Modification of a Transvalvular Microaxial Flow Pump for Instantaneous Determination of Native Cardiac Output and Volume

BACKGROUND

The current Impella cardiopulmonary (CP) pump, used for mechanical circulatory support in patients with cardiogenic shock (CS), cannot assess native cardiac output (CO) and left ventricular (LV) volumes. These data are valuable in facilitating device management and weaning. Admittance technology allows for accurate assessment of cardiac chamber volumes.

OBJECTIVES

This study tested the ability to engineer admittance electrodes onto an existing Impella CP pump to assess total and native CO as well as LV chamber volumes in an instantaneous manner.

METHODS

Impella CP pumps were fitted with 4 admittance electrodes and were placed in the LVs of adult swine (n = 9) that were subjected to 3 different hemodynamic conditions, including Impella CP speed adjustments, administration of escalating doses of dobutamine and microsphere injections into the left main artery to result in cardiac injury. CO, according to admittance electrodes, was calculated from LV volumes and heart rate. In addition, CO was calculated in each instance via thermodilution, continuous CO measurement, the Fick principle, and aortic velocity-time integral by means of echocardiography.

RESULTS

Modified Impella CP pumps were placed in swine LVs successfully. CO, as determined by admittance electrodes, was similar by trend to other methods of CO assessment. It was corrected for pump speed to calculate native CO, and calculated LV chamber volumes trended as expected in each experimental protocol.

CONCLUSIONS

We report, for the first time, that an Impella CP pump can be fitted with admittance electrodes and used to determine total and native CO in various hemodynamic situations.

CONDENSED ABSTRACT

Transvalvular mechanical circulatory support devices such as the Impella CP do not have the ability to provide real-time information on native cardiac output (CO) and left ventricular (LV) volumes. This information is critical in device management and in weaning in patients with cardiogenic shock. We demonstrate, for the first time, that Impella CP pumps coupled with admittance electrodes are able to determine native CO and LV chamber volumes in multiple hemodynamic situations such as Impella pump speed adjustments, escalating dobutamine administration and cardiac injury from microsphere injection.

Smart Drain for Post-Cardiac Surgery Left Ventricular Volumes Evaluated in Large Animal Models

BACKGROUND

Open heart surgeries for coronary arterial bypass graft and valve replacements are performed on 400,000 Americans each year. Unexplained hypotension during recovery causes morbidity and mortality through cerebral, kidney, and coronary hypoperfusion. An early detection method that distinguishes between hypovolemia and decreased myocardial function before onset of hypotension is desirable. We hypothesized that admittance measured from a modified pericardial drain can detect changes in left ventricular end-systolic, end-diastolic, and stroke volumes.

METHODS

Admittance was measured from 2 modified pericardial drains placed in 7 adult female dogs using an open chest preparation, each with 8 electrodes. The resistive and capacitive components of the measured admittance signal were used to distinguish blood and muscle components. Admittance measurements were taken from 12 electrode configurations in each experiment. Left ventricular preload was reduced by inferior vena cava occlusion. Physiologic response to vena cava occlusion was measured by aortic pressure, aortic flow, left ventricle diameter, left ventricular wall thickness, and electrocardiogram.

RESULTS

Admittance successfully detected a drop in left ventricular end-diastolic volume (P < .001), end-systolic volume (P < .001), and stroke volume (P < .001). Measured left ventricular muscle resistance correlated with crystal-derived left ventricular wall thickness (R2 = 0.96), validating the method's ability to distinguish blood from muscle components.

CONCLUSIONS

Admittance measured from chest tubes can detect changes in left ventricular end-systolic, end-diastolic, and stroke volumes and may therefore have diagnostic value for unexplained hypotension.

Data automated bag breathing unit for COVID-19 ventilator shortages

BACKGROUND

The COVID-19 pandemic has caused a global mechanical ventilator shortage for treatment of severe acute respiratory failure. Development of novel breathing devices has been proposed as a low cost, rapid solution when full-featured ventilators are unavailable. Here we report the design, bench testing and preclinical results for an 'Automated Bag Breathing Unit' (ABBU). Output parameters were validated with mechanical test lungs followed by animal model testing.

RESULTS

The ABBU design uses a programmable motor-driven wheel assembled for adult resuscitation bag-valve compression. ABBU can control tidal volume (200-800 ml), respiratory rate (10-40 bpm), inspiratory time (0.5-1.5 s), assist pressure sensing (- 1 to - 20 cm H2O), manual PEEP valve (0-20 cm H2O). All set values are displayed on an LCD screen. Bench testing with lung simulators (Michigan 1600, SmartLung 2000) yielded consistent tidal volume delivery at compliances of 20, 40 and 70 (mL/cm H2O). The delivered fraction of inspired oxygen (FiO2) decreased with increasing minute ventilation (VE), from 98 to 47% when VE was increased from 4 to 16 L/min using a fixed oxygen flow source of 5 L/min. ABBU was tested in Berkshire pigs (n = 6, weight of 50.8 ± 2.6 kg) utilizing normal lung model and saline lavage induced lung injury. Arterial blood gases were measured following changes in tidal volume (200-800 ml), respiratory rate (10-40 bpm), and PEEP (5-20 cm H2O) at baseline and after lung lavage. Physiological levels of PaCO2 (≤ 40 mm Hg [5.3 kPa]) were achieved in all animals at baseline and following lavage injury. PaO2 increased in lavage injured lungs in response to incremental PEEP (5-20 cm H2O) (p < 0.01). At fixed low oxygen flow rates (5 L/min), delivered FiO2 decreased with increased VE.

