Hemolysis test of disposable type vibrating flow pump

The vibrating flow pump (VFP) can generate high frequency oscillated blood flow. Because of the high frequency driving with short stroke volume, the pump system can be small. The disposable type VFP (D-VFP) was developed for use for extracorporeal circulation. The electromagnetic actuator was detached from the vibrating tube, which was newly designed to be a disposable tube with a jellyfish valve. Hemolysis tests of the D-VFP, VFP, centrifugal pump, and roller pump were performed in a mock circulation study using goat blood. Plasma free hemoglobin was measured every 15 min under the same conditions. The plasma free hemoglobin of the D-VFP was 16 mg/dl although that of the VFP was 160 mg/dl at 30 min. The plasma free hemoglobin of the centrifugal pump and roller pump at 30 min were 3 mg/dl and 9 mg/dl, respectively. The hemolysis performance of the D-VFP may be studied further as a result of this study. Two important factors affecting hemolysis development may be the materials of which the vibrating tube is made and heat transmission from the actuator. The D-VFP has a smooth acrylic surface for blood contact compared with the metal surface of old type VFP. The electromagnetic actuator of the VFP surrounded the vibrating tube, so heat from the actuator could be easily transmitted to the blood. Because the D-VFP has a disposable vibrating tube that is detached from the actuator, heat is not readily transmitted to the blood. A mock circulation study of heat transmission was performed using the D-VFP and VFP. Results of the heat transmission study showed that the fluid temperature of the D-VFP was not increased and stayed at room temperature although that of the VFP increased approximately 1 degree C above room temperature. The D-VFP may be a good style for the development of the VFP for use for extracorporeal circulation.

Development of a novel centrifugal pump: magnetic rotary pump

The rotational axis of the centrifugal pump has some associated problems such as blood destruction and sealing between the axis and pump housing. To improve upon these deficits we have developed a new type of blood pump, the magnetic rotary pump (MRP). The MRP has an original design with no rotational axis and no impellers. We made a prototype MRP and examined its hemodynamics in mock circulation. The prototype MRP flow rate is only 1.0 L/min with an afterload of 30 mm Hg, and we have made some modifications in the size and drive mechanisms from these results. The modified MRP can achieve high flow rates and rotational speeds (6.0 L/min with an afterload of 100 mm Hg, 2,000 rpm) in a mock circuit, and the modified MRP was used for left heart assistance in an acute animal experiment. The MRP could maintain the hemodynamics of an anesthetized adult goat. These results suggest that the MRP needs to be improved in several areas, but the MRP may be useful as a blood pump.

Nonlinear mathematical analysis of the hemodynamic parameters during left ventricular assistance with oscillated blood flow

For the development of a totally implantable ventricular assist system (VAS), we have been developing the vibrating flow pump (VFP), which can generate oscillated blood flow with a relatively high frequency (10-50 Hz) for a totally implantable system. In this study, effects of left ventricular assistance with this unique oscillated blood flow were analyzed by nonlinear mathematics for evaluation as the entire circulatory regulatory system, not as a separate part of the system. Left heart bypasses using VFPs from the left atriums to the descending aortas were performed in chronic animal experiments using healthy adult goats. Electrocardiogram (ECG), arterial blood pressure, VFP pump flow, and flow of the descending aorta data taken while the goats were awake were recorded in the data recorder and analyzed in the personal computer system through the AD convertor. Using nonlinear mathematics, time series data were embedded into the phase space, and the Lyapunov numerical method, fractal dimension analysis, and power spectrum analysis were performed to evaluate the nonlinear dynamics. During left ventricular assistance with the VFP, Mayer wave fluctuations were decreased in the power spectrum, the fractal dimension of the hemodynamics was significantly decreased, and peripheral vascular resistance was significantly decreased. These results suggest that nonlinear dynamics, which mediate the cardiovascular dynamics, may be affected during LV bypass with oscillated flow. Decreased power of the Mayer wave in the spectrum caused the limit cycle attractor of the hemodynamics and decreased the peripheral resistance. Decreased sympathetic discharges may be the origin of the decreased Mayer wave and fractal dimension. These nonlinear dynamical analyses may be useful to design the optimal VAS control.

