PubMed Health⌕ Search

Biomedical subjects

Pascal Verdonck

Publications and source records attributed to Pascal Verdonck.

At least 37 records · Page 2Linked to original sources
PubMed2004

RF-based two-dimensional cardiac strain estimation: a validation study in a tissue-mimicking phantom.

Strain and strain rate imaging have been shown to be useful techniques for the assessment of cardiac function. However, one of the major problems of these techniques is their angle dependency. In order to overcome this problem, a new method for estimating the strain (rate) tensor had previously been proposed by our lab. The aim of this study was to validate this methodology in a phantom setup. A tubular thick-walled tissue-mimicking phantom was fixed in a water tank. Varying the intraluminal pressure resulted in a cyclic radial deformation. The 2D strain was calculated from the 2D velocity estimates, obtained from 2D radio frequency (RF) tracking using a 1D kernel. Additionally, ultrasonic microcrystals were implanted on the outer and inner walls of the tube in order to give an independent measurement of the instantaneous wall thickness. The two methods were compared by means of linear regression, the correlation coefficient, and Bland-Altman statistics. As expected, the strain estimates dominated by the azimuth velocity component were less accurate than the ones dominated by the axial velocity component. Correlation coefficients were found to be r = 0.78 for the former estimates and r = 0.83 was found for the latter. Given that the overall shape and timing of the 2D deformation were very accurate (r = 0.95 and r = 0.84), these results were within acceptable limits for clinical applications. The 2D RF-tracking using a 1D kernel thus allows for 2D, and therefore angle-independent, strain estimation.

Algorithms↗
PubMed2004

Assessment of stenosis in vascular access grafts.

The major complication that occurs with grafts used as vascular access for hemodialysis, is stenosis at the venous anastomosis or in the draining vein. 75% area stenosis is considered significant as thrombotic occlusion may occur. The aim of this experimental study was to evaluate invasive and noninvasive indices to detect significant stenoses in a vascular access graft. A compliant underarm loop graft in vitro model was built and studied with 50, 65, 80, and 90% stenosis at flow rates of 500, 1000, and 1500 mL/min. Flow in the system was pulsatile. Velocity was measured with ultrasound Doppler and the pressure was measured invasively. The resistance index (RI), p(venous line)/MAP, and the newly introduced pressure ratio (PR) were calculated and compared. A stenosis can be suspected when a high frequency ultrasound velocity signal develops at the venous anastomosis. RI > 1 confirms a very severe stenosis (90%). The parameter PR < 8% confirms significant stenoses showing its clinical relevancy.

Anastomosis, Surgical↗
PubMed2004

Prediction of the clinical performance of adult arterial cannulas.

The choice of an arterial cannula for cardiac surgery is often difficult. The clinician has to rely on the pressure-flow diagrams provided by the manufacturer that are all produced using water. The conversion of these water data to representative clinical conditions is often difficult if not impossible. In this in vivo study the theory of dynamic similarity is applied to scale the manufacturer's data to the clinical situation, in order to predict the pressure drop desired by the cardiac surgeon. Three hundred and forty-seven samples of pressure drop are obtained in 58 patients. Patients are grouped according to cannula size (20, 22, and 24 Fr). Very good correlation is found between measured and predicted values (r = 0.93; 0.86; 0.87 for 20; 22; 24 Fr). As a result, windows of optimal performance are constructed for each cannula diameter. This technique also allows the construction of an online recommendation for signaling abnormal cannula performance during cardiac surgery.

Adult↗
PubMed2004

The impact of pump speed and inlet cannulation site on left ventricular unloading with a rotary blood pump.

