Real-time continuous measurement of right ventricular volume using a conductance catheter

The authors propose using a multi-electrode conductance catheter to measure continuous right ventricular volume. True ventricular volume measurements are affected by four main sources of error. 1) field non-uniformity, 2) catheter curvature, 3) blood conductivity changes, and 4) leakage of current through surrounding tissues. Three-dimensional finite-element models were developed to investigate the effects of these sources of error and to devise schemes for correcting them. The models include an axisymmetric cylindrical model, a rectangular block model, and a heart model with left and right ventricular chambers. The heart model is built from conical primitives, with major dimensions derived from the literature. Finite-element simulations showed that volume measurements were underestimated due to field nonuniformity to as much as 1/25th actual volume in segments near the exciting electrodes. The extent of underestimation in a segment decreased with increasing distance of the segment from the exciting electrodes and increased for larger segmental volumes. Catheter curvature overestimated measured volume by as much as 4.5 times when the curvature was increased from 0.0 to 1.25 (from a straight catheter to a very curved one). The leakage of current through surrounding tissues overestimated volume by nearly 30%. The sensitivity of volume measurement to blood resistivity changes was found to be very high, at 70%. Correction factors established with the computer models compensate for field nonuniformity. Mathematical mapping of the curved catheter onto a fictitious straight catheter corrects for the catheter curvature error. Correction for both nonuniform field and catheter curvature allowed measurement of total ventricular volume with an error of 7%. Leakage current is determined by using different frequencies to build the catheter electric field and to separate tissue and blood resistance paths. Using this scheme, the percentage overestimation in volume measurement due to leakage could be determined with an accuracy of 85%. The proposed correction scheme for blood conductivity changes involves the in-vivo measurement of blood conductivity with the catheter itself. It was found that blood conductivity could be determined with insignificant error (< 0.5%) so long as the blood volume around the exciting electrodes had a radius of more than the electrode spacing.     

The effect of changing excitation frequency on parallel conductance in different sized hearts

OBJECTIVE: An important component of the ventricular volume measured using the conductance catheter technique is due to parallel conductance (Vc), which results from the extension of the electric field beyond the ventricular blood pool. Parallel conductance volume is normally estimated using the saline dilution method (Vc(saline dilution)), in which the conductivity of blood in the ventricle is transiently increased by injection of hypertonic saline. A simpler alternative has been reported by Gawne et al. [12]. Vc(dual frequency) is estimated from the difference in total conductance measured at two exciting frequencies and the method is based on the assumption that parallel conductance is mainly capacitive and hence is negligible at low frequency. The objective of this study was to determine whether the dual frequency technique could be used to substitute the saline dilution method to estimate Vc in different sized hearts. METHODS: The accuracy and linearity of a custom-built conductance catheter (CC) system was initially assessed in vitro. Subsequently, a CC and micromanometer were inserted into the left ventricle of seven 5 kg pigs (group 1) and six 50 kg pigs (group 2). Cardiac output was determined using thermodilution (group 1) and an ultrasonic flow probe (group 2) from which the slope coefficient (alpha) was determined. Steady state measurements and Vc estimated using saline dilution were performed at frequencies in the range of 5-40 kHz. All measurements were made at end-expiration. Finally, Vc was estimated from the change in end-systolic conductance between 5 kHz and 40 kHz using the dual frequency technique of Gawne et al. [12]. RESULTS: There was no change in measured volume of a simple insulated cylindrical model when the stimulating frequency was varied from 5-40 kHz. Vc(saline dilution) varied significantly with frequency in group 1 (8.63 +/- 2.74 ml at 5 kHz; 11.51 +/- 2.65 ml at 40 kHz) (p = 0.01). Similar results were obtained in group 2 (69.43 +/- 27.76 ml at 5 kHz; 101.24 +/- 15.21 ml at 40 kHz) (p < 0.001). However, the data indicate that the resistive component of the parallel conductance is substantial (Vc at 0 Hz estimated as 8.01 ml in group 1 and 62.3 ml in group 2). There was an increase in alpha with frequency in both groups but this did not reach significance. The correspondence between Vc(dual frequency) and Vc(saline dilution) methods was poor (group 1 R2 = 0.69; group 2 R2 = 0.22). CONCLUSION: At a lower excitation frequency of 5 kHz a smaller percentage of the electric current extends beyond the blood pool so parallel conductance is reduced. While parallel conductance is frequency dependent, it has a substantial resistive component. The dual frequency method is based on the assumption that parallel conductance is negligible at low frequencies and this is clearly not the case. The results of this study confirm that the dual frequency technique cannot be used to substitute the saline dilution technique.     

