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Axial flow pump treatment during myocardial depression in calves: an invasive hemodynamic and echocardiographic tissue Doppler study.
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
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2008 (English)In: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 54, no 4, 367-371 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate flow characteristics and myocardial function after implantation of an axial pump left ventricular assist device while varying afterload and during progressive myocardial depression. Ten calves were included, seven of which fulfilled the protocol. Invasive hemodynamic monitoring and echocardiography with color-coded systolic tissue Doppler velocity (TD velocity) were used during prepump conditions, at three different pump speeds, during modification of the systemic vascular resistance (SVR), and during increasing degrees of beta-blockade. The TD velocity decreased with the myocardial function whereas left ventricular size, fractional shortening, and pump speed did not correlate significantly with the TD velocity. The TD velocity correlated significantly with native stroke volume, heart rate, SVR and cardiac output but none of these alone could explain more than 20% of the changes in TD velocity. The axial flow pump studied is effective in unloading the severely depressed heart and has a high capacity for maintaining an adequate cardiac output, regardless of differing hemodynamic conditions, pump speed or decreasing LV function. Echocardiography with volumetric rendering and TD velocity imaging are valuable tools for monitoring and quantifying residual myocardial function during pump treatment.

Place, publisher, year, edition, pages
Philadelphia, PA USA: Lippincott Williams & Wilkins, 2008. Vol. 54, no 4, 367-371 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-44738DOI: 10.1097/MAT.0b013e31817fd8deISI: 000257861700006Local ID: 77509OAI: oai:DiVA.org:liu-44738DiVA: diva2:265600
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
In thesis
1. Between the Probe and the Pump: An experimental study on cardiac performance analysis based on Echocardiography, tissue and laser Doppler
Open this publication in new window or tab >>Between the Probe and the Pump: An experimental study on cardiac performance analysis based on Echocardiography, tissue and laser Doppler
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Echocardiography is an ultrasound-based bedside, non-invasive and easily available cardiac diagnostic technique visualising the heart’s morphology and function. Quantification of cardiac wall motion can be measured with the tissue Doppler Imaging (TDI) modality which provides in humans a high diagnostic capacity to differentiate healthy from diseased myocardium with reduced function. Heart failure, as a consequence of, for example, myocardial or ischaemic heart disease, demands both bedside and intraoperative diagnostic procedures for myocardial functional and perfusion assessment. In the late stages of heart failure cardiac left ventricular assist devices (LVAD) may be the treatment of choice. Such new technologies are commonly evaluated in large animals before application in humans is accepted.

With the aim of evaluating TDI´s applicability and feasibility in a large animal model 21 calves (aged 3 months and weight around 70 kg), were studied with colour TDI (Paper I). Analysis was performed either during coronary artery occlusion when the laser Doppler perfusion imaging technique (LDMP) was refined (Paper II), or after implantation of the LVAD, Heart Mate II® (Papers III, IV). All animals were haemodynamically monitored (pressures, flows, heart rate) and ECG was continuously recorded. Transthoracic and epicardial echocardiography (TTE) were performed before and after sternotomy and intraoperatively during experimental progressive heart failure. Heart chamber dimensions, native stroke volume, systolic and diastolic regional basal myocardial peak velocities (cm/s; systolic S´, early diastolic E´, and atrial A´, strain (%), strain rate (s-1) and displacement (mm) were determined. Second harmonic imaging (SHI) was applied in order to better visualise air bubbles (Paper IV).

In Paper I compiled baseline values were established before and after sternotomy for central haemodynamic and echocardiographic parameters, including the TDI myocardial motion variables velocity, strain rate, strain and displacement. Blood pressure and heart rate changed significantly after sternotomy, but the TDI derived data did not change significantly.

In Paper II we report that movement artifacts of the laser Doppler myocardial perfusion measurements can be reduced, both when myocardium is normally perfused and during coronary occlusion, by using the TDI velocity registrations showing wall motion to be minimal. The optimum interval depends on the application but late systole as well as late diastole is preferred.

After LVAD implantation in Paper III the flow characteristics and myocardial motion during variations in afterload TDI show that myocardial velocities decrease concomitantly with myocardial depression and are significantly correlated to native stroke volume, heart rate, systemic arterial resistance and cardiac output, but not with left ventricular size, fractional shortening or pump speed. Echocardiography together with TDI thereby offers additional means for monitoring and quantifying residual myocardial function during LVAD treatment.

SHI is superior in the early detection of single air-bubbles in the ascending aorta prior to significant air embolism during manipulation of the LVAD pump speed, as shown in Paper IV. A prompt decrease in size of the left atrium during speed adjustment may be a warning that massive air embolism is imminent whereas the commonly used left atrial pressure not provide the same warning.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 55 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 2101
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-61518 (URN)978-91-7393-327-8 (ISBN)
Public defence
2010-11-26, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
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Note
The title of article II is in the list of publications "Correlation between laser Doppler perfusion monitoring and myocardial tissue Doppler echocardiography in the beating heart" and in the published article the title is "Myocardial tissue motion influence on laser Doppler perfusion monitoring using tissue Doppler imaging".Available from: 2010-11-16 Created: 2010-11-16 Last updated: 2012-05-09Bibliographically approved

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Hübbert, LailaPeterzén, BengtJanerot Sjöberg, BirgittaAhn, Henrik Casimir

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Hübbert, LailaPeterzén, BengtJanerot Sjöberg, BirgittaAhn, Henrik Casimir
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CardiologyFaculty of Health SciencesDepartment of Cardiology in LinköpingThoracic SurgeryDepartment of Thoracic and Vascular SurgeryDepartment of Medical and Health SciencesDepartment of Biomedical EngineeringThe Institute of TechnologyDepartment of Clinical Physiology
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