correlation in SR. SR less than 10% has 84% sensitivity and 98% specificity for detecting segments of scar area greater than 30% with AUC = 0.97.

Conclusions

2DSE is able to assess regional myocardial dysfunction in a rat model of myocardial infarction and has high accuracy in detecting infarct segments with scar area greater than 30%.     

Effect of flow pulsatility on modeling the hemodynamics in the total cavopulmonary connection

Total cavopulmonary connection is the result of a series of palliative surgical repairs performed on patients with single ventricle heart defects. The resulting anatomy has complex and unsteady hemodynamics characterized by flow mixing and flow separation. Although varying degrees of flow pulsatility have been observed in vivo, non-pulsatile (time-averaged) boundary conditions have traditionally been assumed in hemodynamic modeling, and only recently have pulsatile conditions been incorporated without completely characterizing their effect or importance. In this study, 3D numerical simulations with both pulsatile and non-pulsatile boundary conditions were performed for 24 patients with different anatomies and flow boundary conditions from Georgia Tech database. Flow structures, energy dissipation rates and pressure drops were compared under rest and simulated exercise conditions. It was found that flow pulsatility is the primary factor in determining the appropriate choice of boundary conditions, whereas the anatomic configuration and cardiac output had secondary effects. Results show that the hemodynamics can be strongly influenced by the presence of pulsatile flow. However, there was a minimum pulsatility threshold, identified by defining a weighted pulsatility index (wPI), above which the influence was significant. It was shown that when wPI<30%, the relative error in hemodynamic predictions using time-averaged boundary conditions was less than 10% compared to pulsatile simulations. In addition, when wPI<50, the relative error was less than 20%. A correlation was introduced to relate wPI to the relative error in predicting the flow metrics with non-pulsatile flow conditions.     

Influence of connection geometry and SVC-IVC flow rate ratio on flow structures within the total cavopulmonary connection: a numerical study

The total cavopulmonary connection (TCPC) is a palliative cardiothoracic surgical procedure used in patients with one functioning ventricle that excludes the heart from the systemic venous to pulmonary artery pathway. Blood in the superior and inferior vena cavae (SVC, IVC) is diverted directly to the pulmonary arteries. Since only one ventricle is left in the circulation, minimizing pressure drop by optimizing connection geometry becomes crucial. Although there have been numerical and in-vitro studies documenting the effect of connection geometry on overall pressure drop, there is little published data examining the effect of SVC-IVC flow rate ratio on detailed fluid mechanical structures within the various connection geometries. We present here results from a numerical study of the TCPC connection, configured with various connections and SVC:IVC flow ratios. The role of major flow parameters: shear stress, secondary flow, recirculation regions, flow stagnation regions, and flow separation, was examined. Results show a complex interplay among connection geometry, flow rate ratio and the types and effects of the various flow parameters described above. Significant changes in flow structures affected local distribution of pressure, which in turn changed overall pressure drop. Likewise, changes in local flow structure also produced changes in maximum shear stress values; this may have consequences for platelet activation and thrombus formation in the clinical situation. This study sheds light on the local flow structures created by the various connections andflow configurations and as such, provides an additional step toward understanding the detailed fluid mechanical behavior of the more complex physiological configurations seen clinically.     

The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

Little is known about the impact of the total cavopulmonary connection (TCPC) on resting and exercise hemodynamics in a single ventricle (SV) circulation. The aim of this study was to elucidate this mechanism using a lumped parameter model of the SV circulation. Pulmonary vascular resistance (1.96+/-0.80 WU) and systemic vascular resistances (18.4+/-7.2 WU) were obtained from catheterization data on 40 patients with a TCPC. TCPC resistances (0.39+/-0.26 WU) were established using computational fluid dynamic simulations conducted on anatomically accurate three-dimensional models reconstructed from MRI (n=16). These parameters were used in a lumped parameter model of the SV circulation to investigate the impact of TCPC resistance on SV hemodynamics under resting and exercise conditions. A biventricular model was used for comparison. For a biventricular circulation, the cardiac output (CO) dependence on TCPC resistance was negligible (sensitivity=-0.064 l.min(-1).WU(-1)) but not for the SV circulation (sensitivity=-0.88 l.min(-1).WU(-1)). The capacity to increase CO with heart rate was also severely reduced for the SV. At a simulated heart rate of 150 beats/min, the SV patient with the highest resistance (1.08 WU) had a significantly lower increase in CO (20.5%) compared with the SV patient with the lowest resistance (50%) and normal circulation (119%). This was due to the increased afterload (+35%) and decreased preload (-12%) associated with the SV circulation. In conclusion, TCPC resistance has a significant impact on resting hemodynamics and the exercise capacity of patients with a SV physiology.     