CONCLUSIONS

ABBU provides oxygenation and ventilation across a range of parameter settings that may potentially provide a low-cost solution to ventilator shortages. A clinical trial is necessary to establish safety and efficacy in adult patients with diverse etiologies of respiratory failure.

Admittance to detect alterations in left ventricular stroke volume

BACKGROUND

Implantable cardioverter-defibrillators monitor intracardiac electrograms (EGMs) to discriminate between ventricular and supraventricular tachycardias. The incidence of inappropriate shocks remains high because of misclassification of the tachycardia in an otherwise hemodynamically stable individual. Coupling EGMs with an assessment of left ventricular (LV) stroke volume (SV) could help in gauging hemodynamics during an arrhythmia and reducing inappropriate shocks.

OBJECTIVE

The purpose of this study was to use the admittance method to accurately derive LV SV.

METHODS

Ultrasonic flow probe and LV endocardial crystals were used in canines (n = 12) as the standard for LV SV. Biventricular pacing leads were inserted to obtain admittance measurements. A tetrapolar, complex impedance measurement was made between the Bi-V leads. The real and imaginary components of impedance were used to discard the myocardial component from the blood component to derive instantaneous blood conductance (Gb). Alterations in SV were measured during right ventricular pacing, dopamine infusion, and inferior vena cava occlusion.

RESULTS

Gb tracks steady-state changes in SV more accurately than traditional magnitude (ie, |Y|, without removal of the muscle signal) during right ventricular pacing and dopamine infusion (P = .004). Instantaneous LV volume also was tracked more accurately by Gb than ∣Y∣ in the subset of subjects that underwent inferior vena cava occlusions (n = 5, P = .025). Finite element modeling demonstrates that admittance shifts more sensitivity of the measurement to the LV blood chamber as the mechanism for improvement (see Online Appendix).

CONCLUSION

Monitoring LV SV is possible using the admittance method with biventricular pacing leads. The technique could be piggybacked to complement EGMs to determine if arrhythmias are hemodynamically unstable.

Effect of formalin fixation on thermal conductivity of the biological tissue

Effect of formalin fixation on thermal conductivity of the biological tissues is presented. A self-heated thermistor probe was used to measure the tissue thermal conductivity. The thermal conductivity of muscle and fatty tissue samples was measured before the formalin fixation and then 27 hours after formalin fixation. The results indicate that the formalin fixation does not cause a significant change in the tissue thermal conductivity of muscle and fatty tissues. In the clinical setting, tissues removed surgically are often fixed in formalin for subsequent pathological analysis. These results suggest that, in terms of thermal properties, it is equally appropriate to perform in vitro studies in either fresh tissue or formalin-fixed tissue.

Analysis of the spatial sensitivity of conductance/admittance catheter ventricular volume estimation

Conductance catheters are known to have a nonuniform spatial sensitivity due to the distribution of the electric field. The Geselowitz relation is applied to murine and multisegment conductance catheters using finite element models to determine the spatial sensitivity in a uniform medium and simplified left ventricle models. A new formulation is proposed that allows determination of the spatial sensitivity to admittance. Analysis of FEM numerical modeling results using the Geselowitz relation provides a true measure of parallel conductance in simplified left ventricle models for assessment of the admittance method and hypertonic saline techniques. The spatial sensitivity of blood conductance (Gb) is determined throughout the cardiac cycle. Gb is converted to volume using Wei's equation to determine if the presence of myocardium alters the nonlinear relationship through changes to the electric field. Results show that muscle conductance (Gm) from the admittance method matches results from the Geselowitz relation and that the relationship between Gb and volume is accurately fit using Wei's equation. Single-segment admittance measurements in large animals result in a more evenly distributed sensitivity to the LV blood pool. The hypertonic saline method overestimates parallel conductance throughout the cardiac cycle in both murine and multisegment conductance catheters.

A bio-telemetric device for measurement of left ventricular pressure-volume loops using the admittance technique in conscious, ambulatory rats

This paper presents the design, construction and testing of a device to measure pressure-volume loops in the left ventricle of conscious, ambulatory rats. Pressure is measured with a standard sensor, but volume is derived from data collected from a tetrapolar electrode catheter using a novel admittance technique. There are two main advantages of the admittance technique to measure volume. First, the contribution from the adjacent muscle can be instantaneously removed. Second, the admittance technique incorporates the nonlinear relationship between the electric field generated by the catheter and the blood volume. A low power instrument weighing 27 g was designed, which takes pressure-volume loops every 2 min and runs for 24 h. Pressure-volume data are transmitted wirelessly to a base station. The device was first validated on 13 rats with an acute preparation with 2D echocardiography used to measure true volume. From an accuracy standpoint, the admittance technique is superior to both the conductance technique calibrated with hypertonic saline injections, and calibrated with cuvettes. The device was then tested on six rats with 24 h chronic preparation. Stability of animal preparation and careful calibration are important factors affecting the success of the device.

Accuracy considerations in catheter based estimation of left ventricular volume

Cardiac volume estimation in the Left Ventricle from impedance or admittance measurement is subject to two major sources of error: parallel current pathways in surrounding tissues and a non uniform current density field. The accuracy of volume estimation can be enhanced by incorporating the complex electrical properties of myocardium to identify the muscle component in the measurement and by including the transient nature of the field non uniformity. Cardiac muscle is unique in that the permittivity is high enough at audio frequencies to make the muscle component of the signal identifiable in the imaginary part of an admittance measurement. The muscle contribution can thus be uniquely identified and removed from the combined muscle - blood measurement. In general, both error sources are transient and are best removed in real time as data are collected. This paper reviews error correction methods and establishes that the relative magnitudes of the error concerns are different in small and large hearts.