BACKGROUND: Ventricular assist devices are gaining ground in the therapeutic treatment of chronic heart failure. These devices are sometimes used as a bridge to recovery by unloading the left ventricle (LV) and restoring its function. It is therefore important to preserve the heart muscle and apply less invasive implantation methods. METHODS: In this study ventricular unloading was achieved in 7 healthy sheep with a rotary blood pump at different pump flow levels. Ventricular cannulation via the left atrium (LA) and through the mitral valve was compared to atrial cannulation. The unloading of the heart was assessed with LV pressure-volume loops, derived energetic parameters, and an estimate of LV wall stress. RESULTS: No significant difference between the cannulations was found for any flow or pressure. LA cannulation, however, resulted in significantly lower stroke volumes and stroke work for all pump flow levels. Irrespective of cannulation site, LV volumes and energetic parameters showed a significant decrease with increasing pump flow. CONCLUSION: LV assist with a rotary blood pump can provide sufficient unloading with atrial cannulation.

Animals↗
PubMed2004

In vitro assessment of the unloading and perfusion capacities of the PUCA II and the IABP.

The PUCA II pump is a minimally invasive intra-arterial left ventricular assist device that can be used as an alternative for the intra-aortic balloon pump (IABP). In this study, we assessed the cardiac unloading and organ perfusion capacities of both PUCA II and IABP in an in vitro set up, consisting of a heart simulator and a silicone arterial tree, mimicking anatomical geometry and flow distribution. The IABP was positioned in the descending aorta, while the PUCA II was tested both in 'trans-aortic' and 'abdominal' positions. All devices were driven by the same Arrow AutoCat IABP driver at different pump rates. Apart from flow, arterial pressure and pulse pressure, we also calculated haemodynamic indices for myocardial oxygen supply and demand. The 'abdominal' PUCA II assist and the IABP both provide mild unloading of the heart, and a limited improvement of arterial pressure and flow. The 'trans-aortic' PUCA II assist greatly enhances flow and pressure, but does not unload the heart properly in the tested configuration.

Animals↗
PubMed2003

Determinants of left ventricular preload-adjusted maximal power.

Maximal left ventricular (LV) hydraulic power output (PWR(max)), corrected for preload as PWR(max)/(V(ed))(beta) (where V(ed) is the end-diastolic volume and beta is a constant coefficient), is an index of LV contractility. Whereas preload-adjusted maximal power (PAMP) is usually calculated with beta = 2, there is uncertainty about the optimal value of beta (beta = 1 for the normal LV and 2 for the dilated LV). The aim of this work is to study the determining factors of beta. The data set consisted of 245 recordings (steady state and vena cava occlusion) in 10 animals in an ischemic heart pig model. The occlusion data yielded the slope (E(es); 2.01 +/- 0.77 mmHg/ml, range 0.71-4.16 mmHg/ml) and intercept (V(0); -11.9 +/- 22.6 ml; range -76 to 39 ml) of the end-systolic pressure-volume relation, and the optimal beta-factor (assessed by fitting an exponential curve through the V(ed)-PWR(max) relation) was 1.94 +/- 0.88 (range 0.29-4.73). The relation of beta with V(ed) was weak [beta = 0.60 + 0.02(V(ed)); r(2) = 0.20]. In contrast, we found an excellent exponential relation between V(0) and beta [beta = 2.16e(0.0189(V(0))), r(2) = 0.70]. PAMP, calculated from the steady-state data, was 0.64 +/- 0.40 mW/ml(2) (range 0.14-2.83 mW/ml(2)) with a poor correlation with E(es) (r = 0.30, P < 0.001). An alternative formulation of PAMP as PWR(max)/(V(ed) - V(0))(2), incorporating V(0), yielded 0.47 +/- 0.26 mW/ml(2) (range 0.09-1.42 mW/ml(2)) and was highly correlated with E(es) (r = 0.89, P < 0.001). In conclusion, correct preload adjustment of maximal LV power requires incorporation of V(0) and thus of data measured under altered loading conditions.

Animals↗
PubMed2003

Unloading effect of a rotary blood pump assessed by mathematical modeling.