Stereoscopic particle image velocimetry analysis of healthy and emphysemic alveolar sac models

Emphysema is a progressive lung disease that involves permanent destruction of the alveolar walls. Fluid mechanics in the pulmonary region and how they are altered with the presence of emphysema are not well understood. Much of our understanding of the flow fields occurring in the healthy pulmonary region is based on idealized geometries, and little attention has been paid to emphysemic geometries. The goal of this research was to utilize actual replica lung geometries to gain a better understanding of the mechanisms that govern fluid motion and particle transport in the most distal regions of the lung and to compare the differences that exist between healthy and emphysematous lungs. Excised human healthy and emphysemic lungs were cast, scanned, graphically reconstructed, and used to fabricate clear, hollow, compliant models. Three dimensional flow fields were obtained experimentally using stereoscopic particle image velocimetry techniques for healthy and emphysematic breathing conditions. Measured alveolar velocities ranged over two orders of magnitude from the duct entrance to the wall in both models. Recirculating flow was not found in either the healthy or the emphysematic model, while the average flow rate was three times larger in emphysema as compared to healthy. Diffusion dominated particle flow, which is characteristic in the pulmonary region of the healthy lung, was not seen for emphysema, except for very small particle sizes. Flow speeds dissipated quickly in the healthy lung (60% reduction in 0.25 mm) but not in the emphysematic lung (only 8% reduction 0.25 mm). Alveolar ventilation per unit volume was 30% smaller in emphysema compared to healthy. Destruction of the alveolar walls in emphysema leads to significant differences in flow fields between the healthy and emphysemic lung. Models based on replica geometry provide a useful means to quantify these differences and could ultimately improve our understanding of disease progression.     

Flow field analysis in a compliant acinus replica model using particle image velocimetry (PIV)

Inhaled particles reaching the alveolar walls have the potential to cross the blood–gas barrier and enter the blood stream. Experimental evidence of pulmonary dosimetry, however, cannot be explained by current whole lung dosimetry models. Numerical and experimental studies shed some light on the mechanisms of particle transport, but realistic geometries have not been investigated. In this study, a three dimensional expanding model including two generations of respiratory bronchioles and five terminal alveolar sacs was created from a replica human lung cast. Flow visualization techniques were employed to quantify the fluid flow while utilizing streamlines to evaluate recirculation. Pathlines were plotted to track the fluid motion and estimate penetration depth of inhaled air. This study provides evidence that the two generations immediately proximal to the terminal alveolar sacs do not have recirculating eddies, even for intense breathing. Results of Peclet number calculations indicate that substantial convective motion is present in vivo for the case of deep breathing, which significantly increases particle penetration into the alveoli. However, particle diffusion remains the dominant mechanism of particle transport over convection, even for intense breathing because inhaled particles do not reach the alveolar wall in a single breath by convection alone. Examination of the velocity fields revealed significant uneven ventilation of the alveoli during a single breath, likely due to variations in size and location. This flow field data, obtained from replica model geometry with realistic breathing conditions, provides information to better understand fluid and particle behavior in the acinus region of the lung.     

In vivo micro particle image velocimetry measurements of blood-plasma in the embryonic avian heart

