Cardiovascular Engineering (dordrecht, Netherlands)最新文献

Pulmonary dysfunction with impairment of lung function and oxygenation is one of the most serious problems in the early postoperative period after cardiac surgery. In this study we investigated the effect of alveolar recruitment strategy during cardiopulmonary bypass on postoperative gas exchange and lung function. This prospective randomized study included 32 patients undergoing elective myocardial revascularization with cardiopulmonary bypass. In 16 patients 5 cm H(2)O of positive end-expiratory pressure was applied after intubation and maintained until extubation (Group I). In the other 16 patients (group II) a positive end expiratory pressure (PEEP) of 5 cm H(2)O was maintained as well but was increased to 14 cm H(2)O every 20 min for 2 min during cross clamp. Measurements were taken preoperatively, before skin incision, before and after (3, 24, 48 h) cardiopulmonary bypass and before discharge (6th postoperative day). Postoperative gas exchange, extravascular lung water and lung function showed no significant difference between the groups. Postoperative pulmonary function variables were lower in both groups compared to baseline values. In patients with normal preoperative pulmonary function, application of an alveolar recruitment strategy during cardiopulmonary bypass does not improve postoperative gas exchange and lung function after cardiac surgery.

A new method is proposed for estimation of nonlinear elastic properties of soft tissues. The proposed approach involves a combination of nonlinear finite element methods with a genetic algorithm for estimating tissue stiffness profile. A multipoint scheme is introduced that satisfies the uniqueness condition, improves the estimation performance, and reduces the sensitivity to image noise. The utility of the proposed techniques is demonstrated using optical coherence tomography (OCT) images. The approach is, however, applicable to other imaging systems and modalities, as well, provided a reliable image registration scheme. The proposed algorithm is applied to realistic (2D) and idealized (3D) arterial plaque models, and proves promising for the estimation of intra-plaque distribution of nonlinear material properties.

In this paper, we present design of a transdermal drug delivery system for treatment of cardiovascular or hemodynamic disorders such as hypertension. The system comprises of integrated control electronics and microelectromechanical system devices such as micropump, micro blood pressure sensor and microneedle array. The objective is to overcome the limitations of oral therapy such as variable absorption profile and the need for frequent dosing, by fabricating a safe, reliable and cost effective transdermal drug delivery system to dispense various pharmacological agents through the skin for treatment of hemodynamic dysfunction such as hypertension. Moreover, design optimization of a piezoelectrically actuated valveless micropump is presented for the drug delivery system. Because of the complexity in analysis of piezoelectric micropump, which involves structural and fluid field couplings in a complicated geometrical arrangement, finite element (FE) numerical simulation rather than an analytical system has been used. The behavior of the piezoelectric actuator with biocompatible polydimethylsiloxane membrane is first studied by conducting piezoelectric analysis. Then the performance of the valveless micropump is analyzed by building a three dimensional electric-solid-fluid model of the micropump. The effect of geometrical dimensions on micropump characteristics and efficiency of nozzle/diffuser elements of a valveless micropump is investigated in the transient analysis using multiple code coupling method. The deformation results of the membrane using multifield code coupling analysis are in good agreement with analytical as well as results of single code coupling analysis of a piezoelectric micropump. The analysis predicts that to enhance the performance of the micropump, diffuser geometrical dimensions such as diffuser length, diffuser neck width and diffuser angle need to be optimized. Micropump flow rate is not strongly affected at low excitation frequencies from 10 to 200 Hz. The excitation voltage is the more dominant factor that affects the flow rate of the micropump as compared with the excitation frequency. However, at extremely high excitation frequencies beyond 8,000 Hz, the flow rate drops as the membrane exhibits multiple bending peaks which is not desirable for fluid flow. Following the extensive numerical analysis, actual fabrication and performance characterization of the micropump is presented. The performance of the micropump is characterized in terms of piezoelectric actuator deflection and micropump flow rate at different operational parameters. The set of multifield simulations and experimental measurement of deflection and flow rate at varying voltage and excitation frequency is a significant advance in the study of the electric-solid-fluid coupled field effects as it allows transient, three dimensional piezoelectric and fluid analysis of the micropump thereby facilitating a more realistic multifield analysis. The results of

Connection to a 60-Hz or other voltage source can result in cardiac dysrhythmias, a startle reaction, muscle contractions, and a variety of other physiological responses. Such responses can lead to injury, especially if significant ventricular cardiac dysrhythmias occur, or if a person is working at some height above ground and falls as a result of a musculoskeletal response. Physiological reactions are known to relate to intensity and duration of current exposure. The connection current that flows is a function of the applied voltage at the instant of connection, and the electrical impedance encountered by the voltage source in contact with the skin or other body tissues. In this article we describe a rarely investigated phenomenon, namely a contact, or connection, current spike that is many times higher than the steady-state current. This current spike occurs when an electrical connection is made at a non-zero voltage time in a sine wave or other waveform. Such current spikes may occur when electronic or manual switching or connecting of conductors occurs in electronic instrumentation connected to a patient. These findings are relevant to medical devices and instrumentation and to electrical safety in general.

Computer simulation is an important tool to study the interaction between rotary blood pumps (RBPs) and human circulatory system. This interaction is critical for the development of reliable physiological control systems of long-term RBPs. This paper presents a numerical model of the human circulatory system, which innovatively takes the muscle pump into account in dynamic exercise. Simulation results demonstrate that the inclusion of muscle pump will change the response of hemodynamic variables and RBP parameters. These findings also show the necessity to verify the performance of RBPs and their physiological control systems in dynamic exercise with the muscle pump taken into account. By using Matlab Simulink software to simulate real-time circulatory properties, this study provides the bench-top test environment for long-term RBPs and their physiological controller.