Left ventricular epicardial admittance measurement for detection of acute LV dilation

There are two implanted heart failure warning systems incorporated into biventricular pacemakers/automatic implantable cardiac defibrillators and tested in clinical trials: right heart pressures, and lung conductance measurements. However, both warning systems postdate measures of the earliest indicator of impending heart failure: left ventricular (LV) volume. There are currently no proposed implanted technologies that can perform LV blood volume measurements in humans. We propose to solve this problem by incorporating an admittance measurement system onto currently deployed biventricular and automatic implantable cardiac defibrillator leads. This study will demonstrate that an admittance measurement system can detect LV blood conductance from the epicardial position, despite the current generating and sensing electrodes being in constant motion with the heart, and with dynamic removal of the myocardial component of the returning voltage signal. Specifically, in 11 pigs, it will be demonstrated that 1) a physiological LV blood conductance signal can be derived; 2) LV dilation in response to dose-response intravenous neosynephrine can be detected by blood conductance in a similar fashion to the standard of endocardial crystals when admittance is used, but not when only traditional conductance is used; 3) the physiological impact of acute left anterior descending coronary artery occlusion and resultant LV dilation can be detected by blood conductance, before the anticipated secondary rise in right ventricular systolic pressure; and 4) a pleural effusion simulated by placing saline outside the pericardium does not serve as a source of artifact for blood conductance measurements.

Dynamic correction for parallel conductance, GP, and gain factor, alpha, in invasive murine left ventricular volume measurements

The conductance catheter technique could be improved by determining instantaneous parallel conductance (G(P)), which is known to be time varying, and by including a time-varying calibration factor in Baan's equation [alpha(t)]. We have recently proposed solutions to the problems of both time-varying G(P) and time-varying alpha, which we term "admittance" and "Wei's equation," respectively. We validate both our solutions in mice, compared with the currently accepted methods of hypertonic saline (HS) to determine G(P) and Baan's equation calibrated with both stroke volume (SV) and cuvette. We performed simultaneous echocardiography in closed-chest mice (n = 8) as a reference for left ventricular (LV) volume and demonstrate that an off-center position for the miniaturized pressure-volume (PV) catheter in the LV generates end-systolic and diastolic volumes calculated by admittance with less error (P < 0.03) (-2.49 +/- 15.33 microl error) compared with those same parameters calculated by SV calibrated conductance (35.89 +/- 73.22 microl error) and by cuvette calibrated conductance (-7.53 +/- 16.23 microl ES and -29.10 +/- 31.53 microl ED error). To utilize the admittance approach, myocardial permittivity (epsilon(m)) and conductivity (sigma(m)) were calculated in additional mice (n = 7), and those results are used in this calculation. In aortic banded mice (n = 6), increased myocardial permittivity was measured (11,844 +/- 2,700 control, 21,267 +/- 8,005 banded, P < 0.05), demonstrating that muscle properties vary with disease state. Volume error calculated with respect to echo did not significantly change in aortic banded mice (6.74 +/- 13.06 microl, P = not significant). Increased inotropy in response to intravenous dobutamine was detected with greater sensitivity with the admittance technique compared with traditional conductance [4.9 +/- 1.4 to 12.5 +/- 6.6 mmHg/microl Wei's equation (P < 0.05), 3.3 +/- 1.2 to 8.8 +/- 5.1 mmHg/microl using Baan's equation (P = not significant)]. New theory and method for instantaneous G(P) removal, as well as application of Wei's equation, are presented and validated in vivo in mice. We conclude that, for closed-chest mice, admittance (dynamic G(P)) and Wei's equation (dynamic alpha) provide more accurate volumes than traditional conductance, are more sensitive to inotropic changes, eliminate the need for hypertonic saline, and can be accurately extended to aortic banded mice.

Effect of formalin fixation on thermal conductivity of the biological tissue

Effect of formalin fixation on thermal conductivity of the biological tissues is presented. A self-heated thermistor probe was used to measure the tissue thermal conductivity. The thermal conductivity of porcine aorta, fat, heart, and liver was measured before the formalin fixation and then 1 day, 4 days, and 11 days after formalin fixation. The results indicate that the formalin fixation does not cause a significant change in the tissue thermal conductivity of the tissues studied. In the clinical setting, tissues removed surgically are often fixed in formalin for subsequent pathological analysis. These results suggest that, in terms of thermal properties, it is equally appropriate to perform in vitro studies in either fresh tissue or formalin-fixed tissue.

Design of a wireless telemetric backpack device for real-time in vivo measurement of pressure-volume loops in conscious ambulatory rats

Pressure - Volume (PV) analysis is the de facto standard for assessing myocardial function. Conductance based methods have been used for the past 27 years to generate instantaneous left ventricular (LV) volume signal. Our research group has developed the instrumentation and the algorithm for obtaining PV loops based on the measurement of real - time admittance magnitude and phase from the LV of anaesthetized mice and rats. In this study, the instrumentation will be integrated into an ASIC (Application Specific Integrated Circuit) and a backpack device will be designed along with this ASIC. This will enable measurement of real-time in vivo P-V loops from conscious and ambulatory rats, useful for both acute and chronic studies.