The measurement of blood-plasma velocity distributions with spatial and temporal resolution in vivo is inevitable for the determination of shear stress distributions in complex geometries at unsteady flow conditions like in the beating heart. A non-intrusive, whole-field velocity measurement technique is required that is capable of measuring instantaneous flow fields at sub-millimeter scales in highly unsteady flows. Micro particle image velocimetry (muPIV) meets these demands, but requires special consideration and methodologies in order to be utilized for in vivo studies in medical and biological research. We adapt muPIV to measure the blood-plasma velocity in the beating heart of a chicken embryo. In the current work, bio-inert, fluorescent liposomes with a nominal diameter of 400 nm are added to the flow as a tracer. Because of their small dimension and neutral buoyancy the liposomes closely follow the movement of the blood-plasma and allow the determination of the velocity gradient close to the wall. The measurements quantitatively resolve the velocity distribution in the developing ventricle and atrium of the embryo at nine different stages within the cardiac cycle. Up to 400 velocity vectors per measurement give detailed insight into the fluid dynamics of the primitive beating heart. A rapid peristaltic contraction accelerates the flow to peak velocities of 26 mm/s, with the velocity distribution showing a distinct asymmetrical profile in the highly curved section of the outflow tract. In relation to earlier published gene-expression experiments, the results underline the significance of fluid forces for embryonic cardiogenesis. In general, the measurements demonstrate that muPIV has the potential to develop into a general tool for instationary flow conditions in complex flow geometries encountered in cardiovascular research.     

Power dissipation associated with surgical operations' hemodynamics: critical issues and application to the total cavopulmonary connection

The issue of the correct determination of the mechanical power dissipated by the blood flow in the circulatory system is very important. This parameter is particularly critical when the patient's circulation has to overcome structural impairments, such as, e.g., in the case of only one functional ventricle. The surgical palliation of such a condition, which is a relatively common form of congenital heart disease, calls for an optimization of the new connection's hydrodynamics. Starting from the general formulation of the energy dissipation rate in a given control volume, this paper discusses the critical assumptions of the formula usually employed to assess the power dissipation in complex connections, such as the total cavopulmonary connection (TCPC). A new formula is derived, in which the mean elevation of the outlet and inlet sections is shown to be relevant, through the use of the piezometric pressure. Moreover, the flow profile at the boundary of the control volume is also important, since the usual approach implicitly assumes that the flow is perfectly flat: this assumption is doubtful, especially in the venous return (as in the TCPC). In the experimental part of the study, the power dissipation was measured in a physical model of the TCPC, and a large difference was found between the usual method and the proposed one, especially at low regime (85% relative difference, at 1.5 l/min total cardiac output). The proposed approach should be adopted in order to improve the accuracy of the hydrodynamical performance's assessment of surgical connections (e.g., TCPC) or implantable devices (e.g., valved conduit).     

A simple, inexpensive system for digital particle image velocimetry (DPIV) in biomechanics

Functional morphology and biomechanics seek to reveal the mechanistic bases of organismal functions and the physical principles involved at the phenotype-environment interface. Characterization of fluid flow (air or water) within and around organismal structures is an example of this approach. Digital particle imaging velocimetry (DPIV) has been exploited in a variety of biological systems to visualize fluid flow associated with animal movement. DPIV employs particles suspended in air or water that are illuminated by a laser light sheet and recorded with a high-speed video camera. Software tracks particle movement across a specified number of video frames, generating vector diagrams showing patterns of fluid flow through time. As powerful as DPIV methods are, they are limited in application by the high cost and complexity of the equipment required. In this article, we describe a simple DPIV system that substitutes widely available, inexpensive consumer components for scientific-grade equipment to achieve low cost (<$1,000 total) and high accuracy (total error calculated to be approx. 6%, as compared with 5% in professional systems). We have employed this system successfully in our studies on the fluid dynamics of chemosensory tongue-flicking in snakes. This system can be used for research and teaching in labs that typically cannot afford the expense or commitment of a traditional DPIV apparatus and is particularly suited for obtaining preliminary data required to justify further grant and institutional support.     

The effects of different mesh generation methods on computational fluid dynamic analysis and power loss assessment in total cavopulmonary connection

The flow field and energetic efficiency of total cavopulmonary connection (TCPC) models have been studied by both in vitro experiment and computational fluid dynamics (CFD). All the previous CFD studies have employed the structured mesh generation method to create the TCPC simulation model. In this study, a realistic TCPC model with complete anatomical features was numerically simulated using both structured and unstructured mesh generation methods. The flow fields and energy losses were compared in these two meshes. Two different energy loss calculation methods, the control volume and viscous dissipation methods, were investigated. The energy losses were also compared to the in vitro experimental results. The results demonstrated that: (1) the flow fields in the structured model were qualitatively similar to the unstructured model; (2) more vortices were present in the structured model than in the unstructured model; (3) both models had the least energy loss when flow was equally distributed to the left and right pulmonary arteries, while high losses occurred for extreme pulmonary arterial flow splits; (4) the energy loss results calculated using the same method were significantly different for different meshes; and (5) the energy loss results calculated using different methods were significantly different for the same mesh.     