Due to the increased appeal of rotary blood pumps for long-term cardiac assist, we conducted a study of their capacity to unload the left ventricle (LV). We used a validated mathematical model of the cardiovascular system and implemented the pump characteristics of an investigational microdiagonal pump (Medos). The influence of the pump on systemic hemodynamics, LV energetic parameters, and wall stress was evaluated in continuous and synchronous pulsatile modes of operation. For the continuous mode simulations, the influence of heart rate, LV contractility, and pump speed was assessed in a parametric study. For the pulsatile mode, different onsets of a synchronous time-varying pump speed pattern were tested. Our data indicate that the effectiveness of unloading in continuous mode depends on the contractility of the native ventricle. Hypocontractile ventricles are most easily unloaded, while ventricles with moderate contractility require high continuous pump speeds to achieve notable unloading. In pulsatile mode, the pump timing is an important determinant of pump/cardiovascular system interaction, with a counterpulsation setting yielding the best unloading.

Biomechanical Phenomena↗
PubMed2003

Validation of gated blood-pool SPECT cardiac measurements tested using a biventricular dynamic physical phantom.

UNLABELLED: We have developed a biventricular dynamic physical cardiac phantom to test gated blood-pool (GBP) SPECT image-processing algorithms. Such phantoms provide absolute values against which to assess accuracy of both right and left computed ventricular volume and ejection fraction (EF) measurements. METHODS: Two silicon-rubber chambers driven by 2 piston pumps simulated crescent-shaped right ventricles wrapped partway around ellopsoid left ventricles. Twenty experiments were performed at Ghent University, for which right and left ventricular true volume and EF ranges were 65-275 mL and 55-165 mL and 7%-49% and 12%-69%, respectively. Resulting 64 x 64 simulated GBP SPECT images acquired at 16 frames per R-R interval were sent to Columbia University, where 2 observers analyzed images independently of each other, without knowledge of true values. Algorithms automatically segmented right ventricular activity volumetrically from left ventricular activity. Automated valve planes, midventricular planes, and segmentation regions were presented to observers, who accepted these choices or modified them as necessary. One observer repeated measurements >1 mo later without reference to previous determinations. RESULTS: Linear correlation coefficients (r) of the mean of the 3 GBP SPECT observations versus true values for right and left ventricles were 0.80 and 0.94 for EF and 0.94 and 0.95 for volumes, respectively. Correlations for right and left ventricles were 0.97 and 0.97 for EF and 0.96 and 0.89 for volumes, respectively, for interobserver agreement and 0.97 and 0.98 for EF and 0.96 and 0.90 for volumes, respectively, for intraobserver agreement. No trends were detected, though volumes and right ventricular EFs were significantly higher than true values. CONCLUSION: Overall, GBP SPECT measurements correlated strongly with true values. The phantom evaluated shows considerable promise for helping to guide algorithm developments for improved GBP SPECT accuracy.

Computer Simulation↗
PubMed2002

Preload-adjusted maximal power of right ventricle: contribution of end-systolic P-V relation intercept.

To assess whether preload-adjusted maximal power (PAMP), which is calculated as W(max)/V (where W(max) is maximal power and V(ed) is end-diastolic volume with beta = 2) is an index of right ventricular (RV) contractility, we measured RV pressure (P) and volume (V) and pulmonary artery pressure and flow in 10 dogs at baseline and after inotropic stimulation. PAMP was derived from steady-state data, whereas the slope (E(es)) and intercept (V(d)) of the end-systolic P-V relationship were derived from data obtained during vena caval occlusion. Inotropic stimulation increased E(es) (from 0.96 +/- 0.25 to 1.62 +/- 0.28 mmHg/ml; P < 0.001) and V(d) (from -3.0 +/- 17.2 to 12.4 +/- 10.8 ml; P < 0.05) but not PAMP (from 0.24 +/- 0.10 to 0.36 +/- 0.22 mW/ml(2); P = 0.09). We found a strong relationship between the optimal beta-factor for preload adjustment and V(d). A corrected PAMP, PAMP(c) = W(max)/(V(ed) - V(d))(2), which incorporated the V(d) dependency, was sensitive to the inotropic changes (from 0.23 +/- 0.12 to 0.54 +/- 0.17 mW/ml(2); P < 0.001) with a good correlation with E(es) (r = 0.88; P < 0.001).

Animals↗
PubMed2002

Numerical calculation of hemolysis levels in peripheral hemodialysis cannulas.