Development of intracoronary local adhesive delivery technique

Acute coronary occlusion may occur in weak coronary atherosclerotic lesions, including dissection, ulceration or thrombus. In some cases of occlusion "bail-out" is performed by using recently developed New Devices. However, these have not yet completely solved the problem to this end, we designed a new method of coronary revascularization, the Intracoronary Local Adhesive Delivery Technique, utilizing antithrombotic and absorbable adhesive injected locally into the fragile and morbid arterial wall using a drug delivery PTCA catheter more flexible than the existing New Devices. This adhesive strengthened and hardened the lesions. In this study, we examined the efficacy of making an adhesive cylinder in arteries of similar size to the coronary, through acute animal experiments using the existing clinical adhesives and drug delivery PTCA catheters and 12 femoral arteries of adult goats. We were successful in forming firm tunnels along the inside of six arteries, infused with approximately 0.04 ml Cyanoacrylate. These tunnels were observed with intravascular ultrasound (IVUS) imaging and evaluated microscopically. These results suggest the feasibility of this method as a new approach for making synthetic resinous stents.

Enhancement of nasal salmon calcitonin absorption by lauroylcarnitine chloride in rats

PURPOSE

We investigated optimum formulation characteristics in the nasal absorption of salmon calcitonin (sCT) by incorporation of acylcarnitines.

METHODS

Nasal sCT formulations were administered to anesthetized rats. Plasma calcium level was measured and pharmacological bioavailability (P.bioav) was calculated.

RESULTS

Nasal sCT absorption was significantly enhanced by carnitines with acyl groups of 12 or more carbon atoms. Enhancement by lauroylcarnitine chloride (LCC) was observed at its critical micelle concentration and reached a plateau at the concentration of 0.1 percent. Optimal absorption was achieved at a molar ratio of LCC to sCT of 5:1. Enhancement was not influenced by osmolarity and maximum enhancement was obtained at pHs 3.1 and 4.0.

CONCLUSIONS

The 12-carbon LCC was the strongest enhancer among acylcarnitines. Micelle formation played a key role in this enhancement effect.

Fractal dimension analysis of the oscillated blood flow with a vibrating flow pump

To analyze the hemodynamic parameters during circulation with oscillated blood flow, nonlinear mathematical analyzing techniques, including fractal theory, were utilized. Vibrating flow pumps (VFP) were implanted as a left heart bypass, and the ascending aorta was clamped to constitute the total left heart circulation with oscillated blood flow in acute animal experiments using 7 adult goats. Using nonlinear mathematical analyzing techniques, reconstructed attractors of the arterial blood pressure waveform in the phase space during natural circulation and oscillated circulation were analyzed. Using the Grassberger-Procaccia correlation dimension analyzing technique, fractal dimension analysis of the reconstructed attractor was performed. During VFP bypass, lower fractal dimensions of the reconstructed attractor were shown compared with those during natural heart circulation. The results suggest that lower dimensional chaotic dynamics contributed to the circulation with oscillated blood flow.

Totally implantable ventricular assist system using a vibrating flow pump

A totally implantable ventricular assist system (VAS), including a drive system and a percutaneous electric energy transmission system, was developed and evaluated in acute animal experiments using adult goats. This newly designed VAS mainly consists of a vibrating tube, coils, magnets, and a jelly-fish valve as the outlet valve. For energy transmission, a new implantable transmitter with a plain weave structure was proposed as a noncontacting transform by using the spinal amorphous magnetic fibers. The fluid mechanical and hemodynamic properties and the efficiency of the energy transmission system were evaluated in acute animal experiments using healthy adult goats. This vibrating electromagnetic artificial heart (AH) could generate more than 10 L/min as output volume, with 10 Hz vibration using 20 volts as supplied voltage. The total efficiency of the percutaneous energy transmission system was 76%, and temperature increases were within the acceptable range, suggesting the usefulness of our newly developed implantable VAS.