The effect of incorporating vessel compliance in a computational model of blood flow in a total cavopulmonary connection (TCPC) with caval centerline offset

BACKGROUND: The total cavopulmonary connection (TCPC), a palliative correction for congenital defects of the right heart, is based on the corrective technique developed by Fontan and Baudet. Research into the TCPC has primarily focused on reducing power loss through the connection as a means to improve patient longevity and quality of life. The goal of our study is to investigate the efficacy of including a caval offset on the hemodynamics and, ultimately, power loss of a connection. As well, we will quantify the effect of vessel wall compliance on these factors and, in addition, the distribution of hepatic blood to the lungs. METHODS: We employed a computational fluid dynamic model of blood flow in the TCPC that includes both the non-Newtonian shear thinning characteristics of blood and the nonlinear compliance of vessel tissue. RESULTS: Power loss in the rigid-walled simulations decayed exponentially as caval offset increased. The compliant-walled results, however, showed that after an initial substantial decrease in power loss for offsets up to half the caval diameter, power loss increased slightly again. We also found only minimal mixing in both simulations of all offset models. CONCLUSIONS: The increase in power loss beyond an offset of half the caval diameter was due to an increase in the kinetic contribution. Reduced caval flow mixing, on the other hand, was due to the formation of a pressure head in the offset region which acts as a barrier to flow.     

Basics and principles of particle image velocimetry (PIV) for mapping biogenic and biologically relevant flows

Particle image velocimetry (PIV) has proven to be a very useful technique in mapping animal-generated flows or flow patterns relevant to biota. Here, theoretical background is provided and experimental details of 2-dimensional digital PIV are explained for mapping flow produced by or relevant to aquatic biota. The main principles are clarified in sections on flow types, seeding, illumination, imaging, repetitive correlation analysis, post-processing and result interpretation, with reference to experimental situations. Examples from the benthic environment, namely, on filter feeding in barnacles and in bivalves, illustrate what the experiments comprise and what the results look like. Finally, alternative particle imaging flow analysis techniques are discussed briefly in the context of mapping biogenic and biologically relevant flows.     

Comparison of divalent transition metal ion paraCEST MRI contrast agents

Transition-metal-ion-based paramagnetic chemical exchange saturation transfer (paraCEST) agents are a promising new class of compounds for magnetic resonance imaging (MRI) contrast. Members in this class of compounds include paramagnetic complexes of Fe^II, Co^II, and Ni^II. The development of the coordination chemistry for these paraCEST agents is presented with an emphasis on the choice of the azamacrocycle backbone and pendent groups with the goals of controlling the oxidation state, spin state, and stability of the complexes. Chemical exchange saturation transfer spectra and images are compared for different macrocyclic complexes containing amide or heterocyclic pendent groups. The potential of paraCEST agents that function as pH- and redox-activated MRI probes is discussed.     

Comparison of a tartaric acid derived polymeric MRI contrast agent to a small molecule model chelate

Contrast agents with high relaxivity are needed to increase the sensitivity of magnetic resonance imaging (MRI) for novel clinical and research applications. For this reason, polymeric structures containing multiple Gd(III) chelates are of current interest. Described in this communication are the syntheses and characterization of a glycopolymer derived from L-tartaric acid, Gd 4(H2O), as well as a low molecular weight compound, Gd 10(H2O), that models the Gd(III) chelate structure in the repeat unit of polymer Gd 4(H2O). Luminescence lifetime measurements in H2O and D2O for Eu(III) analogues of Gd 4(H2O) and Gd 10(H2O) [named Eu 4(H2O) and Eu 10(H2O)] reveal that the lanthanide in both structures likely has one water ligand in the primary coordination sphere. The relaxivity of the model chelate Gd 10(H 2O) at 400 MHz and 310 K was determined to be 4.7 mmol (-1).s (-1), representing a nearly 50% increase over Magnevist (3.2 mmol (-1).s (-1)). Relaxivity values on a per Gd basis for the polymeric structure Gd 4(H2O) prepared at two degrees of polymerization, n = 12 and 19, are similar, but slightly lower than Gd 10(H2O) (4.4 mmol (-1).s (-1) and 4.5 mmol (-1).s (-1), respectively). However, their molecular relaxivities of 51 mmol (-1).s (-1) and 80 mmol (-1).s (-1), respectively, provide a substantial increase over that of Magnevist.     

