Computer Modeling of Fluid-Stress-Induced Blood Damage in a Mechanical Ventricular Assist Device

2009 ◽  
Author(s):  
Alexandrina Untaroiu ◽  
Houston G. Wood ◽  
Paul E. Allaire
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Damage Index ◽  
Computational Domain ◽  
Ventricular Assist ◽  
Blood Damage ◽  
History Of ◽  
Number Of Particles

Congestive heart failure results the heart is unable to pump the required amount of blood to maintain the systemic circulation. World-wide, millions of patients are diagnosed with congestive heart failure every year, many of which ultimately become candidates for heart transplants. The limited number of available donor hearts, however, has resulted in a tremendous demand for alternative, supplemental circulatory support in the form of artificial heart pumps to serve as a “Bridge-to-Transplant”. The prospect of artificial heart pumps used for long-term support of congestive heart failure patients is directly dependent upon excellent blood compatibility. High fluid stress levels may arise due to high rotational speeds and narrow clearances between the stationary and rotating parts of the pump. Thus, fluid stress may result in damage to red blood cells and activation of platelets, contributing to thrombus formation. Therefore, it is essential to evaluate levels of blood trauma for successful design of a mechanical Ventricular Assist Device. Estimating the fluid stress levels that occur in a blood pump during the design phase also provides valuable information for optimization considerations. This study describes the CFD evaluation of blood damage in a magnetically suspended axial pump that occurs due to fluid stress. Using CFD, a blood damage index, reflecting the percentage of damaged red blood cells, was numerically estimated based on the scalar fluid stress values and exposure time to such stresses. A number of particles, with no mass and reactive properties, was injected at the inflow of the computational domain and traveled along their corresponding streamlines. A Lagrangian particle tracking technique was employed to obtain the stress history of each particle along its streamline, making it possible to consider the damage history of each particle. Maximum scalar stresses of approximately 430 Pa were estimated to occur along the tip surface of the impeller blades, more precisely at the leading edge of the impeller blades. The maximum time required for the vast majority of particles to pass through the pump was approximately 0.085sec. A small number of particles (approximately 5%), which traveled through the narrow gap between the stationary and rotating part of the pump, exited the computational domain in approximately 0.2 sec. The mean value of blood damage index was found to be 0.15% with a maximum value of approximately 0.47%. These values are one order of magnitude lower than the approximated damage indices published in the literature for other Ventricular Assist Devices. The low blood damage index indicates that red blood cells traveling along the streamlines considered are not likely to be ruptured, mainly due to the very small time of exposure to high stress.

scholarly journals Nucleated Red Blood Cells in Congestive Heart Failure

Circulation ◽  
1959 ◽  
Vol 20 (3) ◽  
pp. 367-370 ◽  
Author(s):  
ABRAHAM M. FRUMIN ◽  
THEODORE H. MENDELL ◽  
SOLOMON S. MINTZ ◽  
PAUL NOVACK ◽  
ARTHUR T. FAULK
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Nucleated Red Blood Cells

Mathematical models for shear-induced blood damage based on vortex platform

2021 ◽  
pp. 039139882110035
Author(s):  
Xu Mei ◽  
Min Zhong ◽  
Wanning Ge ◽  
Liudi Zhang
Keyword(s):  
Molecular Weight ◽  
Shear Stress ◽  
Red Blood Cells ◽  
Exposure Time ◽  
Blood Cells ◽  
Ventricular Assist ◽  
Blood Damage ◽  
Weight Analysis ◽  
Von Willebrand

Non-physiological shear stress in Ventricular Assist Device (VAD) is considered to be an important trigger of blood damage, which has become the biggest shackle for clinical application. The researches on blood damage in literature were limited to qualitative but did not make much quantitative analysis. The purpose of this study was to investigate the quantitative influence of two flow-dependent parameters: shear stress (rotational speed) and exposure time on the shear-induced damage of red blood cells and von Willebrand Factor (vWF). A vortex blood-shearing platform was constructed to conduct in vitro experiments. Free hemoglobin assay and vWF molecular weight analysis were then performed on the sheared blood samples. MATLAB was used for regression fitting of original experimental data. The quantitative correlations between the hemolysis index, the degradation of high molecular weight vWF and the two flow-dependent parameters were found both following the power law model. The mathematic models indicated that the sensitivity of blood damage on red blood cells and vWF to exposure time was both greater than that of shear stress. Besides, the damage of vWF was more serious than that of red blood cells at the same flow condition. The models could be used to predict blood damage in blood-contacting medical devices, especially for the slow even stagnant blood flow regions in VAD, thus may provide useful guidance for VAD development and improvement. It also indicated that the vortex platform can be used to study the law of blood damage for the simple structure and easy operation.

scholarly journals Age-Related Frailty: A Clinical Model for Geroscience?