Deterministic chaos in the hemodynamics of an artificial heart

To analyze the hemodynamic parameters during prosthetic circulation as an entity, non linear mathematical techniques were used. To compare natural and prosthetic circulation, two pneumatically actuated ventricular assist devices were implanted as biventricular bypasses in chronic animal experiments using adult goats to consitute the biventricular bypass complete prosthetic circulation model with ventricular fibrillation. After implantation, these goats were placed in a cage and extubated after waking. All hemodynamic parameters with the natural circulation without biventricular bypass pumping, and the artificial circulation with biventricular bypass pumping under ventricular fibrillation were recorded under awake conditions. By the use of a non linear mathematical technique, the arterial blood pressure waveform was embedded into a four dimensional phase space and projected into three dimensional phase space. The Lyapunov numeric method is used as an adjunct to the graphic analysis of the state space. A phase portrait of the attractor showed a high dimension complex structure, with three dimensional solid torus suggesting deterministic chaos during natural circulation. However, a simple attractor, such as a limit cycle attractor, was observed during artificial circulation. Positive Lyapunov exponents during artificial circulation suggest the lower dimensional chaotic system. Thus, hemodynamic parameters during prosthetic circulation must be carefully controlled when unexpected stimuli are fed from outside.

Chaotic behavior of hemodynamics with ventricular assist system

In order to analyze hemodynamic parameters during left ventricular assistance as an entity and not as decomposed parts, non-linear mathematical techniques were utilized. Pneumatically actuated ventricular assist systems (VAS) were implanted as left heart bypasses in acute animal experiments, using healthy adult mongrel dogs. By the use of the non-linear mathematical technique, the arterial blood pressure waveform (AP) was embedded into the four-dimensional phase space and projected into the three-dimensional phase space. The Lyapunov numerical method was used as an adjunct to the graphical analysis of the state space. The phase portrait of the attractor showed a complex structure; a three dimensional solid torus with a screw type structure as a part, suggesting deterministic chaos in the AP without left ventricular assistance. Positive lyapunov exponents confirmed the existence of chaos. During counterpulsation mode left ventricular assistance, the phase portrait of the attractor showed a more complex structure, and positive Lyapunov exponents suggested a greater dimensional deterministic chaos. However, non-structured patterns were seen in the phase space during internal mode VAS driving, suggesting the possibility of dissipative dynamics in the four dimensional phase space. These results suggest that the cardiovascular system with counterpulsation mode VAS driving is in a homeochaotic state, which is thought to be a flexible and intelligent control system. And there is greater dimensional complex dynamics in the circulatory regulatory system with VAD during internal mode assistance.

Chaotic hemodynamic during oscillated blood flow

A vibrating flow pump (VFP), which can generate oscillated blood flow (10-50 Hz/min), has been developed by our team for the artificial heart system. However, the flow pattern of this pump was different from that of the natural heart; therefore, it is important to analyze the effect of this oscillated blood flow on the circulatory regulatory system. To analyze the hemodynamics of high frequency oscillated blood flow as an entity, (not decomposed), nonlinear mathematical techniques were utilized. VFPs were implanted between the left atrium in animal experiments using adult goats. After the implantation procedure, the ascending aorta was clamped to constitute the complete left heart circulation with VFP. Using a nonlinear mathematical technique, an arterial blood pressure waveform was embedded into four-dimensional phase space and projected into three-dimensional phase space. The Lyapunov numerical method was used as an adjunct to graphic analysis of the state space. Phase portrait of the attractor showed a high dimension complex structure, suggesting deterministic chaos during natural circulation. However, phase portrait of the hemodynamics during oscillated blood flow showed a single circle with banding and a forbidden zone, similar to a limit-cycle attractor, suggesting a lower dimensional dynamic system. Positive Lyapunov exponent during oscillated blood flow suggests the existence of lower dimensional chaotic dynamics. These results suggest that the circulatory regulatory system during oscillated blood flow may be a lower dimensional homeochaotic state; thus, hemodynamic parameters must be carefully regulated when unexpected external stimuli are present.