Hemolysis in extracorporeal life support systems presents an underestimated problem. In this article, we investigate the hemolytic potential of peripheral hemodialysis cannulas numerically. An axisymmetrical finite element model of 3 cannula sizes was built (13G, 14G, and 16G) that was refined sufficiently in the vicinity of the cannula tip to compute accurately scalar shear stresses. Scalar shear stresses were utilized in Giersiepen's equation to calculate the red blood cell damage (RBD) along streamlines. The streamlines were chosen such that they bound a percentage of the blood flow through the cannula. By integration of the RBD results, the total damage of the cannula was determined and expressed in modified index of hemolysis for comparison with published results. Calculated RBD was overestimated by Giersiepen's equation. The ranking of the cannulas according to their hemolytic potential was preserved. This indicates that power-law equations may be suited for hemolysis prediction of laminar flow devices.

Blood Flow Velocity↗
PubMed2002

Computational flow modeling in hollow-fiber dialyzers.

A three-dimensional finite volume model of the blood-dialysate interface over the complete length of the dialyzer was developed. Different equations govern dialyzer flow and pressure distribution (Navier-Stokes) and radial transport (Darcy). Blood was modeled as a non-Newtonian fluid with a viscosity varying in radial and axial direction determined by the local hematocrit, the diameter of the capillaries, and the local shear rate. The dialysate flow was assumed to be an incompressible, isothermal laminar Newtonian flow with a constant viscosity. The permeability characteristics of the membrane were calculated from laboratory tests for forward and backfiltration. The oncotic pressure induced by the plasma proteins was implemented as well as the reduction of the overall permeability caused by the adhesion of proteins to the membrane. From the calculated pressure distribution, the impact of flow, hematocrit, and capillary dimensions on the presence and localization of backfiltration can be investigated.

Blood Flow Velocity↗
PubMed2002

Arterial elastance and heart-arterial coupling in aortic regurgitation are determined by aortic leak severity.

BACKGROUND: In aortic valve regurgitation (AR), aortic leak severity modulates left ventricle (LV) arterial system interaction. The aim of this study was to assess (1) how arterial elastance (E(a)), calculated as the ratio of LV end-systolic pressure and stroke volume, relates to arterial properties and leak severity and (2) the validity of E(a)/E(max) (with E(max) the slope of the end-systolic pressure-volume relation) as a heart-arterial coupling parameter in AR. METHODS AND RESULTS: Our work is based on human data obtained from a study on vascular adaptation in chronic AR. These data allowed us to assess the parameters of a computer model of heart-arterial interaction. In particular, total peripheral resistance (R) and aortic leak severity--expressed as leak resistance (R(L,ao))--were quantified for different patient subgroups (group I/IIa/IIb: E(max) = 2.15/0.62/0.47 mm Hg/mL; E(a) = 1.24/0.66/0.90 mm Hg/mL; R = 1.9/0.6/0.85 mm Hg.s/mL, R(L,ao) = 0.35/0.05/0.20 mm Hg.s/mL). A parameter study demonstrated that R(L,ao) was the main determinant of E(a). With all other parameters constant, valve repair would increase E(a) to 2.81, 1.08, and 1.54 mm Hg/mL in groups I, IIa, and IIb, respectively. For a given E(a)/E(max), LV pump efficiency (estimated as the ratio of stroke work and LV systolic pressure-volume area) was lower than the theoretical predicted value, except for the simulations with intact aortic valve. CONCLUSIONS: In AR, E(a) is determined by aortic leak severity rather than by arterial system properties. Using E(a)/E(max) as a coupling parameter in general or as a mechanico-energetic regulatory parameter in particular is questionable.

Aortic Valve Insufficiency↗
PubMed2002

Development and modelling of arterial applanation tonometry: a review.