2020 ◽  
Vol 24 (10) ◽  
pp. 1140-1143 ◽  
Author(s):  
Catherine Takeda ◽  
D. Angioni ◽  
E. Setphan ◽  
T. Macaron ◽  
P. De Souto Barreto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Medical History ◽  
Older Age ◽  
The Other ◽  
Everyday Practice ◽  
Clinical Model ◽  
Main Contributor ◽  
Age Related ◽  
History Of

AbstractIn their everyday practice, geriatricians are confronted with the fact that older age and multimorbidity are associated to frailty. Indeed, if we take the example of a very old person with no diseases that progressively becomes frail with no other explanation, there is a natural temptation to link frailty to aging. On the other hand, when an old person with a medical history of diabetes, arthritis and congestive heart failure becomes frail there appears an obvious relationship between frailty and comorbidity. The unsolved question is: Considering that frailty is multifactorial and in the majority of cases comorbidity and aging are acting synergistically, can we disentangle the main contributor to the origin of frailty: disease or aging? We believe that it is important to be able to differentiate age-related frailty from frailty related to comorbidity. In fact, with the emergence of geroscience, the physiopathology, diagnosis, prognosis and treatment will probably have to be different in the future.

Abstract 16010: Congestive Heart Failure and Coronavirus Disease 2019 Illness Severity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Max Ruge ◽  
Joanne Michelle D Gomez ◽  
Gatha G Nair ◽  
Setri Fugar ◽  
Jeanne du Fay de Lavallaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Congestive Heart Failure ◽  
Case Fatality ◽  
Severity Of Illness ◽  
Severe Infection ◽  
Severe Illness ◽  
Increased Risk ◽  
History Of ◽  
Male Sex

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has killed hundreds of thousands worldwide. Those with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. Congestive heart failure (CHF) may lead to worsening COVID-19 symptoms. However, it is unclear if CHF is an independent risk factor for severe COVID-19 infection or if other accompanying comorbidities are responsible for the increased risk. Methods: From March to June 2020, data was obtained from adult patients diagnosed with COVID-19 infection who were admitted in the Rush University System for Health (RUSH) in Illinois. Heart failure patients, determined by ICD code assignments extracted from the electronic medical records, were identified. Multivariable logistic regression was performed between predictor variables and a composite outcome of severe infection consisting of Intensive Care Unit (ICU) admission, intubation, or in-hospital mortality. Results: In this cohort (n=1136), CHF [odds ratio (OR) 1.02] alone did not predict a more severe illness. Prior myocardial infarction [(MI), OR 3.55], history of atrial fibrillation [(AF), OR 2.14], and male sex (OR 1.55) were all significantly (p<0.001) associated with more severe COVID-19 illness course when controlling for CHF (Figure 1). In the 178 CHF patients, more advanced age (68.8 years vs. 63.8 years; p<0.05) and female sex (54.5% vs. 39.1%; p<0.05) were associated with increased severity of illness. Conclusions: Prior MI, history of AF, and male sex predicted more severe COVID-19 illness course in our cohort, but pre-existing heart failure alone did not. However, CHF patients who are females and older in age are at risk for severe infection. These findings help clinicians identify patients with comorbidities early at risk for severe COVID-19 illness.

scholarly journals Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽  
2010 ◽  
Vol 12 (02) ◽  
pp. 128-134 ◽  
Author(s):  
Erik P. Hess ◽  
Jeffrey J. Perry ◽  
Pam Ladouceur ◽  
George A. Wells ◽  
Ian G. Stiell
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Chest Radiography ◽  
Clinical Decision ◽  
Chest Radiographs ◽  
Clinical Decision Rule ◽  
Coronary Syndrome ◽  
History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

scholarly journals The mechanism of adaptation of the organism of patients with chronic heart failure combined with vitamin D deficiency and the morphofunctional state of peripheral blood erythrocytes

2019 ◽  
Vol 10 (3) ◽  
pp. 352-357
Author(s):  
N. I. Baryla ◽  
I. P. Vakaliuk ◽  
S. L. Pоpеl’
Keyword(s):  
Heart Failure ◽  
Vitamin D ◽  
Chronic Heart Failure ◽  
Red Blood Cells ◽  
Vitamin D Deficiency ◽  
Peripheral Blood ◽  
Blood Cells ◽  
Functional Class ◽  
Exercise Stress ◽  
Control Group