Origin of the rhythmical fluctuations in the animal without a natural heartbeat

In order to analyze the origin of the rhythmical fluctuations in the cardiovascular system, an artificial heart, which does not have rhythmical periodicities such as altering heart rate and cardiac function, was utilized in chronic animal experiments with adult goats. Two pneumatically actuated ventricular assist devices were implanted as a total biventricular bypass under general anesthesia, and then the natural heart was electrically fibrillated to constitute the biventricular bypass type of complete prosthetic circulation model. All hemodynamic data were recorded under awake conditions and were calculated in the computer system by spectral analysis methods. In the power spectrum of the arterial blood pressure of the animal with the artificial heart, the Mayer wave peak and respiratory wave peak were clearly observed, and spectral analysis including the coherence function suggests that the Mayer waves originated from the peripheral vascular resistance and the respiratory waves probably originated from the periodicities of the pulmonary circulation. These fluctuations in the circulatory system influenced the arterial baroreflex system and transfer to the sympathetic outflow through the central baroreflex system, which suggests that rhythmical fluctuations in hemodynamic parameters originate at least in part from these vascular periodicities.

Identification of the deterministic chaos in cardiovascular dynamics by the use of the non-linear mathematics

Chaotic behavior in cardiovascular dynamics was thought to be one of the important information to analyze the circulatory regulatory system. Several investigators studied the attractor in the signals of the electrocardiogram, and found the strange attractor, suggesting dynamics compatible with deterministic chaos, by the use of the non-linear mathematics. It is interesting problem to analyze the hemodynamic parameters by the use of non-linear mathematics for the determination of the physiologically optimal circulatory condition. In this study, Chaos analyzing system was developed to identify the deterministic chaos in cardiovascular regulatory system by the use of the non-linear mathematics including phase plane plots, embedding, and lyapunov exponents. Time series data of the hemodynamic parameters in the chronic animal experiments was analyzed by this system, and satisfactory attractor was obtained by the use of the phase plane plots and embedding techniques. Furthermore, calculation of the lyapunov exponents showed the existence of the deterministic chaos in arterial blood pressure in the chronic animal experiments using adult goats, suggesting this tool is useful for analyzing cardiovascular dynamic behavior.

Scintigraphic monitoring of coronary artery occlusion due to Kawasaki disease

Noninvasive monitoring of the process of coronary occlusion will probably aid in determining the timing of therapeutic interventions for Kawasaki disease. A pair study of coronary angiography and thallium scintigraphy after dipyridamole infusion-single-photon emission computed tomography with dipyridamole infusion (Dp-SPECT) was repeated at least twice at intervals of several years in 29 patients, and these findings were compared and analyzed in a chronologic manner. The current study demonstrated that angiographic stenosis was more severe, with an increase in the severity of the perfusion defect. Positive rates determined by Dp-SPECT increased with increasing severity of stenosis on angiography. Angiographic findings from the first to the second serial study that showed worsening, no change and improvement were correctly diagnosed from scintigraphic changes in 94% of coronary arterial lesions. About half of the arteries with progression in stenotic severity could be found before complete occlusion by scintigraphic monitoring. It is concluded that Dp-SPECT can be used as a noninvasive monitor of the occurrence and progression of coronary stenoses due to Kawasaki disease.

Dependence of baroreceptor-mediated sympathetic outflow on biventricular assist device driving frequency

To investigate the drive condition of the artificial heart from a neurophysiological point of view, the dynamic transduction characteristics of the baroreflex system were analyzed by means of sympathetic neurograms. Two pneumatically actuated ventricular assist devices were implanted as biventricular bypasses (BVBs) in adult mongrel dogs to compare the natural heart circulation and prosthetic circulation. After BVB pumping was initiated, the natural heart was electrically fibrillated. Renal sympathetic nerve activity (RSNA) was recorded to analyze sympathetic outflow. Coherence function between the arterial pressure and RSNA was calculated to evaluate the linearity of the baroreflex system. The largest peak coherency was observed when BVB was driven at the frequency of natural heart beat prior to electrical fibrillation, which suggests that the baroreflex system shows the largest linearity at this frequency. These results suggest the possibility that the natural heart beat frequency is the setting frequency at which the baroreflex system transfers the hemodynamic rhythm to the sympathetic outflow.

