Pressure-flow loops and instantaneous input impedance in the thoracic aorta: Another way to assess the effect of aortic bypass graft implantation on myocardial,

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Presentation transcript:

Pressure-flow loops and instantaneous input impedance in the thoracic aorta: Another way to assess the effect of aortic bypass graft implantation on myocardial, brain, and subdiaphragmatic perfusion Choukri Mekkaoui, PhDa,c, Pierre H. Rolland, PhDa, Alain Friggi, PhDa, Monique Rasigni, PhDc, Thierry G. Mesana, MD, PhDa,b The Journal of Thoracic and Cardiovascular Surgery Volume 125, Issue 3, Pages 699-710 (March 2003) DOI: 10.1067/mtc.2003.104 Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Mesana, Mekkaoui, and Rolland The Journal of Thoracic and Cardiovascular Surgery 2003 125, 699-710DOI: (10.1067/mtc.2003.104) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 The 3 sites for hemodynamic measurement were the AA, the TA, and the DA. The extra-anatomic bypass graft (EAG; double-headed arrow) was proximally inserted between the bronchial arteries and the first intercostal arteries embranchment. The native DA after grafting finally was clamped (C). The Journal of Thoracic and Cardiovascular Surgery 2003 125, 699-710DOI: (10.1067/mtc.2003.104) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 The first 2 steps in mathematic synthesizing of the measured flow waveform in the native AA. A, The flow wave was fractioned into successive segments of curves separated by 2 opposite extreme points according to an algorithm described in Appendix 1. B, Each elementary segment of curve, after scaling the 2 extreme points to measured values, was synthesized into the mathematic function and further considered as part of the second derivative of a sigmoidal function. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 699-710DOI: (10.1067/mtc.2003.104) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 The measured flow waveform was synthesized by summing the individual successive segments and fitting the curve to the original pulse wave to obtain the first model m0 and error 0. Error 0 was iteratively treated in the same manner to give m1 and error 1 and m2 and error 2, subsequently. The synthesized function finally was the sum of serial functions. The model applied to both pressure and flow measured waves, with a quadratic error normalized to original waveforms ranging from 10−7 to 10−8, irrespective of the experimental conditions. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 699-710DOI: (10.1067/mtc.2003.104) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Synthesized pressure and flow waves were plotted as parametric equations for P-Q relationships to give the hysteresis loops in the AA, the TA, and the DA in the native (N) and grafted DA, before (EAG) and after (C) clamping of the DA. Arrows indicate the direction of loops. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 699-710DOI: (10.1067/mtc.2003.104) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 The entry impedance, as calculated from pressure and flow functions along a mean cardiac cycle, is plotted in conjunction with measured flow waves in the native AA (N AA), the native TA (N TA), and the native DA (N DA). Changes in the vicinity of zero values are magnified (insert) in the native AA to highlight the forward-backward changes in impedance and their flow counterparts. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 699-710DOI: (10.1067/mtc.2003.104) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 The entry impedance, as calculated from pressure and flow functions along a mean cardiac cycle, is plotted in conjunction with measured flow waves in the extra-anatomically grafted AA (EAG AA), the extra-anatomically grafted TA (EAG TA), and the extra-anatomically grafted DA (EAG DA). Changes in the vicinity of zero values are magnified (insert) in the extra-anatomically grafted AA to highlight the forward-backward changes in impedance and their flow counterparts. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 699-710DOI: (10.1067/mtc.2003.104) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 7 The entry impedance, as calculated from pressure and flow functions along a mean cardiac cycle, is plotted in conjunction with measured flow waves after clamping of the native DA in the extra-anatomically grafted AA (C AA), the extra-anatomically grafted TA (C TA), and the extra-anatomically grafted DA (C DA). Changes in the vicinity of zero values are magnified (insert) in the extra-anatomically grafted AA to highlight the forward-backward changes in impedance and their flow counterparts. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 699-710DOI: (10.1067/mtc.2003.104) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions