Mano J. Thubrikar, PhD, Francis Robicsek, MD, Brett L. Fowler, BS

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Presentation transcript:

Pressure trap created by vein valve closure and its role in graft stenosis Mano J. Thubrikar, PhD, Francis Robicsek, MD, Brett L. Fowler, BS The Journal of Thoracic and Cardiovascular Surgery Volume 107, Issue 3, Pages 707-716 (March 1994) DOI: 10.5555/uri:pii:S0022522394703264 Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 1 Experimental setup to study flow through vein grafts. Superpump system is designed to simulate left side of heart. P 1 and P 2 represent proximal and distal pressures with respect to vein valve. Resistance and capacitance of distal venous bed are also indicated. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 707-716DOI: (10.5555/uri:pii:S0022522394703264) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 2 Schematic drawing of pressures and flows in vein graft. Proximal and distal pressures are same when mean flow rate through vein graft is high (that is, 100 ml/min) and vein valve remains open all the time.When mean flow rate decreases (that is, 50 to 25 to 0 ml/min) valve begins to open and close and pressure is trapped in distal segment. Consequently, diastolic pressure begins to rise in distal segment. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 707-716DOI: (10.5555/uri:pii:S0022522394703264) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 3 Cross-sectional images of three vein grafts (A, B, and C) in region of valve obtained with intravascular ultrasound technique. Valve can be seen in closed (A1, B1, C4) and open (A2, B2, C3) positions. C1, C2, and C3 show images at various levels of valve as ultrasound catheter is pulled through valve. C1 is just before valve, C2 is just into valve, and C3 is near free margin of leaflet. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 707-716DOI: (10.5555/uri:pii:S0022522394703264) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 4 Schematic drawing of pressures proximal (P 1) and distal (P 2) to vein valve in conditions of poor drainage when valve begins to open and close. Elevated diastolic pressure in distal segment makes that segment hypertensive. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 707-716DOI: (10.5555/uri:pii:S0022522394703264) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 5 Actual traces of pressures and flow in vein graft showing pressure trap when flow is reduced and disappearance of pressure trap when flow is restored. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 707-716DOI: (10.5555/uri:pii:S0022522394703264) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 6 Flow at which vein valve begins to close versus systemic pressure at cardiac output of 3 L/min. Notations 0 c.c. and 1 c.c. refer to amount of air used in compliance chamber. At all three systemic pressures increase in compliance caused valve to close at higher mean flow rates. Mean flow did not correlate directly with systemic pressure but did correlate with pulse pressure (shown in parentheses). Flow increased as pulse pressure increased. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 707-716DOI: (10.5555/uri:pii:S0022522394703264) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 7 Flow at valve closure versus cardiac output at systemic pressure of 120/80 mm Hg. In general, mean flow increased with cardiac output, and at any given cardiac output mean flow increased with compliance. Notations 0 c.c. and 1 c.c. refer to amount of air used in compliance chamber. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 707-716DOI: (10.5555/uri:pii:S0022522394703264) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 8 Difference (ΔP [P 2 – P 1]) in diastolic pressures proximal (P 1) and distal (P 2) to valve versus venous mean flow. Diastolic pressure gradient increased as venous flow decreased. CO, Cardiac output. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 707-716DOI: (10.5555/uri:pii:S0022522394703264) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 9 Diastolic pressure gradient (ΔP [P 2 – P 1 ]) versus venous flow. Gradient increased as flow decreased. Vein grafts1, 2, 3, and 4 are same as those shown in Fig. 8. Note that greater compliance shown in Fig. 8 meant greater starting flows. Both figures also show that different veins have different starting flows. Relationship between flow and gradient appears almost linear. CO, Cardiac output. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 707-716DOI: (10.5555/uri:pii:S0022522394703264) Copyright © 1994 Mosby, Inc. Terms and Conditions