Comparison between Gd-DTPA and several bisamide derivatives as potential MRI contrast agents

Four neutral gadolinium complexes of diethylenetriaminepentaacetic acid (DTPA)-bisamide derivatives have been synthesized and characterized. Their potential application as tissue-specific and low-osmolarity MRI contrast agents has been evaluated by in vitro and in vivo experiments. Their measured relaxivities in D(2)O, bovine serum albumin and human serum transferrin solutions showed favorable relaxation ability. In vivo studies have proven that Gd(DTPA-BDMA), Gd(DTPA-BIN), and Gd(cyclic-DTPA-1,2-pn) could be promising liver-specific MRI contrast agents and Gd(DTPA-BDMA), and Gd(cyclic-DTPA-1,2-pn) have favorable renal excretion capability. Among them, Gd(cyclic-DTPA-1,2-pn) is a more powerful hepatic contrast agent and Gd(DTPA-BIN) provides the stable imaging contrast for several hours. They also show a lower toxicity.     

Comparison between GdDTPA and two gadolinium polyoxometalates as potential MRI contrast agents

Two gadolinium polyoxometalates, Gd(2)P(2)W(18)O(62) and K(15)[(GdO)(3)(PW(9)O(34))(2)], have been evaluated by in vivo as well as in vitro experiments as the candidates of tissue-specific magnetic resonance imaging (MRI) contrast agents. T(1)-relaxivities of 28.4 mM(-1).s(-1) for Gd(2)P(2)W(18)O(62) and 11.2 mM(-1).s(-1) for K(15)[(GdO)(3)(PW(9)O(34))(2)] (400 MHz, 25 degrees C) were higher than that of the commercial MRI contrast agent (GdDTPA). Their relaxivities in bovine serum albumin and human serum transferrin were also reported. The favorable liver-specific contrast enhancement and renal excretion capability in in vivo MRI with Sprague-Dawley rats after i.v. administration of K(15)[(GdO)(3)(PW(9)O(34))(2)] was demonstrated. In vivo and in vitro assay showed that K(15)[(GdO)(3)(PW(9)O(34))(2)] is a promising liver-specific MRI contrast agent. However, Gd(2)P(2)W(18)O(62) did not show the favorable quality in vivo as expected from its high relaxivity in vitro, which was attributed to low bioavailability, indicating that it is of limited value as tissue-specific MRI contrast agent.     

Synthesis and visualization of a membrane-permeable MRI contrast agent

The study of in vivo developmental events has undergone significant advances with the advent of biological molecular imaging techniques such as computer enhanced light microscopy imaging, positron emission tomography (PET), micro-CT, and magnetic resonance imaging (MRI). MRI has proven to be a particularly powerful tool in clinical and biological settings. Images can be acquired of opaque living animals, with the benefit of tracking events of extended periods of time on the same specimen. Contrast agents are routinely used to enhance regions, tissues, and cells that are magnetically similar but histologically distinct. A principal barrier to the development of MR contrast agents for investigating developmental biological questions is the ability to deliver the agent across cellular membranes. As part of our research, we are investigating a number of small molecules that facilitate transport of charged and uncharged species across cell membranes. Here we describe the synthesis and testing of a Gd(III)-based MR contrast agent conjugated to polyarginine that is able to permeate cell membranes. We confirmed cellular uptake of the agent using two-photon laser microscopy to visualize a Eu(III) derivative of the contrast agent in cell culture, and verified this uptake by T₁ analysis of the Gd(III) agent in cells.Abbreviations DOTA 1,4,7,10-tetraazacyclododecane-N,N,N,N-tetraacetic acid - DOTA(tris-t-Bu ester) 1,4,7,10-tetraazacyclododecane-1,4,7-tris(acetic acid-tert-butyl ester)-10-acetic acid - DO3A(tris-t-Bu ester) 1,4,7-tris(tert-butoxycarbonylmethyl)-1,4,7,10-tetraazacyclododecane - MRI magnetic resonance imaging - PET positron emission tomography - TPLM two-photon laser microscopy