The problem of structural changes in peripheral blood erythrocytes in patients with chronic heart failure in combination with vitamin D deficiency during exercise stress remains insufficiently studied. Vitamin receptors are located on smooth myocytes, endothelial cells, cardiomyocytes and blood cells. It affects the state of the cell membrane, the contractile function of the myocardium, the regulation of blood pressure, cardiac remodeling and reduction of left ventricular hypertrophy. Therefore, it is important to assess the level of vitamin D in blood plasma in individuals with chronic heart failure and to identify the effect of its deficiency on the state of peripheral red blood cells when performing a 6-minute walk test. A total of 75 patients of the main group with chronic heart failure stage II A, I–II functional class with different levels of vitamin D deficiency were examined. The control group included 25 patients with chronic heart failure stage II A, functional class I–II without signs of vitamin D deficiency. The average age of patients was 57.5 ± 7.5 years. All patients were asked to undergo the 6 minutes walking test. The level of total vitamin D in plasma was determined by enzyme immunoassay. Morphological studies of erythrocytes were performed on the light-optical and electron-microscopic level. The obtained results showed that patients of the main group with chronic heart failure had a decrease in vitamin D by 2.2 times compared with the control group. Correlation analysis showed a directly proportional relationship between vitamin D deficiency and the number of red blood cells of a modified form and red blood cells with low osmotic resistance. Dosed exercise stress in patients with chronic heart failure against a background of vitamin D deficiency leads to an increase in the number of reversibly and irreversibly deformed erythrocytes and a decrease in their osmotic stability. This indicates a disorder in the structural integrity of their membrane and can have negative consequences for the somatic health of such patients.

SWEATING IN CONGENITAL HEART DISEASE

PEDIATRICS ◽  
1968 ◽  
Vol 41 (1) ◽  
pp. 123-129
Author(s):  
Blanche P. Alter ◽  
Emily E. Czapek ◽  
Richard D. Rowe
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Sweat Test ◽  
Endocardial Fibroelastosis ◽  
History Of Or ◽  
History Of ◽  
Sweat Tests

Sweating was found to be increased in children with congenital heart disease who had a propensity to congestive heart failure, e.g., children with endocardial fibroelastosis or large or moderate sized left-to-right shunts. This was suggested in a review of cardiac clinic records of 220 patients and was supported by the results of pilocarpine sweat tests which were performed on 34 cardiac patients. By history and by measurement of the amount of sweat produced, children with a history of or tendency toward heart failure could be predicted though patients did not need to be in failure when tested. Contrary to previous opinion, the left-to-right shunt was not in itself sufficient to cause the child to sweat. The shunt had to be large enough to be associated with failure at some time. It is suggested that the pilocarpine sweat test might actually be useful as an aid in predicting a child's potential for heart failure. Several theories regarding the mechanism of sweating in these situations are discussed.

Cor triatriatum sinistrum diagnosed in the adulthood: a systematic review

Heart ◽  
2019 ◽  
pp. heartjnl-2019-314714 ◽  
Author(s):  
Virginija Rudienė ◽  
Cristel M S Hjortshøj ◽  
Sigita Glaveckaitė ◽  
Diana Zakarkaitė ◽  
Žaneta Petrulionienė ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Congestive Heart Failure ◽  
Natural History ◽  
Cor Triatriatum ◽  
Interventional Treatment ◽  
Cardiac Defects ◽  
First Choice ◽  
History Of ◽  
Membrane Physiology

BackgroundWe performed a systematic review of cor triatriatum sinistrum (CTS) diagnosed in adults. The aim of this review was to describe the clinical presentation, natural history and management of this congenital heart disease.MethodsA PubMed literature search for ‘cor triatriatum sinistrum’ published since 2005 was performed. Included patients were divided into those with and without obstructive membrane physiology. The clinical course differences were compared.ResultsA total of 171 published cases were included. The median age at diagnosis was 43 years (IQR, 30–60). Obstructive membrane physiology was observed in 70 (41%), and this patient group was younger at presentation (median age 39 (IQR, 28–52) vs 50 years (IQR, 32–64), p=0.003).Patients with obstructive membrane more frequently had associated cardiac defects (58.6% vs 42.4%, p=0.039). Overall, the most frequent clinical symptom was atrial fibrillation, as this was present in 56 (32.8%) of all patients. CTS-related symptoms were more frequent in patients with obstructive membrane: congestive heart failure (44.3% vs 15.2%, p<0.001), pulmonary hypertension (27.1% vs 6.1%, p<0.001), haemorrhage (8.6% vs 0%, p=0.004) and infections manifestation (8.6% vs 0%, p=0.004).A total of 71 (41.5%) patients with CTS required interventional treatment, mainly within patients with the obstructive membrane (86.8% vs 12.6%, p<0.001).ConclusionThe natural history of CTS most often manifests with symptoms of congestive heart failure. Patients with obstructive membrane most often have associated cardiac defects and higher risk for infections and haemorrhage. The interventional treatment of CTS remains the first choice for obstructive membrane.

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