Comparison of continuous left ventricular volumes by transthoracic two-dimensional digital echo quantification with simultaneous conductance catheter measurements in patients with cardiac diseases

Automated border detection enables real-time tracking of left ventricular (LV) volume by 2-dimensional transthoracic echocardiography. This technique has not been previously compared with simultaneously measured continuous LV volumes at rest or during transients in humans. We performed 18 studies in 16 patients (age 50 +/- 15 years, range 22 to 70; ejection fraction 63 +/- 20%, range 15% to 85%) in which continuous LV volumes acquired by digital echo quantification (DEQ) were compared with simultaneous conductance catheter volume obtained by cardiac catheterization. Both volume signals were calibrated by thermodilution-derived cardiac output and ventriculogram-derived ejection fraction. Volume traces acquired at rest were averaged to generate a comparison cycle. The averaged volume waveforms acquired by DEQ and by conductance catheter were similar during all phases of the cardiac cycle and significantly correlated (conductance catheter = slope. DEQ + intercept, slope = 0.94 +/- 0.09, intercept = 5 +/- 8 ml, r2 = 0.86 +/- 0.12, all p <0.0001). Steady-state hemodynamic parameters calculated using either averaged volume signal were significantly correlated. Transient obstruction of the inferior vena cava yielded a 45 +/- 13% decrease in end-diastolic volume. Successful recordings of DEQ volume during preload reduction were obtained in only 50% of studies. End-diastolic volumes from the 2 methods were significantly correlated (mean slope 0.88 +/- 0.31, mean intercept 14 +/- 37 ml, average r2 = 0.89 +/- 0.11, all p <0.01), as were end-systolic volumes: mean slope 0.80 +/- 0.43, intercept = -20 +/- 26 ml, r2 = 0.67 +/- 0.18, all p <0.05). We conclude that automated border detection technique by DEQ is reliable for noninvasive, transthoracic, continuous tracking of LV volumes at steady state, but has limitations in use during preload reduction maneuvers in humans.     

Usefulness of radiologic monitoring of epidural catheters using epidurography

INTRODUCTION: Peridural analgesia involves a segmental block which at the thoracic level allows for early pulmonary recovery after chest or high abdominal surgery. The approach is difficult in children for reasons related to anatomy, maintenance, insertion of the catheter and dosing. OBJECTIVE: To report the radiologic monitoring of epidural catheter placement by epidurography as a technique for placing the epidural catheter in 17 patients for whom postoperative analgesia was to be provided by the same route. PATIENTS AND METHODS: Eighteen children (aged from 2 to 12) were given general anesthesia followed by epidural anesthesia. After catheterization of the epidural space, 1 or 1-5 ml of contrast was injected. Immediately afterwards an X-ray of the thoracic or lumbar spinal column, as appropriate to each case, was obtained. Epidural analgesia was provided with a mixture of bupivacaine 0.125% and fentanyl, in continuous perfusion or in fractionated doses. RESULTS: Placement of the catheter tip was confirmed in 17 cases by visualization of symmetry and the presence of contrast medium in the epidural space. In one case we observed extravasation of contrast medium, which had invaded the paravertebral space. The course was linear in 17 cases, with no looping. No complications related to injection of contrast medium were observed. CONCLUSIONS: Epidurography provides objective monitoring of tip placement and trajectory of epidural catheters, advantages which argue in favor of more frequent application of this imaging technique.     

