Apparatus Setup Jason Quill Eric Richardson

System Schematic

Learning to Use the System Start by learning the day after setup Familiarize yourself with the subsystems and components Take your time doing it, there’s no rush Then learn to set up everything on the day of the study

Apparatus Setup: Day of Study Jason Quill

Overview Rack setup Millar sensors Other pressure transducers Flow probes ECG Defib. Patches Oxygen sensor Camera setup Reservoir sensor Kreb’s cart Oxygen Prewarming chamber Reservoir Prime the pumps Left side pump Right side pump Heating Circuit Hook up cannulated Heart

Rack Setup Transport from surgical suite Start IOX and any other programs needed Attach sensors and calibrate

Reservoir Sensor Melt a hole in the reservoir using the soldering iron Place the reservoir sensor in the reservoir Turn on the sensor

Kreb’s Cart Wheel in from across the hall Retrieve pump and connect Do not plug in yet! Turn on oxygen Drop aerator into Kreb’s container Clamp oxygen line so that flow only goes to the Kreb’s container (don’t be wasteful) Make sure float sensor in the prewarming chamber is attached

Filling the System Prewarming Chamber Reservoir Make sure the float sensor is connected Plug in the pump Reservoir Make sure the reservoir sensor is connected and active Turn the orange valve to fill the reservoir

Starting the Pumps Prime the Pumps Left Side Pump Right Side Pump Lower the pump heads to get the air out Clamp the outlet to prevent air from coming back in Left Side Pump Fill the left side chamber Switch the clamp Keep the reservoir filled (or you’ll get to prime the pumps again) Right Side Pump Adjust the flow in the right side chamber so that it is slowly going into the overflow tank Keep the reservoir filled

Heating Circuit Pumps can be turned on at any time Heater should not be turned on until the heart is cannulated and ready to be attached to the apparatus

Calibration Millar sensors (LVP/RVP) Pressure transducers Connect, wrap with Parafilm Zero using syringe Calibrate at: RVP=100; LVP=200 Pressure transducers Flush and zero Calibrate at: RAP=100; PAP=100; ART=200

Calibration Flow sensors Oxygen tank sensor ECG Camera Setup On the flow sensor board push the zero button, check IOX values Push the 10 button, check IOX values Push Meas. Oxygen tank sensor Zero transducer (open to atmosphere) Check that alarm is on and limits are acceptable ECG No calibration required Camera Setup Attach side-view camera lens (and any other required cameras) White balance

Attaching the Heart Paul will cannulate the heart with the assistance of a grad. Student Turn on the Heater in the heating circuit and the heat sensor (blue box) Once the cannula are attached to the apparatus, assist Paul is removing air from the heart

Clean up! Rinse Wash Ethanol Rinse Try to stay dry

Apparatus Setup: Day After Study Jason Quill Eric Richardson

Overview Oxygenator Setup Heating Circuit Systemic Lines Reservoir Return Lines Oxygen Circuit Connections to the Heart Sensors Clamps

Oxygenator Setup Key located at exit of the lab Located in storeroom Remove top part put in drawer

Oxygenator Setup Pink to pink Put in screw cap on top Place in visible heart apparatus

Heating Circuit “Bottom to top” Quick Releases Two tubes – connect tubes to reservoir before connecting quick releases

Systemic lines Inflow to the pump drains the reservoir RESERVOIR

Left pump outflow enters the oxygenator Systemic lines Left pump outflow enters the oxygenator Left pump outflow Oxygenator inlet

Reservoir Return Lines All return lines go to the top of the reservoir One of two pulmonary afterload holding chamber returns Second pulmonary afterload holding chamber return Aortic overflow return Left side holding chamber overflow return Right holding chamber overflow return 1 2 3 4 5

Pulmonary Afterload Holding Chamber Placement The only holding chamber needing to be attached to the visible heart apparatus Clamps at location shown

Reservoir Return Lines All return lines go to the top of the reservoir “orange to orange”: the orange valve line returns to the top (central) orange port of the reservoir

Oxygen Circuit Oxygen inlet from ceiling 3 outlet lines (2 shown) 1 Oxygen inlet from ceiling 3 outlet lines (2 shown) Oxygen outlet Oxygen Outlet Oxygen Inlet

Oxygen Circuit Oxygen supply to the oxygenator The oxygenator supply tube is the longest of the oxygen tubes and runs along the far side of the apparatus with respect to the oxygen inlet 1

Oxygen Circuit Right side holding chamber oxygen supply Left side holding chamber oxygen supply Prewarming chamber oxygen supply 1 2 3 Note: the oxygen supply for the right side holding chamber and the left side holding chamber share a supply line and the individual chambers’ oxygen supply pressure is controlled through clamps on the lines.

Connections to the Heart 1 2 3 4 Pulmonary artery Pulmonary vein Aorta IVC Note: the Ys need to be inserted to monitor pressures during experiments. Many clamp positions can be seen from the picture as well

Sensors Pressure sensors Temperature probe See “Connections to the Heart” slide for Y placement Temperature probe Located at the bottom of the oxygenator Temperature Probe

Clamps Clamps at inlets to heart and outlets to drain during start up Langendorff perfusion pathway Working mode

Langedorff Mode

Langedorff Mode

Working Mode

Words of “Wisdom” Its easier to remember the connections in the visible heart apparatus if you can relate the components of the system to the anatomy and physiology of the cardiovascular system. When your memory fails, look for a connection that fits and figure out if its wrong later…unless you are afraid of getting your shoes wet