Volume catheter parallel conductance varies between end-systole and end-diastole

In order for the conductance catheter system to accurately measure instantaneous cardiac blood volume, it is necessary to determine and remove the contribution from parallel myocardial tissue. In previous studies, the myocardium has been treated as either purely resistive or purely capacitive when developing methods to estimate the myocardial contribution. We propose that both the capacitive and the resistive properties of the myocardium are substantial, and neither should be ignored. Hence, the measured result should be labeled admittance rather than conductance. We have measured the admittance (magnitude and phase angle) of the left ventricle in the mouse, and have shown that it is measurable and increases with frequency. Further, this more accurate technique suggests that the myocardial contribution to measured admittance varies between end-systole and end-diastole, contrary to previous literature. We have tested these hypotheses both with numerical finite-element models for a mouse left ventricle constructed from magnetic resonance imaging images, and with in vivo admittance measurements in the murine left ventricle. Finally, we propose a new method to determine the instantaneous myocardial contribution to the measured left ventricular admittance that does not require saline injection or other intervention to calibrate.

Evidence of time-varying myocardial contribution by in vivo magnitude and phase measurement in mice

Cardiac volume can be estimated by a conductance catheter system. Both blood and myocardium are conductive, but only the blood conductance is desired. Therefore, the parallel myocardium contribution should be removed from the total measured conductance. Several methods have been developed to estimate the contribution from myocardium, and they only determine a single steady state value for the parallel contribution. Besides, myocardium was treated as purely resistive or mainly capacitive when estimating the myocardial contribution. We question these assumptions and propose that the myocardium is both resistive and capacitive, and its contribution changes during a single cardiac cycle. In vivo magnitude and phase experiments were performed in mice to confirm this hypothesis.

Impact of physiological variables and genetic background on myocardial frequency-resistivity relations in the intact beating murine heart

Conductance measurements for generation of an instantaneous left ventricular (LV) volume signal in the mouse are limited, because the volume signal is a combination of blood and LV muscle, and only the blood signal is desired. We have developed a conductance system that operates at two simultaneous frequencies to identify and remove the myocardial contribution to the instantaneous volume signal. This system is based on the observation that myocardial resistivity varies with frequency, whereas blood resistivity does not. For calculation of LV blood volume with the dual-frequency conductance system in mice, in vivo murine myocardial resistivity was measured and combined with an analytic approach. The goals of the present study were to identify and minimize the sources of error in the measurement of myocardial resistivity to enhance the accuracy of the dual-frequency conductance system. We extended these findings to a gene-altered mouse model to determine the impact of measured myocardial resistivity on the calculation of LV pressure-volume relations. We examined the impact of temperature, timing of the measurement during the cardiac cycle, breeding strain, anisotropy, and intrameasurement and interanimal variability on the measurement of intact murine myocardial resistivity. Applying this knowledge to diabetic and nondiabetic 11- and 20- to 24-wk-old mice, we demonstrated differences in myocardial resistivity at low frequencies, enhancement of LV systolic function at 11 wk and LV dilation at 20–24 wk, and histological and electron-microscopic studies demonstrating greater glycogen deposition in the diabetic mice. This study demonstrated the accurate technique of measuring myocardial resistivity and its impact on the determination of LV pressure-volume relations in gene-altered mice.

Instrument to measure the heat convection coefficient on the endothelial surface of arteries and veins

The primary objective of the paper was to present the design and analysis of an instrument to measure the heat convection coefficient h on the endothelial surfaces of arteries and veins. An invasive thermistor probe was designed to be inserted through the vessel wall and positioned on the endothelial surface. Electrical power was supplied to the thermistor by a constant temperature anemometry circuit. Empirical calibrations were used to relate electrical measurements in the thermistor to the h at the endothelial surface. As the thermal processes are strongly dependent on baseline blood temperature, the instrument was calibrated at multiple temperatures to minimise this potentially significant source of error. Three different sizes of thermistor were evaluated to optimise accuracy and invasiveness, and the smallest thermistors provided the best results. The sensitivity to thermistor position was evaluated by testing the device at multiple locations, varying both depth of thermistor penetration and position along the vessel. Finally, the measurement accuracy of the instrument was determined for the range of h from 430 to 4200 W m(-2)K, and the average error of the reading was 4.9% for the smallest thermistor. Although the instrument was designed specifically for measurements in the portal vein to obtain useful data for current numerical modelling, the device can be used in any large vessel.

Real time pressure-volume loops in mice using complex admittance: measurement and implications

Real time left ventricular (LV) pressure-volume (P-V) loops have provided a framework for understanding cardiac mechanics in experimental animals and humans. Conductance measurements have been used for the past 25 years to generate an instantaneous left ventricular (LV) volume signal. The standard conductance method yields a combination of blood and ventricular muscle conductance; however, only the blood signal is used to estimate LV volume. The state of the art techniques like hypertonic saline injection and IVC occlusion, determine only a single steady-state value of the parallel conductance of the cardiac muscle. This is inaccurate, since the cardiac muscle component should vary instantaneously throughout the cardiac cycle as the LV contracts and fills, because the distance from the catheter to the muscle changes. The capacitive nature of cardiac muscle can be used to identify its contribution to the combined conductance signal. This method, in contrast to existing techniques, yields an instantaneous estimate of the parallel admittance of cardiac muscle that can be used to correct the measurement in real time. The corrected signal consists of blood conductance alone. We present the results of real time in vivo measurements of pressure-admittance and pressure-phase loops inside the murine left ventricle. We then use the magnitude and phase angle of the measured admittance to determine pressure volume loops inside the LV on a beat by beat basis. These results may be used to achieve a substantial improvement in the state of the art in this measurement method by eliminating the need for hypertonic saline injection.