Mayer waves in dogs with total artificial heart

To assess the effect of a total artificial heart (TAH) on the autonomic nervous system a power spectral analysis of the hemodynamics in a TAH animal was done by the maximum entropy method. Two pneumatically driven sac-type ventricular assist devices were implanted as total biventricular bypass (BVB) in adult mongrel dogs to compare the differences between natural heart and TAH. Once the BVB was pumping, the natural heart was electrically fibrillated to constitute the BVB-type TAH model. In the arterial pressure waveform in animals with TAH, respiratory waves were not changed (97.7 +/- 24.6%) though Mayer waves were significantly decreased (47.5 +/- 22.6%) compared with the animal with a natural heart. These results suggest that prosthetic hemodynamics in the TAH animal affect fluctuations in the cardiovascular system.

Estimation of the following cardiac output using sympathetic tone and hemodynamics for the control of a total artificial heart

A sympathetic neurogram is potentially useful for the development of a real time total artificial heart (TAH) control system. We used sympathetic tone and hemodynamic derivatives to estimate the following cardiac output in acute animal experiments using adult mongrel dogs. Moving averages of the mean left atrial pressure and mean aortic pressure were used as parameters of the preload and afterload, respectively. Renal sympathetic nerve activity (RSNA) was employed as a parameter of sympathetic tone. Equations for the following cardiac output were calculated using multiple linear regression analysis of the time series data. A significant correlation was observed between the estimated and following measured cardiac output. These results suggest the potential usefulness of the sympathetic neurogram for the real time TAH automatic control system.

Fundamental rhythm of sympathetic nerve discharges in animals with total artificial hearts

To evaluate the effect of total artificial heart replacement on the autonomic nervous system, sympathetic neurograms were analyzed by power spectrum and coherence function. Two pneumatically driven, sac type ventricular assist devices were implanted as biventricular bypasses (BVB) in adult, mongrel dogs. After initiation of BVB pumping, the natural heart was electrically fibrillated to form a BVB TAH model. Renal sympathetic nerve activity (RSNA) was recorded using a bipolar electrode attached to the left renal sympathetic nerve. RSNA was amplified and integrated by use of an R-C integrator. Power spectra of the RSNA and values of squared coherence between the arterial pressure wave form and the RSNA were calculated by computer. In animals with total artificial hearts (TAHs), coherence at the cardiac rhythm frequency was decreased, and coherence at the TAH pumping rhythm frequency was increased. These results indicate that the arterial pulse wave observed in TAH animals contributed to the sympathetic neurogram.

Cardiac-related sympathetic nerve activity during circulation with only the left ventricular assist device

Circulatory maintenance with a left ventricular assist device (LVAD) alone during cardiac arrest until heart transplantation has been evaluated. To assess the effect on the autonomic nervous system, the sympathetic neurogram was analyzed by power spectrum and coherence function. LVAD were inserted between the left atrium and the descending aorta in seven adult mongrel dogs and ventricular fibrillation was induced electrically. Renal sympathetic nerve activity (RSNA) was detected by bipolar electrodes attached to the left renal sympathetic nerve. Values of squared coherence between the arterial pulse wave and RSNA were calculated. Under the condition of circulatory maintenance with only LVAD, coherence at the cardiac rhythm frequency was decreased, and coherence at the LVAD pumping rhythm frequency was increased. These results indicate that the arterial pulse wave observed during maintenance of the circulation with only LVAD contributed to the sympathetic neurogram.

Cardiac-Related Sympathetic Nerve Activity during Circulation with Only the Left Ventricular Assist Device

Circulatory maintenance with a left ventricular assist device (LVAD) alone during cardiac arrest until heart transplantation has been evaluated. To assess the effect on the autonomic nervous system, the sympathetic neurogram was analyzed by power spectrum and coherence function. LVAD were inserted between the left atrium and the descending aorta in seven adult mongrel dogs and ventricular fibrillation was induced electrically. Renal sympathetic nerve activity (RSNA) was detected by bipolar electrodes attached to the left renal sympathetic nerve. Values of squared coherence between the arterial pulse wave and RSNA were calculated. Under the condition of circulatory maintenance with only LVAD, coherence at the cardiac rhythm frequency was decreased, and coherence at the LVAD pumping rhythm frequency was increased. These results indicate that the arterial pulse wave observed during maintenance of the circulation with only LVAD contributed to the sympathetic neurogram.