Regulation of cytoplasmic pH in osteoclasts. Contribution of proton pumps and a proton-selective conductance

Osteoclasts resorb bone by secreting protons into an extracellular resorption zone through vacuolar-type proton pumps located in the ruffled border. The present study was undertaken to evaluate whether proton pumps also contribute to intracellular pH (pHi) regulation. Fluorescence imaging and photometry, and electrophysiological methods were used to characterize the mechanisms of pH regulation in isolated rabbit osteoclasts. The fluorescence of single osteoclasts cultured on glass coverslips and loaded with a pH-sensitive indicator was measured in nominally HCO(3-)-free solutions. When suspended in Na(+)-rich medium, the cells recovered from an acute acid load primarily by means of an amiloride-sensitive Na+/H+ antiporter. However, rapid recovery was also observed in Na(+)-free medium when K+ was used as the substitute. Bafilomycin-sensitive, vacuolar-type pumps were found to contribute marginally to pH regulation and no evidence was found for K+/H+ exchange. In contrast, pHi recovery in high K+ medium was largely attributed to a Zn(2+)-sensitive proton conductive pathway. The properties of this conductance were analyzed by patch-clamping osteoclasts in the whole-cell configuration. Depolarizing pulses induced a slowly developing outward current and a concomitant cytosolic alkalinization. Determination of the reversal potential during ion substitution experiments indicated that the current was due to H+ (equivalent) translocation across the membrane. The H+ current was greatly stimulated by reducing pHi, consistent with a homeostatic role of the conductive pathway during intracellular acidosis. These results suggest that vacuolar-type proton pumps contribute minimally to the recovery of cytoplasmic pH from intracellular acid loads. Instead, the data indicate the presence of a pH- and membrane potential-sensitive H+ conductance in the plasma membrane of osteoclasts. This conductance may contribute to translocation of charges and acid equivalents during bone resorption and/or generation of reactive oxygen intermediates by osteoclasts.     

A novel, volume-correlated Cl- conductance in marginal cells dissociated from the stria vascularis of gerbils

Using the whole-cell patch-clamp technique, we examined Cl-selective currents manifested by strial marginal cells isolated from the inner ear of gerbils. A large Cl-selective conductance of approximately 18 nS/pF was found from nonswollen cells in isotonic buffer containing 150 mM Cl-. Under a quasi-symmetrical Cl- condition, the "instantaneous' current-voltage relation was close to linear, while the current-voltage relation obtained at the end of command pulses of duration 400 msec showed weak outward rectification. The permeability sequence for anionic currents was as SCN- > Br- approximately = Cl- > F- > NO3- approximately = I- > gluconate-, corresponding to Eisenmann's sequence V. When whole-cell voltage clamped in isotonic bathing solutions, the cells exhibited volume changes that were accounted for by the Cl- currents driven by the imposed electrochemical potential gradients. The volume change was elicited by lowered extracellular Cl- concentration, anion substitution and altered holding potentials. The Cl- conductance varied in parallel with cell volume when challenged by bath anisotonicity. The whole-cell Cl- current was only partially blocked by both 5-nitro-2-(3-phenylpropylamino) benzoic acid (NPPB, 0.5 mM) and diphenylamine-2-carboxylic acid (DPC, 1.0 mM), but 4-acetamido-4'-isothiocyanato-stilbene-2,2'-disulfonic acid (SITS, 0.5 mM) was without effect. The properties of the present whole-cell Cl- current resembled those of the single Cl- channel previously found in the basolateral membrane of the marginal cell (Takeuchi et al., Hearing Res. 83:89-100, 1995), suggesting that the volume-correlated Cl- conductance could be ascribed predominantly to the basolateral membrane. This Cl- conductance may function not only in cell volume regulation but also for the transport of Cl- and the setting of membrane potential in marginal cells under physiological conditions.     