Finite element analysis and experimental verification of multilayered tissue characterization using the thermal technique

The objective of this research is to develop noninvasive techniques to determine thermal properties of layered biologic structures based on measurements from the surface. The self-heated thermistor technique is evaluated both numerically and experimentally. The finite element analyses, which confirm the experimental results, are used to study the temperature profiles occurring in the thermistor-tissue system. An in vitro tissue model was constructed by placing Teflon of varying thickness between the biologic tissue and the self-heated thermistor. The experiments were performed using two different-sized thermistors on six tissue samples. A self-heated thermistor was used to determine the thermal conductivity of tissue covered by a thin layer Teflon. The results from experimental data clearly indicate that this technique can penetrate below the thin layers of Teflon and thus is sensitive to the thermal properties of the underlying tissue. The factors which may introduce error in the experimental data are (i) poor thermal/physical contact between the thermistor probe and tissue sample, and (ii) water loss from tissue during the course of experimentation. The finite element analysis was used to simulate the experimental conditions and to calculate transient temperature profile generated by the thermistor bead. The results of finite element analysis are in accordance with the experimental data.

Effects of the time response of the temperature sensor on thermodilution measurements

Thermodilution is widely used to measure cardiac output, ejection fraction and end diastolic volume. Even though the method is based on dynamic temperature measurements, little attention has been paid to the characterization of the dynamic behavior of the temperature sensor and to its influence on the accuracy of the method. This paper presents several theoretical and empirical results related to the thermodilution method. The results show that, at flow velocities above 0.2 m s(-1), the response of temperature sensors embedded in Swan-Ganz catheters can be accurately described by a convolution operation between the true temperature of the blood and the impulse response of the sensor. The model developed is used to assess the influence of the probe response on the measurement of cardiac output, and this study leads us to the conclusion that the probe response can cause errors in the cardiac output measurement, but this error is usually small (2% in cases with a high degree of arrhythmia). The results show that these small errors appear during arrhythmias that affect the R-R interval and when the real temperature distribution at the pulmonary artery does not possess a shape with perfect temperature plateaux.

Nonlinear conductance-volume relationship for murine conductance catheter measurement system

The conductance catheter system is a tool to determine instantaneous left ventricular volume in vivo by converting measured conductance to volume. The currently adopted conductance-to-volume conversion equation was proposed by Baan, and the accuracy of this equation is limited by the assumption of a linear conductance-volume relationship. The electric field generated by a conductance catheter is nonuniform, which results in a nonlinear relationship between conductance and volume. This paper investigates this nonlinear relationship and proposes a new nonlinear conductance-to-volume conversion equation. The proposed nonlinear equation uses a single empirically determined calibration coefficient, derived from independently measured stroke volume. In vitro experiments and numerical model simulations were performed to verify and validate the proposed equation.

Analysis of a thermal method for assessing endothelial dysfunction

The presence of atherosclerosis not only affects the normal functioning of the coronary blood vessels but also of the peripheral vasculature. Property measurements made in the peripheral vasculature hence do reflect the condition of the coronary blood vessels. The endothelial cells form the inner lining of the blood vessels, and are responsible for the release of nitric oxide (NO) in order to control the vascular tone. Under normal conditions the artery will dilate in response to increased blood flow, mediated by the release of NO. The hampering of this normal response, caused by certain cardiovascular diseases, is referred to as endothelial dysfunction (EDF). Occlusion of the arm using a standard blood pressure cuff for five minutes followed by sudden release of the occlusion is known to create a reactive hyperemia in a normally functioning vasculature. We propose to measure the EDF by attempting to create this reactive hyperemia in the arm and measuring the temperature response in the hand and forearm, using a computer-based data acquisition system. The rate of temperature fall during occlusion and the temperature rate of rise after release are combined to assess EDF. An engineering analysis of the instrument was performed. Initial studies on normal subjects have indicated that the rate of rise is significantly higher than the rate of fall of temperature.

Design of instrumentation and data-acquisition system for complex admittance measurement

Instantaneous left ventricular volume measurements have been made for many years using a tetrapolar conductance catheter. The main objective is to determine the efficiency of the beating heart, using a tetrapolar catheter inserted in the left ventricle of transgenic mice. The effect of the parallel myocardium contribution must be removed from the total measurement. A dual-frequency technique involving 1 kHz and 100 kHz was chosen because it has been established that the imaginary part (the capacitive reactance) of the complex admittance of the cardiac muscle is much smaller in the lower frequency than at the higher frequency. The design involves generation of an accurate frequency source for both the frequencies careful selection of operational amplifiers for the current conversion stage so that the current is not too large to kill the mouse and that it is capable of performing at high frequencies. The band pass filter stage involved careful design with minimal overlap of the pass bands of both the channels. The overall circuit was designed so that there is minimal shift in the phase due to the circuit elements alone. Work also involved design of GPIB--based data acquisition system using LabVIEW and a digital oscilloscope for effective data acquisition even at high frequencies, which are normally limited by the sampling frequency. This data acquisition system is currently being used in laboratory studies in vivo.

In vivo measurements of heat transfer on the endocardial surface

A catheter-based instrument was used to measure the heat transfer on the right atrial and ventricular endocardial surfaces of two pigs in vivo. The heat transfer parameters will assist in calculating the proper dose for radio-frequency ablation. The time constant of the device was 0.05 s. It was found that the average heat convection coefficient varies significantly both spatially and temporally on the endocardium. The average heat convection coefficients found were between 510 and 4800 W m(-2) K(-1).