Arterial tonometry allows non-invasive and continuous registration of the arterial pressure waveform, by applanating (flattening) a superficial artery supported by bone with an external transducer. Inspired by ocular tonometry used for eye disease diagnosis, G.L. Pressman and P.M. Newgard built the first arterial tonometer in 1963, and derived a discrete, linear mechanical model. Accuracy remained poor until new sensor production techniques (silicon technology) arrived. G.M. Drzewiecki et al. published a second, more elaborate theoretical model for tonometer positioning in 1983. Few years later, the first modern tonometers were commercialised. Although the problems of sensor positioning, motion artefacts and calibration still exist, the tonometer has proven its usefulness in arterial compliance and hypertension studies. Attention should now go to analysis of the arterial pressure waveforms, and the combination with other signals (e.g. flow wave morphology) to allow a complete non-invasive haemodynamical description of the heart and the arterial tree.

Arteries↗
PubMed2002

Excessive pressure in multichambered cuffs used for sequential compression therapy.

BACKGROUND AND PURPOSE: Pneumatic compression devices, used as part of the therapeutic strategy for lymphatic drainage, often have cuffs with multiple chambers that are inflated sequentially. The purpose of this study was to investigate (1) the relationship between cuff chamber pressure (P(chamber)) and the pressure on the cuff-skin interface (P(interface)) and (2) the mechanical interaction of cuff chambers and consequences for device control. SUBJECTS AND METHODS: In this study, we used 3 cylindrical (60-, 80-, and 100-mm-diameter) model limbs and 1 ellipsoidal model of the arm to test a commercially available pressure controller using "target pressures," indicated by the controller, of 30, 60, 80, and 100 mm Hg. We studied the time course of P(chamber) and P(interface) during the inflation sequence and the effect of local curvature on P(interface). RESULTS: Our data indicated that, overall, P(interface) is of the same order of magnitude as P(chamber). There was some effect of model diameter and shape, with the smaller curvatures yielding the highest P(interface). Cuff chamber interaction led to P(chamber) and P(interface) values in the most distal (first inflated) chamber that were up to 80% higher than the target pressure. For the 80-mm cylindrical model, for instance, pressure in this chamber reached 54, 98, 121, and 141 mm Hg, respectively, instead of the 30, 60, 80, and 100 mm Hg indicated by the controller. DISCUSSION AND CONCLUSION: The discrepancy between the target pressure, indicated by the controller, and the pressure measured inside the cuff chambers undermines the therapeutic control and efficacy of the pneumatic compression devices. Because the measured pressures were far beyond the pressure level indicated by the controller, it is recommended that pneumatic compression devices be used at much lower target pressures (<30 mm Hg) than those applied in clinical practice.

Analysis of Variance↗
PubMedDate not supplied

Experimental analysis of the hemodynamics in punctured vascular access grafts.

The hemodynamics in the vascular access graft are influenced by the flow aspirated and injected through the two needles during hemodialysis. For the first time, the impact of needle flow on vascular access performance, measured in an in vitro set up, is reported. A vascular access model, consisting of a loop polytetrafluoroethylene graft sewn to a compliant artery and vein, simulated the patient. The extracorporeal circuit was connected to the model. Three mean access flow rates (QG; 500, 1,000, and 1,500 ml/min) and five roller pump flow rates (Q(R); 0, 200, 300, 400, and 500 ml/min) were studied. Mean, systolic, and diastolic pressure and according pressure drops were derived at 14 loci. Systolic, diastolic, and mean pressures drop along the graft decreased with increasing Q(R) and decreasing Q(G). At Q(R) = 500 ml/min and Q(G) = 500 ml/min, the mean pressure drop over the graft was negative (-10 mm Hg), indicating a reversed pressure profile, originating at the puncture site of the venous needle. Mean pressure in the venous outlet segment was about 100 mm Hg compared with only 75 mm Hg without needle flow. The combination of a low Q(G) (500 ml/min) and high Q(R) (> 300 ml/min) must be avoided because venous pressures can rise to 100 mm Hg and load the venous system. The results of this in vitro setup indicate that high Q(R) (> 400 ml/min) should be avoided at Q(G) up to 1,000 ml/min; however, in vivo tests have to be performed to prove this thesis. This study demonstrates the need for a well-functioning vascular access (Q(G) > 600 ml/ min) to perform adequate dialysis and to avoid venous system loading.

Arteriovenous Shunt, Surgical↗