Assessment of the contribution of the cytochrome b moiety of the NADPH oxidase to the transmembrane H+ conductance of leukocytes

Phagocytic cells can kill microorganisms by synthesizing superoxide. Activation of the NADPH oxidase that generates superoxide is accompanied by a large intracellular burst of metabolic acid production. Despite the excess acid generation, cytosolic pH (pHi) remains near neutrality due to the concomitant stimulation of several homeostatic H+ extrusion mechanisms including a recently described H(+)-conductive pathway. Activation of the conductance by phorbol esters is defective in neutrophils of chronic granulomatous disease (CGD) patients lacking the transmembrane cytochrome b subunits of the NADPH oxidase. This finding suggests that the oxidase itself undertakes H+ translocation or that, alternatively, assembly of the oxidase is required to activate a separate H+ conducting entity. To distinguish between these possibilities, the presence of the conductive pathway was assessed in unstimulated normal and CGD cells by manipulating pHi and the transmembrane potential. Using fluorimetric determinations of pHi, a conductive, Zn(2+)-sensitive alkalinization was observed in neutrophils from both normal and cytochrome b-deficient CGD donors. The electrophysiological properties of the conductance were defined in purified blood monocytes using the whole cell configuration of the patch clamp. Depolarizing pulses induced slowly activating outward currents in cells from both normal and cytochrome b-deficient individuals. The elicited currents were potentiated by cytosolic acidification and did not inactivate within the times tested. As in control leukocytes, the reversal potential of tail currents in the CGD cells closely approximated the H+ equilibrium potential and was unaffected by substitution of the major ionic components of the external bathing medium. At all voltages tested, the magnitude of the evoked currents was comparable in normal and CGD cells. The results indicate that, like macrophages and granulocytes, human monocytes display a voltage-gated highly H(+)-selective conductance. More importantly, our findings imply that the conductive pathway is present in cells devoid of cytochrome b. Therefore, the defective activation of the conductive pathway by protein kinase C agonists in CGD cells is not due to the physical absence of the transporter. Instead we propose that the oxidase functions in a regulatory capacity, facilitating the opening of a distinct H+ conductance during cellular stimulation.     

Three-dimensional coupled fluid-structure simulation of pericardial bioprosthetic aortic valve function

A computational, three-dimensional coupled fluid-structure dynamics model was developed for a generic pericardial aortic valve in a rigid aortic root graft with physiologic sinuses. Valve geometry was based on that of the natural valve. Blood flow was modeled as pulsatile, laminar, Newtonian, incompressible flow. The structural model accounted for material and geometric nonlinearities and also simulated leaflet coaptation. A body fitted grid was used to subdivide the flow domain into computational finite volume cells. Shell finite elements were used to discretize the leaflet volume. A finite volume computational fluid dynamics code and finite element structure dynamics code were used to solve the flow and structure equations, respectively. The fluid flow and structural equations were coupled using an implicit "influence coefficient" technique. Physiologic ventricular and aortic pressure waveforms were prescribed as the flow boundary conditions. The aortic flow field, valve structural configuration, and leaflet stresses were computed at 2 msec intervals. Model predictions on aortic flow and transient variation in valve orifice area were in close agreement with corresponding experimental in vitro data. These findings suggest that the computer model has potential for being a powerful design tool for bioprosthetic aortic valves.     