An instrument to measure the heat convection coefficient on the endocardial surface

This work describes the fundamentals and calibration procedure of an instrument for in vivo evaluation of the heat convection coefficient between the endocardium and the circulating blood flow. The instrument is to be used immediately before radio-frequency cardiac ablation is performed. Thus, this instrument provides researchers with a valuable parameter to predict lesion size to be achieved by the procedure. The probe is a thermistor mounted in a Swan-Ganz catheter, and it is driven by a constant-temperature anemometer circuit. A 1D model of the sensor behaviour in a convective medium, the calibration procedure and the apparatus are explained in detail. Finally, a performance analysis of the instrument in the range of 200-3500 W m(-2) K(-1) shows that the average absolute error of full scale is 7.4%.

Cyclic capillary electrophoresis

A strategy is described here for increasing both the resolution and the flexibility of capillary electrophoresis performed in a sieving medium of ungelled polymer. This strategy is based on analysis and, sometimes, re-analysis that is done in several stages of constant-field electrophoresis. Enhancement-stages are between the analysis-stages. An enhancement-stage (i) increases the separation between peaks, while (ii) moving DNA molecules in the reverse direction. An enhancement-stage is based on an electrophoretic ratchet generated by a pulsed electrical field that can be zero-integrated. The ratchet-generating pulses are longer than the field pulses that have previously been used to improve the resolution of DNA molecules. No limit has been found to the resolution enhancement achievable. Apparently, diffusion-induced peak broadening is inhibited and, in some cases, may be reversed by the ratchet. The enhancement-stages are critically dependent on the electrical field-dependence of a plot of electrophoretic mobility as a function of DNA length. To generate the pulsed electrical field, a computer-controlled system with a time resolution of 30 microseconds has been developed. Programming is flexible enough to embed other pulses within ratchet-generating pulses. These other pulses can be either the previously used, shorter field-inversion pulses or high-frequency periodic oscillations previously found to sharpen peaks.

Measurement of ejection fraction with standard thermodilution catheters

Right ventricle ejection fraction (RVEF) is clinically used to evaluate right ventricular function. The thermodilution method can be modified to estimate the RVEF. However, this method requires a thermistor with a fast time response in order to yield correct estimates. Digital signal processing techniques that were developed in previous works, allow the use of industry-standard slow time response thermistors for the measurement EF. However, these algorithms were not automated, and the works did not present a complete evaluation of the method's performance. This article presents a modified automated version of these algorithms, and uses numerical and in vitro simulations to test their performance. In the simulations, the measured ejection fraction was compared to the true ejection fraction. RVEFs ranging from 0.20 to 0.80 were tested for heart rates ranging from 30 to 120 heart beats per min. Statistical analysis of data showed that the new method presents an improved performance.

Measurement of directional thermal properties of biomaterials

This paper presents an experimental technique to measure the directional thermal conductivity and thermal diffusivity of materials. A heated thermistor heats the sample and a sensing thermistor placed about 2.5 mm away measures the temperature rise due the heating pulse at the heated thermistor. An empirical relation between the power delivered by the first thermistor and the temperature rise recorded by the sensing thermistor is used to measure the thermal conductivity of the material along the line joining the thermistors. Diffusivity of the material is determined from the delay between the power pulse in the heated thermistor and the temperature pulse at the sensing thermistor. Signal processing was done to eliminate errors in the measurement due to change of base line temperature. Uncertainty of the measurement technique was found to be 5% when tested in media of known thermal properties. The thermal conductivity and thermal diffusivity of swine left ventricle in normal and ablated conditions were measured using this technique. The thermal conductivity of the tissue dropped significantly from 0.61 to 0.50 W.m(-1).K(-1) after ablation while the diffusivity dropped from 2.1 x 10(-7) to 1.7 x 10(-7)m2.s(-1).

Optical and thermal properties of nasal septal cartilage

BACKGROUNDS AND OBJECTIVES

The aim of the study was to measure the spectral dependence of optical absorption and reduced scattering coefficients and thermal conductivity and diffusivity of porcine nasal septal cartilage. Values of optical and thermal properties determined in this study may aid in determining laser dosimetry and allow selection of an optical source wavelength for noninvasive diagnostics for laser-assisted reshaping of cartilage.

MATERIALS AND METHODS

The diffuse reflectance and transmittance of ex vivo porcine nasal septal cartilage were measured in the 400- to 1,400-nm spectral range by using a spectrophotometer. The reflectance and transmittance data were analyzed by using an inverse adding-doubling algorithm to obtain the absorption (mu(a)) and reduced scattering (mu(a)') coefficients. A multichannel thermal probe controller system and infrared imaging radiometer methods were applied to measure the thermal properties of cartilage. The multichannel thermal probe controller system was used as an invasive technique to measure thermal conductivity and diffusivity of cartilage at three temperatures (27, 37, 50 degrees C). An infrared imaging radiometer was used as a noninvasive method to measure the thermal diffusivity of cartilage by using a CO(2) laser source (lambda = 10.6 microm) and an infrared focal plane array (IR-FPA) camera.

RESULTS

The optical absorption peaks at 980 nm and 1,180 nm in cartilage were observed and corresponded to known absorption bands of water. The determined reduced scattering coefficient gradually decreased at longer wavelengths. The thermal conductivity values of cartilage measured by using an invasive probe at 27, 37, and 50 degrees C were 4.78, 5.18, and 5.76 mW/cm degrees C, respectively. The corresponding thermal diffusivity values were 1.28, 1.31, and 1.40x 10(-3) cm(2)/sec. Because no statistically significant difference in thermal diffusivity values with increasing temperature is found, the average thermal diffusivity is 1.32 x 10(-3) cm(2)/sec. The numerical estimate for thermal diffusivity obtained from infrared radiometry measurements was 1.38 x 10(-3) cm(2)/sec.