Echo-guided transaortic left ventricular myotomy for idiopathic hypertrophic subaortic stenosis

Idiopathic hypertrophic subaortic stenosis (IHSS) is a progressive cardiac disease known to induce sudden death occasionally. The authors tested echocardiography as a method of guiding myotomy, and observed its clinical usefulness as a safe surgical procedure for IHSS.

Systemic circulation with high frequency blood flow--analysis from neurophysiological point of view

The vibrating electromagnetically driven univalved artificial heart, which provided more than 10 1/min at 10 Hz/sec. vibration, was developed in our team. This vibrating electromagnetic pump (VEMP) produced the original flow pattern compared with the flow pattern of the natural heart, so that circulatory regulatory system during maintain the circulation with VEMP must be investigated before the clinical application. In order to assess the effect of high frequency blood flow produced by the VEMP from the neurophysiological point of view, power spectral analysis of the hemodynamics was performed. VEMP was implanted as the total left heart bypass in adult goats and right heart circulation was maintained by natural hearts. In arterial blood pressure during maintain circulation by the high frequency blood flow, Mayer waves (0.01-0.15 Hz) were significantly decreased, though respiratory waves (0.25-0.40 Hz) were not significantly changed. These results suggest that circulatory regulatory system was influenced by the high frequency blood flow produced by the VEMP.

Sympathetic nerve activity during maintaining circulation with only left ventricular assist device

Maintaining circulation with an left ventricular assist device (LVAD) alone during cardiac arrest until heart transplantation, was evaluated by the use of the sympathetic neurogram. To evaluate the influences of this method on autonomic nervous system, sympathetic neurogram was analyzed by power spectrum and coherence function. In acute animal experiments using mongrel dogs, LVAD were implanted. After the LVAD implantation, ventricular fibrillation was induced electrically. Renal sympathetic nerve activity (RSNA) was detected by the use of bipolar electrodes attached to the left renal sympathetic nerve. Values of squared coherence between the arterial pulse wave and RSNA were calculated. Under the condition of circulatory maintenance with LVAD, coherence at the cardiac rhythm frequency was decreased, and coherence at the LVAD pumping rhythm frequency was increased. These results suggest that the arterial pressure which was observed during maintaining the circulation with only LVAD contributed to sympathetic neurogram.

Hydrodynamic endurance test of the prosthetic valve used in the various types of the ventricular assist device

To evaluate the various basic designs of the pump chambers used in the ventricular assist devices (VADs), hydrodynamic endurance test was performed from the viewpoint of the durability of the prosthetic valves used in the VAD. For the hydrodynamic analysis, we designed three basic types of pump (sac type, diaphragm type, and pusher plate type) using the same material and having the same capacity and shape. Prosthetic valves in these VADs were tested from the standpoint of the water hammer effect, which affects the valve durability, to determine which pump design would be most durable as a prosthetic valve in the VAD. The water-hammer phenomenon was evaluated using the maximum pressure gradient (MPG) across the prosthetic valve in the moc circulatory loop. Maximum pump output was recorded when we used the diaphragm type model, and minimum MPG in the commonly used driving condition of the VAD were recorded when we used the sac type model. The results suggest that the sac type VAD model is the most durable design for the prosthetic value.

Coherence function between sympathetic neurogram and arterial pulse wave in animal with total artificial heart

To assess the influence of the total artificial heart replacement on autonomic nervous system, sympathetic neurogram was analyzed by power spectrum and coherence function. Two pneumatically driven sac-type ventricular assist devices were implanted as biventricular bypass (BVB) in adult mongrel dogs. After the BVB pumping, natural heart was electrically fibrillated to constitute the BVB type TAH model. Renal sympathetic nerve activity (RSNA) was recorded using the bipolar electrode attached to the left renal sympathetic nerve. RSNA was amplified and integrated by the use of R-C integrator. Power spectra of the RSNA and the values of squared coherence between the arterial pressure waveform and the RSNA were calculated by the computer system. In animal with TAH, coherence at the cardiac rhythm frequency was decreased, and coherence at the TAH pumping rhythm frequency was increased. These results indicate that the arterial pulse wave which was observed in TAH animal contributed to sympathetic neurogram.