Baroreflex control of coronary blood flow varies regionally in awake dogs

1. Baroreflex responses to changes in aortic pressure were measured simultaneously in three main coronary regions of awake dogs. 2. Pulsed Doppler flow probes were mounted at prior surgery on the right, circumflex and anterior descending coronary arteries; the animals were placed in complete heart block and the left ventricle was paced. After 2-4 weeks recovery, baroreflexes were evoked by inflating a balloon catheter placed in the mid-thoracic aorta via the femoral arteriotomy. Flow and pressure data were collected at rest, and during acute (8s) and steady-state (25s) baroreflex challenge. 3. Changing ventricular rate alone caused a fall in aortic pressure at low rates; however, over the range 60 to 180 b.p.m., circumflex and anterior descending coronary flow and conductance changed directly with ventricular rate, but right coronary flow and conductance remained unchanged. 4. Acute aortic pressure elevation increased flow at 8s in all beds at all rates. Conductance effects at 60 b.p.m. were negligible in all three beds, but rose at 100 and 180 b.p.m. in the right and circumflex beds. 5. Sustained aortic pressure elevation (25s) caused flow to return towards control in all beds ventricular rates, but in the right coronary at 60 b.p.m. flow fell below control. Conductance at this time was unchanged at all rates in the anterior descending bed, fell modestly in the circumflex, and decreased to below resting in the right coronary bed. 6. Baroreflex control of coronary flow and conductance thus varies between territories, and within territories, depending on ventricular rate. The right coronary bed appears to be regulated by a bidirectional, baroreflex-linked mechanism, which is functionally opposite in action to that found in most vascular beds.     

Analysis of right ventricular function during bypass of the left side of the heart by afterload alterations in both normal and failing hearts

This study investigated the mechanism of right ventricular failure during bypass of the left side of the heart by precisely assessing right ventricular function with use of a conductance catheter. Bypass of the left side of the heart was established with a centrifugal pump in 10 mongrel dogs weighing 11 to 19 kg. Right ventricular function during left heart bypass was evaluated by two parameters that were both derived from measurement of relative change in right ventricular volume by the conductance catheter technique. One parameter was the right ventricular end-systolic pressure-volume relationship as a load-independent index, and the other was the peak right ventricular pressure-right ventricular stroke volume relationship as a "force-velocity relationship." These parameters were measured in both normal and failing hearts while afterload was increased by bilateral intrapulmonary balloon inflation. Moreover, changes in these relationships were observed by varying assist ratios of left heart bypass from 0% to 100%. Failing heart models were induced by normothermic aortic clamping for 20 minutes. The right ventricular end-systolic pressure-volume relationship in normal hearts did not change, irrespective of the assist ratio of left heart bypass, whereas that in failing hearts decreased from 4.25 +/- 1.41 mm Hg/ml without bypass of the left side of the heart to 3.53 +/- 1.30 mm Hg/ml after 100% assist of left heart bypass (p < 0.05). In the peak right ventricular pressure-right ventricular stroke volume relationship, right ventricular stroke volume was almost constant in normal hearts when afterload was increased regardless of the assist ratio of left heart bypass. Moreover, right ventricular stroke volume was maintained at a higher level during bypass of the left side of the heart compared with that without left heart bypass. However, that slope of the relationship in failing hearts was inversely linear and became significantly steeper after 100% assist of bypass of the left side of the heart compared with that without left heart bypass (-0.131 +/- 0.042 versus -0.051 +/- 0.038, p < 0.005). Therefore ++these two slopes of the relationship intersected at a point that was considered the critical point of afterload during bypass of the left side of the heart. In other words, right ventricular stroke volume was decreased by 100% left heart bypass above the critical point of afterload. In conclusion, this study demonstrates not only that bypass of the left side of the heart results in an increase in right ventricular stroke volume in both normal and failing hearts at the physiologic range of afterload, but also that right ventricular function against higher afterload is impaired by 100% assist of bypass of the left side of the heart in failing hearts.     

Seismic Analysis of Segmental Retaining Walls. I: Model Verification

Block-faced geosynthetic reinforced soil retaining walls, referred to as “segmental” retaining walls, have been extensively used in recent years as permanent civil engineering structures. The disjointed concrete facing blocks are held together through interface friction and concrete keys or mechanical connectors. Because of the disjointed nature of the facing blocks, the design of the segmental wall must consider the available shear resistance between these blocks. Connection capacity must also be considered. Of concern also is the permanent deformation of the segmental wall face following an earthquake. This paper describes a finite-element analysis of a model segmental wall subjected to earthquakelike loading generated by a shake table. The finite-element analysis used the computer program DYNA3D. Results from DYNA3D, using a simple model—Ramberg-Osgood model—to simulate the nonlinear hysteretic behavior of soil, are consistent with observed results from laboratory shake table tests on segmental walls.     