CONCLUSION

Values of the spectral dependence of the optical absorption and reduced scattering coefficients, and thermal conductivity and diffusivity of cartilage were measured. The invasive and noninvasive diffusivity measurements were consistent and concluded that the infrared imaging radiometric technique has an advantage to determine thermal properties, because damage to the cartilage sample may be avoided. The measured values of absorption and reduced scattering coefficients can be used for predicting the optical fluence distribution in cartilage and determining optical source wavelengths for the laser-assisted cartilage reshaping studies. The thermal conductivity and diffusivity values can play role in understanding thermal-dependent phenomenon in cartilage during laser irradiation and determining laser dosimetry for the laser-assisted cartilage reshaping studies.

Development of a multifrequency conductance catheter-based system to determine LV function in mice

Transgenic mice offer a valuable way to relate gene products to phenotype, but the ability to assess the cardiovascular phenotype with pressure-volume analysis has lagged. Conductance measurement offers a method to generate an instantaneous left ventricular (LV) volume signal in the mouse but has been limited by the volume signal being a combination of blood and LV muscle. We hypothesized that by developing a mouse conductance system that operates at several simultaneous frequencies, we could identify and correct for the myocardial contribution to the instantaneous volume signal. This hypothesis is based on the assumption that mouse myocardial conductivity will vary with frequency, whereas mouse blood conductivity will not. Consistent with this hypothesis, we demonstrated that at higher excitation frequency, greater end-diastolic and end-systolic conductance are detected, as well as a smaller difference between the two. We then empirically solved for LV blood volume using two frequencies. We combined measured resistivity of mouse myocardium with an analytic approach and extracted an estimate of LV blood volume from the raw conductance signal. Development of a multifrequency catheter-based system to determine LV function could be a tool to assess cardiovascular phenotype in transgenic mice.

Morphometry of the canine prostate vasculature

Morphometric data of the tissue vasculature are fundamental to the development of models for blood perfused tissue mass and heat transfer. Vascular casts of six canine prostates were made and morphometry was performed on 14 transverse sections. The region sampled was restricted to the midsection within the parenchyma. General vascular features that were observed include the radially arranged arteries and veins within the parenchyma, the axially oriented periurethral venous plexae, and the parenchymal arteries ramifying less than the veins. The arterial and venous lumen diameters (mean +/- SD) are 84 +/- 31 (N = 42) and 125 +/- 51 (N = 117), respectively. The lengths for a single vessel generation are 2147 +/- 1196 microm (N = 14) and 1265 +/- 693 microm (N = 39) for the arteries and veins, respectively. Intervessel distances are 4056 +/- 2350 microm (N = 33) between arteries, 1526 +/- 982 microm (N = 330) between veins, and 1498 +/- 874 microm (N = 108) between arteries and veins. A simple vasculature model of evenly distributed vessels imbedded in tissue for heat transfer analysis was developed. The artery-artery distance being about three times that of the vein-vein distance suggested a rete-like configuration of arteries surrounded by veins. An effective distance of 1519 microm between vessels was used. Based upon this vasculature model, the vessel density was calculated to be 5.6 arteries/cm(2) and 44.5 veins/cm(2).

Analysis of the Weinbaum-Jiji model of blood flow in the canine kidney cortex for self-heated thermistors

The Weinbaum-Jiji equation can be applied to situations where: 1) the vascular anatomy is know; 2) the blood velocities are known; 3) the effective modeling volume includes many vessels; and 4) the vessel equilibration length is small compared to the actual length of the vessel. These criteria are satisfied in the situation where steady-state heated thermistors are placed in the kidney cortex. In this paper, the Weinbaum-Jiji bioheat equation is used to analyze the steady state response of four different sized self-heated thermistors in the canine kidney. This heat transfer model is developed based on actual physical measurements of the vasculature of the canine kidney cortex. In this model, parallel-structured interlobular arterioles and venules with a 60 microns diameter play the dominant role in the heat transfer due to blood flow. Continuous power is applied to the thermistor, and the instrument measures the resulting steady state temperature rise. If an accurate thermal model is available, perfusion can be calculated from these steady-state measurements. The finite element simulations correlate well in shape and amplitude with experimental results in the canine kidney. In addition, this paper shows that the Weinbaum-Jiji equation can not be used to model the transient response of the thermistor because the modeling volume does not include enough vessels and the vessel equilibration length is not small compared to the actual length of the vessel.

A small artery heat transfer model for self-heated thermistor measurements of perfusion in the kidney cortex

A small artery model (SAM) for self-heated thermistor measurements of perfusion in the canine kidney is developed based on the anatomy of the cortex vasculature. In this model interlobular arteries and veins play a dominant role in the heat transfer due to blood flow. Effective thermal conductivity, kss, is calculated from steady state thermistor measurements of heat transfer in the kidney cortex. This small artery and vein model of perfusion correctly indicates the shape of the measured kss versus perfusion curve. It also correctly predicts that the sinusoidal response of the thermistor can be used to measure intrinsic tissue conductivity, km, in perfused tissue. Although this model is specific for the canine kidney cortex, the modeling approach is applicable for a wide variety of biologic tissues.

Progress in developing improved programs for pulsed field agarose gel electrophoresis of DNA

Details are described here for using a rotating gel to perform pulsed field agarose gel electrophoresis (PFGE) with programmable control of the following variables: magnitude of the electrical field, polarity of the electrical field, temperature of the gel and position of the rotating disk upon which the agarose gel rests. By use of this procedure for programmable control, modes of PFGE have been explored that have the following characteristics: (i) resolution by DNA length is completely lost for DNA shorter than a critical length that increases as the pulse times increase, and (ii) resolution by DNA length is enhanced for longer DNAs that are shorter than a second critical length. This window of resolution can be moved to the position of the 2-6 Mb chromosomes of Schizosaccharomyces pombe.