The objective of this 14-pig study was designed to determine the amount of lung ventilation obtainable by only rhythmic chest compression (100/min, 100 lbs). Tidal volume (TV), dead space (DS), and respiration rate (R) were measured with normal breathing and with rhythmic chest compression during ventricular fibrillation. The ratio of TV/DS was calculated in both cases. For normal breathing the ratio was 2.54 +/- 0.68; for chest compression breathing the ratio was 0.80 +/- 0.07. Minute alveolar ventilation (TV - DS)R was computed for both cases. With spontaneous breathing, the minute alveolar volume was 5.48 +/- 2.1 l/min. With only chest-compression breathing, the alveolar ventilation was -1.49 +/- 0.64 l/min. The negative minute alveolar volume and fractional ratio reveals that TV was less than the dead space indicating that chest-compression alone does not ventilate the lungs.

The wavelet transform-based correlation analysis has been used to study skin temperature fluctuations caused by periodic changes in blood flow resulting from oscillations in vasomotor smooth muscle tone. We considered two cases, one in which temperature measurements and blood flow recordings by laser Doppler flowmetry are made simultaneously and another in which two temperature signals are measured concurrently. Twelve healthy subjects participated in our study. The gapped wavelet technique was used to suppress artifacts caused by boundary effects. Simultaneous recordings of skin temperature fluctuations and the signal of the laser Doppler flowmeter provided correlation coefficients essentially exceeding the values obtained for noise signals within three spectral ranges corresponding to myogenic (0.05-0.14 Hz), neurogenic (0.02-0.05 Hz), and endothelial (0.0095-0.02 Hz) regulation mechanisms. Within the frequency range from 0.14 to 2 Hz the values of the correlation function are compatible with the values of noise correlations. The same results were obtained for two concurrently measured temperature signals. Reduction in the amplitude of temperature fluctuations and in the level of correlations with the frequency arises because the skin has the properties of a low-frequency filter. As temperature fluctuations propagate their amplitude decays as an exponential function of frequency. Hence small oscillations in the spectral range reflecting the influence of heartbeat and respiration cannot be distinguished from external thermal noise.

A thorough understanding of ventricular interaction and the effects of septal function on right and left ventricular performance in the human heart requires measurement of interventricular pressure gradients using high fidelity pressure transducers. The advent of newer echocardiographic techniques provides an opportunity to combine high resolution images with bi-ventricular catheterization data in the cardiac catheterization laboratory, and obtain the detailed hemodynamic and echocardiographic information necessary to more fully understand the clinical manifestations of normal and abnormal septal and free wall mechanical function. We have anticipated these developments and modified the description of heart mechanics in our integrated multi-scale model of the human cardio-respiratory system (H-CRS) to closely analyze how the mechanical properties of the inter-ventricular septum affect the work, energy utilization, and oxygen consumption of the atria, ventricles, septum, and each ventricular free wall. Combined with the H-CRS model, these modifications allow one to observe how tissue properties of the septum affect the entire heart and circulation. For example, the normal septum transfers energy from the left to the right ventricle, and assists the pre-load of both, acting as a third pump. Diseases that increase septal elastance cause abnormalities resembling left ventricular diastolic dysfunction (LVDD), including a decrease in cardiac output and an increase in pulmonary pressures despite a normal left ventricular ejection fraction. Similar applications of the H-CRS model to other regional disorders such as hypertrophic obstructive cardiomyopathy and myocardial infarction might likewise allow one to study their clinical implications in greater detail.

The esophageal Doppler monitor (EDM) is a clinically useful device for minimally invasive assessment of cardiac output, preload, afterload, and contractility. An empirical model, based upon the logistic function, has been developed. Use of this model illustrates how the EDM could estimate the net effect of aortic and non-aortic contributions to inertia, resistance, and elastance within real time. This is based on an assumed mechanical impedance conceptually resembling that of a series arrangement of a spring, mass, and dashpot. In addition, when used with an invasive radial arterial catheter, the EDM may also estimate aortic pulse wave velocity, as well as aortic characteristic impedance, and characteristic volume. Approximations of left ventricular stroke work and stroke power can also be made. Furthermore, the effects of inertia, resistance, and elastance, on mean blood pressure during systole, can be quantified. These additional parameters could offer insight for clinicians, as well as researchers, and may be beneficial in further examining and utilizing clinical hemodynamics with the EDM. These additional measurements also underscore the need to integrate the EDM with existing and future monitoring equipment.

In this paper we compare several approaches to identifying certain key respiratory control parameters relying on data normally available from non-invasive measurements. We consider a simple model of the respiratory control system and describe issues related to numerical estimates of key parameters involved in respiratory function such as central and peripheral control gains, transport delay, and lung compartment volumes. The combination of model-specific structure and limited data availability influences the parameter estimation process. Methods for studying how to improve the parameter estimation process are examined including classical and generalized sensitivity analysis, and eigenvalue grouping. These methods are applied and compared in the context of clinically available data. These methods are also compared in conjunction with specialized tests such as the minimally invasive single-breath CO2 test that can improve the estimation, and the enforced fixed breathing test, which opens the control loop in the system. The analysis shows that it is impossible to estimate central and peripheral gain simultaneously without usage of ventilation measurement and a controlled perturbation of the respiratory system, such as the CO2 test. The numerical results are certainly model dependent, but the illustrated methods, the nature of the comparisons, and protocols will carry over to other models and data configurations.