Hepatocellular ATP-binding cassette protein expression enhances ATP release and autocrine regulation of cell volume

In a model liver cell line, recovery from swelling is mediated by a sensitive autocrine pathway involving conductive release of ATP, P2 receptor stimulation, and opening of membrane Cl- channels (Wang, Y., Roman, R. M., Lidofsky, S. D., and Fitz, J. G. (1996) Proc. Natl. Acad. Sci. U. S. A. 93, 12020-12025). However, the mechanisms coupling changes in cell volume to ATP release are not known. Based on evidence that certain ATP-binding cassette (ABC) proteins may function as ATP channels or channel regulators, we evaluated the potential role of ABC proteins by comparing ATP release and volume regulation in rat HTC and HTC-R hepatoma cells, the latter of which overexpress Mdr proteins. In both cell types, Cl- current activation (ICl-swell) and volume recovery following swelling were dependent on conductive ATP efflux. The rate of volume recovery was approximately 6-fold faster in HTC-R cells compared with HTC cells. This effect is likely due to enhanced ABC protein-dependent ATP release since (i) ICl-swell and cell volume recovery were eliminated by inhibition of P-glycoprotein transport (20 microM verapamil and 15 microM cyclosporin A); (ii) swelling-induced Cl- current density was similar in both cell types (approximately -50 pA/pF; not significant); and (iii) ATP conductance measured by whole-cell techniques was increased approximately 3-fold in HTC-R cells compared with HTC cells. Moreover, HTC-R cells exhibited enhanced survival during hypotonic stress. By modulating ATP release, hepatic ABC proteins may play a key role in the cellular pathways coupling changes in cell volume to ion permeability and secretion.     

Halves of epithelial somites and segmental plate show distinct muscle differentiation behavior in vitro compared to entire somites and segmental plate

Medial and lateral halves of the somite are known to differ with respect to their developmental fates: Cells from the medial half of the somite give rise to the epaxial muscle of the back and cells from the lateral half of the somite give rise to the skeletal muscles of the limbs and the ventrolateral body wall. To get a better insight into myogenic determination of somite hemispheres, isolated entire somites as well as medial and lateral parts of somites and of segmental plate from 2 day chick embryos were explanted in vitro. These parts of the paraxial mesoderm were also cocultured in contact with somite surrounding tissues such as neural tube lacking floorplate, neural tube including notochord-floorplate complex, and intermediate mesoderm, which were examined with respect to their muscle promoting or inhibiting influences. Skeletal muscle differentiation was monitored by the use of anti-myosin heavy chain antibody (MF20). It is shown that medial and lateral halves of segmental plate and epithelial somites are capable of undergoing myogenesis in the absence of axial organs. In contrast, cultures of intact segmental plate and epithelial somites from the same levels did not show muscle differentiation. Neural tube lacking floorplate promoted muscle differentiation in the medial halves especially of epithelial somites and also of segmental plate, but not in the lateral halves of the paraxial mesoderm at these levels. Intermediate mesoderm was found to inhibit muscle differentiation in medial and lateral halves of segmental plate and of epithelial somites. We further demonstrate that the arrangement of the myoblasts within tissue cultures is influenced by the presence or absence of axial organs.     