Self-heated thermistor measurements of perfusion

A microcomputer-based control system applies a combination of steady state and sinusoidal power to a thermistor probe which is inserted into the tissue of interest. The steady-state temperature response is an indication of the effective thermal conductivity (keff), which includes a component due to intrinsic conduction plus a convective component due to the tissue blood flow near the probe. By careful choice of the excitation frequency, the sinusoidal temperature response can be used to measure intrinsic thermal conductivity (km) in the presence of blood flow. Optimal sinusoidal heating frequency depends on the thermistor size. Experimental results in the alcohol-fixed canine kidney cortex show that perfusion is linearly related to the difference keff minus km. The instrument can measure tissue thermal conductivity with an accuracy of 2%. The instrument can resolve changes in perfusion of 10 mL/100g-min with a Thermometrics P60DA102M thermistor. The maximum error in measured perfusion is about 30%. When tissue trauma due to probe insertion is minimized, the self-heated thermistor method gives a reliable indication of local tissue blood flow.

A self-heated thermistor technique to measure effective thermal properties from the tissue surface

A microcomputer based instrument to measure effective thermal conductivity and diffusivity at the surface of a tissue has been developed. Self-heated spherical thermistors, partially embedded in an insulator, are used to simultaneously heat tissue and measure the resulting temperature rise. The temperature increase of the thermistor for a given applied power is a function of the combined thermal properties of the insulator, the thermistor, and the tissue. Once the probe is calibrated, the instrument accurately measures the thermal properties of tissue. Conductivity measurements are accurate to 2 percent and diffusivity measurements are accurate to 4 percent. A simplified bioheat equation is used which assumes the effective tissue thermal conductivity is a linear function of perfusion. Since tissue blood flow strongly affects heat transfer, the surface thermistor probe is quite sensitive to perfusion.

Steady-state analysis of self-heated thermistors using finite elements

The purpose of this work is to validate, using numerical, finite element methods, the thermal assumptions made in the analytical analysis of a coupled thermistor probe-tissue model upon which a thermal conductivity measurement scheme has been based. Analytic, closed form temperature profiles generated by the self-heated thermistors can be found if three simplifying assumptions are made: the thermistor is spherical; heat is generated in all regions of the bead; and heat is generated uniformly in the bead. This analytic solution is used to derive a linear relationship between tissue thermal conductivity and the ratio of thermistor temperature rise over electrical power required to maintain that temperature rise. This derived, linear relationship is used to determine thermal conductivity from the observed experimental data. However, in reality, the thermistor bead is a prolate spheroid surrounded by a passive shell, and the heating pattern in the bead is highly nonuniform. In the physical system, the exact relationship between the tissue thermal conductivity and parameters measured by the thermistor is not known. The finite element method was used to calculate the steady-state temperature profiles generated by thermistor beads with realistic geometry and heating patterns. The results of the finite element analysis show that the empirical, linear relationship remains valid when all three simplified assumptions are significantly relaxed.

Effect of laser radiation on tissue during laser angioplasty

The thermal properties of adipose and ceramic atherosclerotic plaque deposits and normal arterial vessel wall were measured in the temperature range of 25-95 degrees C. In general, the data indicate that fatty plaques exhibit the lowest thermal conductivity and thermal diffusivity of the three types, whereas calcified plaques seem to have the highest values. By using a video scanning thermograph, temperature rise was recorded in normal vessel wall and plaque during ablation of tissue. Theoretical analysis suggested that realistic modeling of laser angioplasty should account for scattering of light, water content, and ablation. This paper is a preliminary report of these results.

The simultaneous measurement of thermal conductivity, thermal diffusivity, and perfusion in small volumes of tissue

An improved technique is presented for the "in-vivo" determination of thermal conductivity, thermal diffusivity, and perfusion using a self-heated spherical thermistor probe. In the presence of flow, solution of the time-dependent, probe-tissue coupled thermal model allows the measurement of "effective" thermal conductivity and "effective" thermal diffusivity, which represent the thermal properties of the perfused tissue. Perfusion can be quantified from both "effective" thermal properties. In the presence of flow, it has been shown that the transient power responses does not follow t-1/2 as has been previously assumed. An isolated rat liver preparation has been developed validate the measurement technique. Radioactive microspheres are used to determine the true perfusion from the total collected hepatic vein flow. Experimental data demonstrates the ability to quantify perfusion in small volumes of tissue.

An isolated rat liver model for the evaluation of thermal techniques to quantify perfusion

An isolated, thermally regulated, perfused rat liver model system is presented. The model was developed to evaluate thermal methods to quantify perfusion in small volumes of tissue. The surgically isolated rat liver is perfused with an isothermal oxygenated Krebs-Ringer bicarbonate buffer solution via the cannulated portal vein. A constant-pressure head variable-resistance scheme is utilized to control the total flow to the liver. Total flow is quantified by hepatic vein collection. The spatial distribution of perfusion within the liver is determined using two independent methods. In the first method, radio-labelled microspheres are injected into the portal vein, and the regional flow distribution is determined from the relative radioactivity of each section of tissue. In the second method, the tissue is thermally perturbed, and the time constant of the tissue temperature recovery is measured. The regional distribution is determined from the relative time constants of each section of tissue. Both methods require the measurement of total liver flow to determine the absolute perfusion at each point. Results obtained by the two methods were well correlated (0.973). The rat liver system offers a stable, controllable, and measurable perfusion model for the evaluation of new perfusion measurement techniques.