The importance of slice location on the accuracy of aortic regurgitation measurements with magnetic resonance phase velocity mapping

Although several methods have been used clinically to evaluate the severity of aortic regurgitation, there is no purely quantitative approach for aortic regurgitant volume (ARV) measurements. Magnetic resonance phase velocity mapping can be used to quantify the ARV, with a single imaging slice in the ascending aorta, from through-slice velocity measurements. To investigate the accuracy of this technique, in vitro experiments were performed with a compliant model of the ascending aorta. Our goals were to study the effects of slice location on the reliability of the ARV measurements and to determine the location that provides the most accurate results. It was found that when the slice was placed between the aortic valve and the coronary ostia, the measurements were most accurate. Beyond the coronary ostia, aortic compliance and coronary flow negatively affected the accuracy of the measurements, introducing significant errors. This study shows that slice location is important in quantifying the ARV accurately. The higher accuracy achieved with the slice placed between the aortic valve and the coronary ostia suggests that this slice location should be considered and thoroughly examined as the preferred measurement site clinically.     

Effect of Ice Sheet on Stochastic Response of Offshore Wind Turbine–Seawater–Soil Interaction Systems Subjected to Random Seismic Excitation

To investigate the effect of the presence of surrounding ice sheet on the stochastic response of offshore wind turbines subjected to random seismic excitation, this research uses a three-dimensional, numerical, finite-element model that includes viscous boundaries. The model of the ice–seawater–offshore wind turbine–soil interaction system uses the Lagrangian fluid (displacement-based) and solid-quadrilateral-isoparametric finite elements. Random seismic excitation from a filtered white-noise model and applied to each support point of the three-dimensional finite-element model of the coupled interaction system provides the experimental environment. A parametric study examines the effects of both the presence of and variation in mechanical and geometric properties of the surrounding ice sheet on the stochastic response of offshore wind turbines. The investigation also includes the effect of the wind turbine’s wall thickness in relation to the ice sheet on the stochastic seismic response of the coupled interaction system.     

Seismic Analysis of Segmental Retaining Walls.?II: Effects of Facing Details

This paper describes a finite-element analysis of two 6-m-high segmental walls, subjected to seismic loading, with special attention to connection performance and permanent deformation of the facing. The first segmental wall uses concrete facing blocks with pins, and the second wall uses the same concrete blocks but without pins. The analysis provides some insight into the behavior of segmental walls, particularly the load transfer mechanism between the geosynthetic reinforcement and the segmental facing units duiring earthquake loading.     

Desflurane, sevoflurane, and isoflurane impair canine left ventricular-arterial coupling and mechanical efficiency

BACKGROUND: The effects of desflurane, sevoflurane, and isoflurane on left ventricular-arterial coupling and mechanical efficiency were examined and compared in acutely instrumented dogs. METHODS: Twenty-four open-chest, barbiturate-anesthetized dogs were instrumented for measurement of aortic and left ventricular (LV) pressure (micromanometer-tipped catheter), dP/dtmax, and LV volume (conductance catheter). Myocardial contractility was assessed with the end-systolic pressure-volume relation (Ees) and preload recruitable stroke work (Msw) generated from a series of LV pressure-volume diagrams. Left ventricular-arterial coupling and mechanical efficiency were determined by the ratio of Ees to effective arterial elastance (Ea; the ratio of end-systolic arterial pressure to stroke volume) and the ratio of stroke work (SW) to pressure-volume area (PVA), respectively. RESULTS: Desflurane, sevoflurane, and isoflurane reduced heart rate, mean arterial pressure, and left ventricular systolic pressure. All three anesthetics caused similar decreases in myocardial contractility and left ventricular afterload, as indicated by reductions in Ees, Msw, and dP/dtmax and Ea, respectively. Despite causing simultaneous declines in Ees and Ea, desflurane decreased Ees/Ea (1.02 +/- 0.16 during control to 0.62 +/- 0.14 at 1.2 minimum alveolar concentration) and SW/PVA (0.51 +/- 0.04 during control to 0.43 +/- 0.05 at 1.2 minimum alveolar concentration). Similar results were observed with sevoflurane and isoflurane. CONCLUSIONS: The present findings indicate that volatile anesthetics preserve optimum left ventricular-arterial coupling and efficiency at low anesthetic concentrations (< 0.9 minimum alveolar concentration); however, mechanical matching of energy transfer from the left ventricle to the arterial circulation degenerates at higher end-tidal concentrations. These detrimental alterations in left ventricular-arterial coupling produced by desflurane, sevoflurane, and isoflurane contribute to reductions in overall cardiac performance observed with these agents in vivo.     

Tracheal replacement with cryopreserved tracheal allograft: experiment in dogs

The purpose of this study was to assess the feasibility of a newly developed field inhomogeneity catheter for interventional MRI in vivo. Different prototypes of a field inhomogeneity catheter (pigtail and multipurpose configuration, balloon catheters) were investigated in pigs. The catheters were introduced in Seldinger technique via the femoral vessels over a guidewire on an interventional MR system (Philips Gyroscan NT combined with a C-arm fluoroscopy unit [Philips BV 212]). Catheters were placed in veins and arteries. The catheter position was controlled by a fast gradient-echo sequence (turbo field echo [TFE]). Catheters were introduced over a guidewire without complications in all cases. Using the field inhomogeneity concept, catheters were easily visualized in the inferior vena cava and the aorta by the fast gradient-echo technique on MR in all cases. Although aortic branches were successful cannulated, the catheters were not well displayed by the TFE technique due to the complex and tortuous anatomy. All animals survived the experiments without complications. MR-guided visualization of a field inhomogeneity catheter is a simple concept that can be realized on each MR scanner and may allow intravascular MR-guided interventions in future.     

Stochastic Finite Elements with Multiple Random Non-Gaussian Properties

The spectral formulation of the stochastic finite-element method is applied to the problem of heat conduction in a random medium. Specifically, the conductivity of the medium, as well as its heat capacity are treated as uncorrelated random processes with spatial random fluctuations. Using the spectral stochastic finite-element method, this paper analyzes the sensitivity of heat conduction problems to probabilistic models of random data. In particular, both the thermal conductivity and the heat capacity of the medium are assumed to be uncertain. The implementation of the method is demonstrated for both Gaussian and lognormal material properties, modeled either as random variables or random processes.     

Polyvinylidene fluoride monofilament sutures: can they be used safely for long-term anastomoses in the thoracic aorta?

Polyvinylidene fluoride (PVDF) represents an attractive alternative to polypropylene as a monofilament vascular suture because of its satisfactory physicochemical properties, it ease of handling, and its good biocompatibility. However, the polymer's ability to remain mechanically and chemically stable when exposed to a mild hydrolytic environment over the long term has yet to be demonstrated. One in vitro study involved the comparison of the long-term relative resistance of PVDF and polypropylene sutures to hydrolysis for a period of 9 years. The PVDF suture showed major molecular rearrangements from the original ratio of three crystalline structures to the single beta crystalline phase. The observation of some surface oxidation and water inhibition did not significantly modify the tensile strength of the PVDF suture, which retained 92.5% of its original value. In contrast, the polypropylene sample did not undergo any recrystallization but was associated with more oxidation byproducts and more water molecules near the surface, which contributed to a 46.6% loss in initial tensile strength. An in vivo study confirmed that PVDF sutures are biocompatible and are able to maintain satisfactory biostability when used to anastomose thoracic aortic allografts for a period of 6 months in the dog. The cellular reaction of fresh allografts as well as the control autografts to PVDF sutures was minimal. In other allografts that had been preserved in a supplemented medium for 1 week prior to implantation, the PVDF sutures healed satisfactorily with the formation of neocollagen and few macrophages surrounding the monofilament. No evidence of instability at the allograft-host artery junction was observed, confirming that the PVDF sutures were able to ensure a secure anastomosis in the thoracic aorta. PVDF sutures have demonstrated superior long-term biostability in vitro and minimal tissue response in vivo. These are two essential requirements when evaluating the use of a suture for vascular surgery in general and thoracic aortic surgery in particular.